Medicare Part D

Medicare Part D, the program that covers prescription drugs, is a world of Potemkin web sites.

Everyone explains the program has three phases. No coverage for the first $310 and no coverage after $2,830. Another part of medicare takes over after you spend $4,550. The $1,720 between is the infamous doughnut hole where the patient pays everything. Insurance, of course, is available to cover those extra costs.

After that simple information, everything is hidden. The deductible and the doughnut hole running balance counts everything you and the insurance company pay, except the premium.

You know what you pay, without the help of fancy websites. You cannot find out what the insurance company says it pays or, for that matter, if that list price is in fact what it does pay. The excuse is prices change weekly. The real reason may be more nefarious.

I began with the government’s medicare site which ranks plans by zip code. All the rest of the cost information is useless, since it only calculates premiums and co-pays. I discovered there were 47 available plans, of which six had ratings of four stars or more out of five. Those six are offered by four companies. Three charge standard co-pays, and one charges 25% of the unknown drug costs.

I called all four, and asked them to mail information. The one that charges by percent still has sent me nothing, despite two requests. I should note I live in a primarily rural county with high rates of diabetes, alcohol caused accidents and heroine use. While Medicare allows insurance companies to offer rates based on an individual’s health and age, most choose the location option which places me a high risk group. No doubt the one that won’t send information is willing to offer something in other parts of the state, but tries not to offer anything here.

Next, I made a list of the drugs I took in the past year, figured what I paid currently, and what I thought the actual insurance company cost was, based on one of those websites that list costs for Canadian and American sources. I used the numbers it listed for CVS drugstores.

Every month I need a bone density drug that’s listed as tier 2. I currently pay $30 a month, and the drug website listed it as$104, or roughly 29%.

Almost every month I need a hormone replacement that’s listed as tier 2. Again, I currently pay $30 a month and it was listed as $104.71, and again I now pay roughly 29%.

Those two drugs alone would cost $2,520 for a year, just $310 less than the coverage cut-off. Any other drug requirement would take me into the area where I paid everything again, unless I paid a much high monthly premium.

Because of serious muscle problems this past year, I took Celebrex and expect to need to buy it maybe six times in the coming year. My insurance company only grudgingly authorizes the use of the anti-inflammatory after the doctor writes a letter showing any alternative would cause serious stomach problems.

My co-pay was $55, and my local drug store couldn’t tell me in fact what it would cost me if I didn’t have insurance. The listed price for the tier 3 drug ranges from $50 a month in Canada to $122 for the American company I’ve been using as a standard. However, I suspect the number is much higher.

One medicare part D plan charges $42 for Tier 2 and $90 for Tier 3, with a monthly premium of $34. The total cost per month is close to $208, with no deductible.

The second provider charges $38 for Tier 2, $73 for Tier 3, and a monthly premium of $33, for a rounded monthly total of $183. If I allocate its $180 minimum deductible for the year, the monthly rate rises to $198.

The third charges $33 for Tier 2, $90 for Tier 3, and $47 a month, for a total of $202, with no deductible.

If price alone could be calculated, the choice would seem simple. However, I’ve never heard of the people who provide the second plan and only know they’re in Texas, while the others come from people with reputations, AARP and a national drug chain.

Since losing coverage when one reaches the doughnut hole depends on what the companies say they pay for the drug, everything ultimately depends of their veracity. One, AARP, has a plan that will cover the gap between Medicare and catastrophic coverage, and the premium difference is $556 year. It’s only worth it if the cost of drugs is greater than that. Since I can get no reliable information on Celebrex, I have no idea how much I would spend.

Once I go through a year on Medicare, and get the periodic statements that indicate exactly what the drugs cost, I can make a more informed decision the following year. However, the first year is an absolute blind pig shoot.