Why would anyone in her right mind spend July 4 — and then July 5 and July 6 — trying to make sense out of Medicare Part D, the drug plan added six years ago to an otherwise user-friendly health care system widely beloved by the 65-and-over set?
My 65th birthday is approaching, and with it the deadlines for enrolling in Medicare. As a retiree, I must switch my primary health coverage to its new role as secondary provider to the government program. I’d been writing about the elderly for years, had cared for my mother through the last four years of her life, was Dear Abby on this subject to my friends on a daily basis. I thought I had it all down cold.
Only Part D scared me, because my mother died before its advent and I had no experience helping someone else with this. And I recalled, vividly, a recent article by a colleague at The Times, Gina Kolata, just before the new program took effect, when she assumed the task of choosing the best plan for her aged father. Ms. Kolata is a science writer and a whiz with numbers, which I’m not — and still she was still flummoxed by what Medicare purported to be a simple online calculator for choosing a drug plan.
What she was looking for — what we are all looking for — is one whose formulary best matches the list of medications we take, and their doses, and the pharmacies at which we obtain them, and even the number of pills we must pop. It’s like solving a Chinese tangram: Each time one puzzle piece doesn’t fit, it’s back to square one.
Enrolling in Medicare Parts A and B was a snap. One phone call, and within days I had my very own Medicare card, ready for Sept. 1, the start of the month of my 65th birthday. The euphoria of that first phone call gave way to some additional questions about cost. Part A (hospitalization) is free after a lifetime of Medicare taxes. The cost of Part B (doctors fees, tests, equipment, etc.) depends on one’s adjusted gross income and tax-exempt interest income. I called my accountant to check on the first, my investment guy the second. My cost would be $99.90 a month. Four calls, all to real people, and done.
Next, I had to arrange the switch from my retiree health plan, which would become secondary coverage once I was eligible for Medicare. Now, $308.90 is deducted from my monthly pension check for health care. As of Sept. 1, that will drop to $48.49, as Medicare will be responsible for most of my needs and will bill me for my share of it. All of this happens seamlessly, or so everyone promised. Until shown otherwise, I believe them.
I shunned Part D until I was about out of time. My mailbox was full of daily solicitations to buy this drug plan or that. I kept all the brochures in a folder until it got so fat it exploded onto my office floor, all but burying me. There were phone calls from agents, who said all their fees came from the insurers; still, in their infinite generosity they had figured out exactly which plan was right for me.
This legion of snake-oil salesmen did not exist when Part D was new, and maybe Ms. Kolata would not have been further confused by their barrage. But one look at the Medicare Web site made me sweat. So I took the coward’s way out and let one of the sales guys wax on about the virtues of his plan until, ready to sign, the reporter in me came alive.
Again I called Medicare. The monthly premium he had quoted me was wrong, as was the plan’s formulary. He never even mentioned that the plan covered only certain dosages per pill and certain numbers of pills a month. OMG, as one might say, if one weren’t almost 65.
Saved from myself, I called SHIP, the State Health Insurance Assistance Program. After punching in my ZIP code, I was connected to a counselor in the local aging office. A county employee had me spell the names of the drugs I take, and the quantity and frequency of each. She asked my preferred pharmacy. Patiently searching the database, she found three plans that covered all my drugs.
They cost $95 to $109 a month (more than twice what the soliciting agent had quoted), and one had a $300 deductible. But all included the most expensive drug I took, which seemed to warrant their price tag. Still, all three limited one of my medications to one tablet a day; I now take four.
So I put SHIP on hold and called my pharmacist. He said I should ask about formularies with 100-milligram tablets rather than 50-milligram tablets, and instead should take two a day instead of four. He also told me that I should look for a formulary that excluded another drug I took that I could buy over the counter for only $20 a month.
The permutations, I could see, were endless. I’d used up the battery juice in two telephone handsets and was tangled in sheets of calculations.
Back to the SHIP lady, chipper even when I asked her to run another set of formularies. Up popped a plan for a mere $26 a month. It had no deductible and no co-pays if I used only generic drugs. It allowed every medication that I needed, once I’d fiddled with the dosages and frequency (this after more calls to the pharmacist).
But the plan seemed to require I use one of the large chain drugstores. My loyalty to my local pharmacist, especially now, made that unthinkable.
What’s one more call at this point, well into Day 3 of this project? I called the insurance carrier with the promising plan. Yes, a representative said, I could use my own pharmacist for a slightly higher co-pay for each drug, or $34 a month in all. Even someone as math-impaired as I knew this was the best deal.
This is the moment to talk about how if time is money, Medicare Part D could use some streamlining. It is the moment to talk about how the government cannot expect an elderly person with cognitive, visual or other deficits to manage this task —and it cannot assume that everyone has a daughter who can.
In three days, I learned two things: how grateful I am to have found a plan that will pay for a generic version of Ambien, so the next time I do this I won’t have to spend three nights thrumming with tension because I can’t afford to sleep. And how anticlimactic —even celebratory —my 65th birthday will be, compared with the run-up.
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