Why is Part D so complicated?

QUESTION: Why is Part D so complicated?

ANSWER:  Insurance companies run Part D and there are over 1,000 plan variations across the country – 29 in Arizona!  Medicare pays the bills, but Part D is administered by insurance companies.

Part D plans change every year, so this year’s lowest-cost plan might double its premium next year.  The brand drug that was covered this year might not be covered next year.  People, no matter how old or how ill they are, must review their Part D plan each year during the Open Enrollment Period (OEP).  (The OEP has just ended, so it’s too late to review your Part D for 2015.)

On Sunday, the last day of the OEP, my neighbor asked me to look at her list of prescriptions to determine if she has the correct Part D plan.  Fortunately, she had already put her long list into the Medicare.gov Plan Finder.  She gave me the id # for her list and I looked at how the Plan Finder sorted the 29 Part D plan choices.  (Why so many???!!)

Sue, my neighbor, has a masters degree and is a recently retired health care consultant, but she said she could not comprehend the information she found in the Plan Finder.

I looked at Sue’s current plan, AARP Medicare Rx Preferred, and found that one of her brand drugs will not be covered in 2015.  The monthly premium is going up to over $40 and her drug costs would jump dramatically.

I showed Sue the first three plans that came up in the Plan Finder.  One has a $320 deductible and costs $29.80.  One costs $42 and has no deductible, while the plan that comes in second (in terms of cost) has a $18.70 premium and no deductible.

Sue and I checked the website for the $18.70 plan (Silverscript) to be sure the info we saw in the Plan Finder was correct.  Sue was satisfied that she had found the right plan and I told her she could enroll on the plan’s website.  She did this on the last day of the Open Enrollment Period, just under the wire.

Why I hate Part D:

The idea of having drug coverage (insurance) for people on Medicare is a good one – but it is too complicated.  Medicare pays the bills, but Part D is administered by hundreds of insurance companies.  How can that possibly be cost-efficient?  Each of those companies makes a profit from Part  D and each one has large administrative costs.  What a waste of taxpayers’ money!

I noticed the Plan Finder now states that Medicare pays the bills for Part D.  But who notices this?  See the screenshot below and the title:  “Estimated Full Cost the Plan Charges Medicare for Your Drugs”.

So Medicare pays the bills, insurance companies make a profit, and seniors and disabled Americans get confused and probably pay too much.  A recent study of Part D showed that over 80% of people are in the wrong Part D plan and paying too much money for their premium or for their drugs.

I have a perfect example of this.  I met a man last month who showed me his Part D premium bill.  He is paying $119 for his Part D premium – and he takes two generics!!!!   He showed me his Part D card and it said “Health Net Orange”.  Yikes!  I told him Health Net sold their Part D business three years ago.  That means he has not looked at his Part D for at least three years. He just kept paying the ever-increasing premium without questioning it.  He and his wife got on the phone and enrolled in another Part D plan for January 1st.

medicare cost


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