Text 35442, 81 rader
Skriven 2009-08-30 05:56:08 av Bob Ackley (1:300/3)
  Kommentar till text 35384 av Robert Bashe (2:2448/44)
Ärende: Universal health insurance
==================================
Replying to a message of Robert Bashe to Wayne Chirnside:

 WC>> Well, people such as myself, disabled and ultra-poor have to pay the
 WC>> first 250 of their medicare part D plan.

 WC>> First problem is under medicare part D one of my drugs is not covered
 WC>> and the other's $96  year.

 RB> So in other words, you have no benefit at all, since the deductible is
 RB> $250 a year. Why is there a limitation as to the type of drug? Or is
 RB> that a stupid question?

Health care organizations usually have a formulary of drugs for their members/
subscribers.  They buy those drugs in huge mass purchases from the makers and
get quantity discounts on them for that reason.  The decision to carry or not 
carry some drugs is up to each organization - in most cases if a specific drug
is not available in the formulary a similar drug is carried (I ran into this a
couple
of years ago when the drug 'Avalide' was dropped from the formulary, it took
the
physician quite a while to figure out that its replacement was called 'Hyzaar,'
which has the same active ingredient - hydrochlorothiazide).

I suspect that some drugs with limited applications are not carried in most
formularies, particularly if they're expensive.

 WC>> To get coverage for the second and more expensive drug, $210 a year
 WC>> I'd have to join a prvate plan. A private insurance carrier
 WC>> authorizd under part D.

 RB> Oh, brother! Then you might as well take the private insurance and
 RB> forget Mecicare.

If one is Medicare eligible, which I will be in December, one does not have
that choice.  You cannot 'forget' Medicare, in this country it is illegal for a
provider to give medical care to a Medicare eligible elderly person outside of
the Medicare system (and that includes providing that care for free).

 WC>> This is generally encouraged however what is generally not known is
 WC>> joining such a private plan loses you a *lot* of options regards to
 WC>> hospitalization and doctor care.

 RB> There's a connection? I must admit I don't understand why.

 WC>> Doughnut hole being a euphamism for medicare part D only covering
 WC>> your medications for the first half of the year as you have a cap on
 WC>> maximum drug costs per year. After that you're on your own again.

 RB> Jeez... so what's the point? The chronicly ill need medicines in a
 RB> full year, not just in half, and not capped. I really don't
 RB> understand this system.

I don't either.  I recently received a notice from Social Security that
included 
what appears to be an application for Part D (drug coverage).  They want to 
know a lot of very personal information, particularly financial information,
that
IMO is none of their d*mn business.

 RB> I might note that my wife is diabetic, i.e. chronically ill, and gets
 RB> her insulin part from private insurance and part from the insurance
 RB> her former employer (the state government) still provides, although
 RB> she is now pensioned. All in all, 100% is reimbursed.

 WC>> Now for the wealthy the deal is a good bit better.

 RB> Well... wealthy. At least better off, who can pay private insurance.
 RB> Not much different here.

 RB> Seems like you have a pretty difficult situation.

I will be contacting the local Tricare office about this soon.  I have two
chronic problems - diabetes and hypertension, plus borderline high cholesterol
-
and take eight prescription drugs every morning.  So far the drugs have been
provided from the military medical system (I'm retired military) at no cost to
me; I suspect that after 26 years is about to change but I need to confirm
that.

--- FleetStreet 1.19+
 * Origin: Bob's Boneyard, Emerson, Iowa (1:300/3)