Medicare Part D Coverage and How it Makes the Elderly a Vulnerable Population - Essay Example

Medicare Part D Coverage and how it makes the Elderly a Vulnerable Population Copyright Major changes were introduced in Medicare for the first time in thirty years as the Medicare Modernization Act of 2003 offered prescription drug assistance to all Medicare beneficiaries with such assistance also being offered through a large number of private health insurers. This move was politically important as it had been noticed that a substantial number of elderly Americans and the disabled needed assistance, because they could not afford the rising cost of prescription drugs which had started to play an important role in modern therapy. However, the package that was finally approved by the Congress has been criticized as being complex and ill conceived, with a capacity for adding to the difficulties of the elderly who are a vulnerable segment of the population and find it difficult to negotiate complex administrative procedures or to fight for their rights. Broadly speaking, some assistance with prescription drug expenditure has been provided for annul expenditures on prescription drugs with an upper limit of about $ 2,250 after which the enrollees pay out of their pocket until catastrophic assistance with prescription drug expenditure cuts in at about $ 5,100. Although the previously mentioned ‘doughnut’ is expected to keep expenses on healthcare under control, Medicare Part D has been criticized as being too complex, with an ability to add to the vulnerabilities of the elderly Americans. A very large number of plans are now being offered and it has to be wondered why the tax cuts that had been announced could not have been used to device a simpler system without a doughnut to better care for the elderly and the disabled. This brief essay presents an examination of why Medicare Part D coverage makes the elderly a vulnerable population. Declaration I hereby certify that, except where cited in the text, this work is the result of the research carried out by the author of this study. The main content of the study which has been presented contains work that has not previously been reported anywhere. _____________________________________________ (Name and Signature of Author) April 2007 This write up is submitted in fulfillment of the requirements for a research paper about Medicare Part D coverage and its impact. Biographical Sketch Acknowledgements Contents Introduction 1 Medicare Part D and the Elderly Americans 4 Conclusion and Recommendations 16 Bibliography / References 18 List of Figures Figure 1: Trends in the Impressions about Medicare Part D held by Elderly Americans 3 Figure 2: Average Change in Annual Cost of Therapy due to Increase in Manufacturer Prices for Drugs 8 Figure 3: Cumulative Change in Annual Cost of Therapy Due to Price Increases for Five Widely Used Prescription Drugs 9 Figure 4: Distribution of Price Changes for Widely Used Prescription Drugs for 2006 10 Figure 5: Prescription Drugs with the Highest Change in Manufacturer Prices for 2006 11 Figure 6: Average Annual Change in Prescription Drug Prices by Manufacturers 12 Figure 7: Factors Influencing Quality of Life for the Elderly 13 Figure 8: Popularity of Proposed Measures to Improve and to Provide Stability to Medicare Part D 15 (This page has been left intentionally blank) Introduction Major changes were made to the Medicare Program for the first time in 30 years, when The Medicare Modernization Act (MMA) of 2003 made it possible for all Medicare beneficiaries to receive prescription drug assistance (Quimby, 2006, Pp. 1 – 10). Prescription drugs are important because they play a vital role in improving health outcomes and the quality of life in many ailments which may otherwise require surgery or other expensive and invasive treatments. Prescription drugs are essential for promoting early recovery in many ailments, but such drugs had been out of the reach of some senior citizens and the disabled, because they could not afford the monthly cost of prescription drugs. Sensing that assistance was needed, the Federal government in the United States of America enacted legislation as part of MMA to subsidize the cost of prescription drugs for Medicare recipients, with the legislation going into effect in January, 2006 (Wikipedia, 2007, “Medicare Part D”). Although the motives behind the launch of the Medicare Part D program, in which D stands for drugs, are noble enough, critics say that the benefit which was passed by the Congress is complicated, wasteful and needs reform. Nearly seven million Americans were eligible for coverage which commenced in January, 2006 and the program which was designed to target those senior citizens with an income within 150 % of federal poverty level and assets not exceeding $ 11, 500 per person could only enroll 661,000 individuals by mid – December (McWhinney, 2006, Paragraph 1). The biggest criticism that has been levied at the Medicare Part D is that the plan is too complicated and requires a great deal of in – depth research to make any sense at all. Such research is beyond the capabilities of many senior citizens and the disabled, who still have to pay in order to be included in a Medicare basic plan, if they are to be eligible for Medicare Part D coverage (McWhinney, 2006, “Too Many Expenses”). Thus, no matter what option is selected in order to try and extend coverage for prescription drugs, it will cost money to do so. Enrollees are required to pay a $ 250 deductible and then 25 % of the cost of prescription drugs, until the annual cost of such drugs reaches $2,250. Any annual prescription drug costs above $2,250 are to be paid by the enrollee until the annual cost of drugs reaches $ 5,100 when catastrophic insurance coverage is expected to take over and pay for a significant percentage of additional expenses. It has been said that such a ‘doughnut hole’ in which an enrollee gets some level of assistance on either side of fixed expenditure sums, but nothing in the middle can wreck the budgets of many seniors who are recognized as being poor. When the value of an individual’s assets does not exceed $ 11,500 the $ 5100 figure for expenses on prescription drugs to be paid completely by an enrollee can be quite daunting and it is unlikely that a poor senior or a disabled person can somehow increase their income when they are in need of prescription drugs. In addition to the questions that have been raised about the ability of Medicare Part D coverage to provide meaningful assistance to seniors and the disabled, it has also been asserted that the program fails to leverage the buying power of 45 million Americans in order to get a better price out of pharmaceutical companies. In view of the fact that the plan is also being offered to the public through private health insurance firms, operating in different parts of the country in addition to Medicare, many different offerings have been made available. A list of permissible prescription drugs is likely to be attached with each plan and this means that an enrollee must know which prescription drugs they are likely to need and how much of such drugs they are likely to consume. Built in penalties exist for signing – up after the initial enrolment period and this means that it is also important to know when to sign up. Because Medicare Part D is so complicated and private insurance companies are able to offer numerous plans, it is possible to con seniors into signing – up when they do not have an adequate understanding of their needs. It has been said that the Medicare Part D was designed for the benefit of pharmaceutical and insurance companies rather then the elderly (Miller, 2006, Paragraph 2). Figure 1: Trends in the Impressions about Medicare Part D held by Elderly Americans (The Kaiser Family Foundation/Harvard School of Public Health, 2006, Chart 2) In view of the fact that any decent society ought to ensure that its senior citizens and the disabled are adequately cared for and looked after, it is important to examine just why it is being said that the Medicare Part D plan has made the elderly in America a more vulnerable group. Medicare Part D has received a lot of criticism and some of such criticism is likely to be correct. This brief research paper presents a discussion about the failings of Medicare Part D plan and its implications for the elderly Americans. Medicare Part D and the Elderly Americans Even doctors and pharmacists agree with the opinion presented by many elderly citizens that the Medicare Part D plan is too complicated and a broad opinion persists in the community that the plan can be vastly improved with some minor changes (The Kaiser Family Foundation/Harvard School of Public Health, 2006, Chart 5). A real sense of disappointment persists that the administration has opted not to permit negotiations with the drug and pharmaceutical manufacturing companies to get cheaper prices for prescription drugs, despite the fact that health insurance schemes for veterans do negotiate cheaper prices for such drugs. Perhaps if attempts had been made to negotiate with drug manufacturers, the elderly could have been better insulated against rising drug prices which can destabilize their budgets (Perry, 2006, Pp. 2 – 10). Many seniors have had to pay higher then expected out of pocket expenses and some have even complained that they were not told about the doughnut hole. Clearly, the complexity that is involved with the plans results in many making ill – informed decisions and the many organizations offering prescription drug plans have not been very helpful in extending assistance to explain the many offerings that are available to the elderly. Some elderly have been complaining that their costs have increased since they enrolled in prescription drug plans and they cannot afford the new costs, while others say that they are having difficulties in having specific medications which they need included in their cover. Several plans which have been offered have run into problems later and this has resulted in elderly enrollees trying to contact organizations which offered these plans, but affirmative action to satisfy their needs has been lacking. Despite the fact that the impressions about the Medicare Part D coverage have somewhat improved as those who are eligible for coverage have started to get a better understanding of what is being offered, it was certainly possible to device something better which was capable of providing greater stability and fairer coverage, perhaps without a doughnut hole, if some of the announced tax cuts had not been sanctioned and the federal income from these tax cuts were to be used for providing fairer health insurance for the elderly Americans. Elderly Americans and the disabled are not in a position to fight administrative barriers, confusion and the greed of salespersons associated with Medicare Part D and they should have been offered something far simpler which presented genuine and sincere attempts to assist them with their health problems, especially when drugs have become an increasingly critical component of modern healthcare (Boyle, 2005, Chapter 2). The most important and noble aim behind the implementation of Medicare Part D was to draw out the expenditure on prescription drugs by the elderly and the disabled and to add this expenditure on to welfare (Boyle, 2005, Chapter 2). It had been estimated that the prescription drug expenditure of a vast majority of elderly in the United States was about $ 2000 per annum. Having payment support for prescription drugs will invariably mean that the number of prescriptions involving such drugs was expected to increase, but studies have indicated that the increased use of prescription drugs did not enhance the overall health of the elderly and also the rates of hospitalization were not reduced (Khan, 2007, Pp. 22 – 24). This will tend to indicate that better approaches to enhance the quality of life and the health of the elderly are possible. Thus, all the benefits that are being provided to the elderly Americans have to be carefully balanced and coordinated in order to make an optimal impact on the individual. Furthermore, it has been noticed that the price of prescription drugs, especially those that are largely being used by the elderly, have shown a rather disproportionate increase since the introduction of Medicare Part D, despite the efforts of the health insurers to somehow make a difference by trying to influence the pharmaceutical companies and the distributors or the over – the – counter retailers (Berndt, 2007, Pp. 33 – 35) and (AARP, 2007, Pp. 13). Although, it is likely that those who have enrolled for plans built to include prescription drug coverage will continue to enjoy benefits and support for their needs associated with the use of prescription drugs, life is certainly going to become a lot tougher for those who have not enrolled in any such plans because they find the Medicare Part D confusing, or because the insurance plans become too expensive for them to afford. Also, those with needs that place them above the $ 2000 per annum ceiling for prescription drug benefits, for which assistance is provided, are also likely to suffer because they will have to pay for all their prescription drug expenses above the $ 2000 limit to $ 5000, above which they start receiving catastrophic assistance. It has been observed that those who are most likely to need prescription drug assistance are the elderly who are often the poorest and the most uneducated and who are in the greatest need for assistance. However, these individuals find it difficult to pay for a plan, properly comprehend a plan that is being offered or to meet the payments associated with the doughnut hole for Medicare Part D coverage. Also, with an increase in cost of the prescription drugs for the elderly, the number of prescriptions that can be filled out within the $ 2000 ceiling of the doughnut hole is reduced, while what can be done to increase the income of the elderly is rather limited. Thus, it will appear that the complexities of the Medicare Part D and the doughnut hole do act to enhance the vulnerability of those elderly Americans who are really poor, uneducated and have a greater likelihood of being in poor health as compared to the more affluent elderly. Thus, even though it has to be appreciated that the resources of the federal government and health insurers are not infinite and that the doughnut hole does provide some sort of a saving in expenditure, it probably will have been better if a doughnut hole was not included in the plan and perhaps the overall level of assistance was slightly reduced, up to the catastrophic level, if this were to result in a manageable cost. After all, someone is likely to pay if an elderly American was to be found in dire need of assistance without any money for healthcare and it ought to be possible to juggle tax cuts and benefits that do deliver meaningful assistance without complications or the need to have a doughnut for benefits cutting in to assist individuals. Figure 2: Average Change in Annual Cost of Therapy due to Increase in Manufacturer Prices for Drugs (AARP, 2007, Pp. 5) Figure 3: Cumulative Change in Annual Cost of Therapy Due to Price Increases for Five Widely Used Prescription Drugs (AARP, 2007, Pp. 7) Figure 4: Distribution of Price Changes for Widely Used Prescription Drugs for 2006 (AARP, 2007, Pp.8) Figure 5: Prescription Drugs with the Highest Change in Manufacturer Prices for 2006 (AARP, 2007, Pp.9) Figure 6: Average Annual Change in Prescription Drug Prices by Manufacturers (AARP, 2007, Pp. 11) Figure 7: Factors Influencing Quality of Life for the Elderly (Hollar, 2000, Pp. 42) The United States of America and many highly developed Western economies are individualistic societies in which individuals do not depend on family or other individuals and the government has always been responsible for providing assistance to individuals in time of need or hardship. Also, despite the myth of the Asian Values and the Asian concept of family, an individual is far better off depending on the administrative mechanisms of a government, rather then on anyone else. Thus, it is important that the elderly and the disabled be cared for by the whole society rather then becoming dependant on their families or friends in times of hardship. Extra help is available for many elderly and disabled people who may be in need of assistance by the government (AARP, 2007, “Extra Help for People with Limited Incomes”). However, it is certainly possible to device a tax system which can adequately distribute the burden for caring on all, rather then making only the family or friends suffer in times of hardship when they may have to assist an elderly to apply for extra help and assist while such help is being approved. Although the doughnut hole does reduce expenditure that is incurred while paying for Medicare Part D coverage, perhaps a more judicious reduction in federal taxes will have helped in eliminating the doughnut hole altogether. The doughnut hole and the wide variety of plans offered by a large number of health insurers only makes choices confusing and the administrative procedures for seeking extra assistance can be time consuming and difficult to comply with for people at an advanced age. Some of the elderly are 70 – 80 years old and do not want complications in their lives. Elder people and the disabled should be able to live with dignity, independence and be cared for by the whole nation so that the families themselves are not burdened and those with no family can also be looked after. Figure 8: Popularity of Proposed Measures to Improve and to Provide Stability to Medicare Part D (The Kaiser Family Foundation/Harvard School of Public Health, 2006, Chart 11) Won’t it be better if all Americans were to somehow pay a miniscule amount of higher taxes so that no single American is unduly burdened while caring for the elderly and the disabled? After all, what great miracles have been performed for the American economy by the tax cuts that the administration has rolled out and why is it impossible for the American consumers to leverage their buying power to bulk purchase from pharmaceutical companies? The prices of medications are already far higher in the United States of America then in many developing countries and this should put the drug manufacturers to shame. Conclusions and Recommendations From the previous discussion it is clear that the implementation of Medicare Part D is somewhat flawed and this has somehow placed a substantial burden on a segment of the American population, which is no longer able to fight adequately in order to protect its interests. However, any civilized nation ought to do everything to protect and cater for the needs of its elderly and disabled population. Thus, it should be possible to improve upon the Medicare Part D by removing the doughnut hole and simplifying the plan as a whole. Americans will probably not complain if they were to pay a miniscule amount of extra taxes that can assist with the added burden of eliminating the doughnut in Medicare Part D coverage. (This page has been left intentionally blank) Bibliography / References 1. AARP. (2007). Extra Help for People with Limited Incomes. AARP. Retrieved: July 11, 2007. From: http://www.aarp.org/health/rx_drugs/ 2. AARP. (2007). 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