## Medicare#039;s drug coverage has me dazed, confused

Published 12:00 am Friday, November 18, 2005

Sometimes I think the Bush administration does everything to prove that government doesn't work. I called the Social Security Administration office last week to find out about this new program.

The hypothetical conversation may have gone something like this.

“Ma'am can you explain if this new program will help me?” I asked.

“Absolutely, sir. How much do you currently pay a year in prescriptions?” the woman responded.

“Humm. Not exactly sure, but, well maybe about $1,200 out of pocket. And I think the company I work for pays 60 percent, so I suppose my total cost is $3,000,” I said.

“Well, that helps sir. First, there is a $250 individual deductible,” she said.

“OK, so I pay the first $250, which would mean you pay $2,750?” I asked.

“Oh no sir, it doesn't work that way. After you pay the first $250 you pay 25 percent of each prescription,” she told me.

“OK, so if the total is $2,750, I pay about $587 more. Then you guys pay the rest?” I asked.

“No, sir, there is also a $32 a month membership fee in the program.

“Ouch! That's $384 a year.

OK, then you pay the rest?” I asked.

“Well sir, not exactly. You see, your coverage is only good up to $2,250 a year. So you would pay the $750 after $2,250 until your total of $3,000.”

“Wow, this is getting confusing,” I said.

“Not at all sir, it is perfectly clear,” the woman said politely.

“Hummm. OK, so I pay $250 up front. Then I pay a $32 a month premium, or $384 a year. Then, if I have it right, I pay 25 percent

of my prescription costs between $251 and $2,250 per year, or $500. After that I pay everything over $2,250, which is $750. Is that it?”

“Why yes sir, that is correct,” she said.

“So, I pay $1,884 and you pay $1,116. That means I pay 63 percent of my costs to be on your plan and you pay 37 percent, right?”

“Yes, sir.”

“OK, so that's it, I have it all, correct?”

“Not exactly sir. You must select a plan from those offered in your state. No one plan offers all drugs, so be sure to select one that offers many of your prescriptions.”

“Whoa! What if no plan pays for all of my prescriptions?”

“Well sir, that is certainly possible. You would pick the best match, then pay the entire costs of any prescription outside of the plan you choose.”

“But if I had to choose between plans that pay either for my Lipitor or my Plavix the one not included would cost me almost $300 a month. That would be $3,600 a year. Are you kidding? I mean, that is really possible?”

“Sir, the plans are created by private companies,” she said. “We have no say over what drugs are included in each plan.”

“OK, well, do I have it all now?” I asked.

“Just about sir. One last thing. There is not coverage between $2,250 and a total out of pocket of $3,600. Once you have paid $3,600 in any year of your own money, then Medicare will pay 95 percent of your costs for the balance of the year.”

“Great. So I pay $1,884 then have to pay for Plavix which costs $3,000. I pay $3,600, then you pay 95 percent of $1,284, or $1,224, and I pay $3,600 plus $64 for a total of $3,664. So, the final deal is I pay $3,664 and Medicare pays $2,340. I pay 61 percent and you pay 39 percent. So that's it, right?”

“One last detail, sir. Should you not enroll by June 2006 your premium percentage rises 1 percent for each month you delay after June.”

“Thanks for your help. I can't imagine why people don't understand this stuff. By the way, will you use this program?”

“No, sir, I buy my prescriptions from Canada. Don't tell anyone.”

Dr. Jim Crawford is an administrator at Ohio University Southern. He can be reached at drjim893@msn.com.