Part D for Drug Coverage — and Drudgery

BY JANE GROSS DECEMBER 1, 2014 5:21 PM December 1, 2014 5:21 pm 111

Death and taxes have always been twinned in cliché for their unavoidable awfulness. But death only happens to each of us once, not annually. Wouldn’t our annual encounter with the Internal Revenue Service be more aptly paired with the Medicare Part D open enrollment period, a yearly torture between mid-October and early December? Both take days out of our lives and leave us sitting in a heap of papers with a splitting headache and residual worry that we got something wrong and will wind up in jail or the poorhouse.

It’s my third year of eligibility for Part D, the Medicare option, added in 2006, that provides coverage for prescription drugs. When I turned 65, I had nothing but good things to say about Medicare Parts A and B, the 1964 hallmark legislation that covers hospital and outpatient medical care. That’s still mostly true, but for the growing numbers of doctors who have “opted out’’ of the government program because of inadequate reimbursement and onerous paper work. Part D, designed as a public/private hybrid, is another story. Forgive my cynicism, but any “benefit’’ that twins the insurance industry with Big Pharma can’t really have the public interest at heart.

My first experience choosing a drug plan was chronicled here, after a Fourth of July weekend that will live in memory as the worst I ever spent. I should have expected as much, since my colleague Gina Kolata, a whiz at math, wrote of her effort to choose a plan for her father, testing if the Centers for Medicare and Medicaid Services website was as simple as promised and found it an exasperating mess. Since my mathematical abilities are limited to counting on my fingers, and Gina had struggled, I was braced for trouble. But not the trouble I found myself in.

Year two I had an excuse not to try, even when the booklet of changes for the coming year arrived from my insurance carrier and everything was more expensive by many multiples. In the midst of selling one home and buying another, who could fault me for taking a slide? And how comforting to find out, and recount here, that a Kaiser Family Foundation study had found 87 percent of Part D policyholders between 2006 and 2010 made no change, even when they knew they were overpaying, because it was too hard. Kaiser went so far as to say that the Part D plans had observed and responded to this behavior, offering reasonable rates one year and over-the-moon rates the next in a classic bait-and-switch.

Now, in year three, I vowed I would behave responsibly and do what the experts advised: Review my current plan and its changes since 2014, then compare it to everything else available.

The biggest overall changes in Part D for 2015 are fewer plans to choose from. (Still, in 2015, there will be 1,001 Part D plans available nationwide, and an average of 30 in each region, for Part D’s 10 million customers.) Most of the plans are more expensive, and all have more drugs in the highest, more expensive tiers, with many requiring monthly pre-approval.

Experts also cautioned not to be seduced by plans with no deductibles versus those that expect the consumer to pay the first $320, since the medication you take will often push the total price higher than a $0 deductible plan.

Here’s when befuddlement set in. On the government website, medicare.gov, you can compare plans, but only three at a time. But I was interested in five. So I ended up going to the individual health insurers’ websites and punching into each the medications I take, the dosage and the frequency. There’s one plan with no deductible (I now pay $310) and a $30 (vs. $64) monthly premium. But all my drugs, now ranked at Tier One, the least expensive, would either bump up to Tier Four, the most costly, or require prior approval each and every month.

Sometimes figuring out each plan required a call to the health insurance company for clarification. In each case you have to to spell your name, give your date of birth, your phone number (home and cell), your mailing address and billing address, the last four digits of your social security number and your mother’s maiden name. Usually you have to say them more than once. In a half-dozen calls I spoke to agents named Bamer, Sergei, Miyosha, to name a few. All were very polite. Few understood the policies they were selling.

And some, relieving my tedium, went off script.

“You may want to contact your Social Security office.”

“I don’t have access to that book.’’

“That’s not something I’m familiar with. Please hold and I’ll get a supervisor.’’

The temptation to hang up was trumped by knowing I’d only have to start over.

At the end of the process, after adding up all the numbers and seeing which plan was most economical for me, I had a new plan. It had taken me two days, maybe 10 hours. I wish I had started earlier but, like taxes, we procrastinate. And those wishing to change their plan have only until Dec. 7, a Sunday, to make a change.

My new plan came with a 16-digit customer I.D. number. There was also a customer service phone number, available 8 a.m. to 8 p.m. seven days a week. Somehow, I’d wind up automatically disenrolled from my current plan and one refill on each prescription would be transferred from my existing pharmacy chain to the new one, which is right across the street. If I did the math right, this would cost me about $800 a year. That seemed reasonable, assuming unanticipated medications didn’t get added to the list.

I’d made a decision. In a year I’d know if it was a good one. Meantime, my cholesterol medication has been discontinued. It was one where the new plan saved me a dollar a month. And I might as well pay for a Tier Four shingles vaccine now. If I dawdle until after the first of the year, it will cost $250 because the deductible won’t be met. Now I can get one for $95.

The pharmacy I now must use advertises on television as being “at the corner of healthy and happy.’’ Only time will tell.

Jane Gross is the founding blogger of the “The New Old Age’’ and author of “A Bittersweet Season: Caring for Our Aging Parents — and Ourselves (Knopf 2011/Vintage 2012).

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