Medicare Story Ideas
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Deane Beebe, Public Affairs Director
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Medicare Rights Center
Part D Consumer Stories | Part D Business Stories | Part D Political Stories
Medicare Private Health Plans | 24-Month Medicare Waiting Period
Part D Consumer Stories
- What are the reasons 18 million people (or regional number) have decided not to sign up for Part D? Are they still going without medications or do they have an alternative source?
- Millions of low-income people with Medicare have yet to get to enroll in the Extra Help program. Why aren't they applying? How much money have tax payers and the drug industry spent supporting programs to help people enroll? Given that historically government programs for low income people are under-enrolled (especially Medicare Savings Programs which serve the same population), what changes would increase enrollment?
- Are the poorest and sickest people going without their medications because appeals process for "off-formulary" and "restricted" drugs requires extensive documentation from doctors? Many poor people do not have a regular doctor and may use emergency rooms for treatment or clinics where their doctors may not be routinely onsite. Are these individuals having less success in the appeals process?
- Benzodiazepines, low-cost drugs used to treat certain mental health disorders, are not covered by the Part D drug benefit. How is this affecting people with Medicare?
- What impact is Part D having on medical practices? How does the clinician devote the time necessary to see that a patient with Part D coverage can actually fill a prescription? How are doctors in your community handling this timely responsibility?
- Pharmacists have played a critical role in helping people get their medications from private plans. Many have been losing money because private plans have been slow to pay them for drugs they have dispensed. How are both the small and large chain pharmacists fairing under the weight of Part D?
- As it stands now (and as President Bush said it will continue to stand), people were locked into their drug plan beginning May 15. Are people finding that the drugs plans they chose at the end of '05 or in early '06 meeting their needs later in this year? Have formularies changed? Have they developed new medical conditions that require drugs that are not covered by their plans?
- How are sick people with chronic conditions fairing under Part D? Some have lost help from the drug company patient assistance programs and do not qualify for the "extra help." Many take drugs on "specialty" or high tiers. Are they able to access their medications easily and are they able to afford them?
- The drug benefit will drop out for many people after they get $2,250 worth of drugs but they will still be responsible for paying the monthly premium. How are people fairing in the doughnut hole? Are they able to get their medications? Are they being taken by surprise?
- What is the clinical impact on a patient who loses access to medicines taken for chronic conditions when they hit the donut hole? Would they be better off to stay off the medication entirely?
- To get out of the doughnut hole and get catastrophic coverage will require that someone with Medicare spend $3,600 out of pocket. Do people with Medicare have the means to get out of the doughnut hole? If they use their savings or get help from a family member or friend in 2006, are they going to be able to get out of the doughnut hole again in 2007 and years beyond?
- In October, private drug plans will announce whether or not they will offer Part D in '07? When plans pull out of Medicare, how will it impact consumers who lose their plans?
Back to TopPart D Business Stories
- What is the impact of Part D on the profitability of plan sponsors?
- Who reaps the benefits of rebates that drug plans get from drug companies?
- Drug plans choose some drugs over others for their formularies. Is the choice based on lucrative rebates from the drug companies or the needs of consumers?
- Come October, private drug plans will be announcing whether they will continue to offer the Part D benefit. How many plans will continue to do so? How will the premiums, formularies and the doughnut hole compare to '06? How will this impact pharmacists?
- CMS is threatening to re-assign dual eligibles to new plans in 2007 depending on the premium benchmarks. How will that affect insurers and consumers?
- Are companies that did not benefit from the auto-enrollment of duals having financial success?
Part D Political Stories
- Trace the career paths of the Congressional members and staff who championed the Medicare Modernization Act. Similar question for members of the Administration. How many are now being compensated by the industries profiting from Part D? How many are doing so openly, e.g., Tauzin, and quietly, e.g. Breaux.
- Compare public statements by Administration regarding dual transition in late 2005 with the reality and ultimate admissions in 2006. Were they really caught by surprise? Did they really disbelieve the consumer voices warning of a "train wreck?"
- Who devised the political strategy to deny problems with roll out? Who directed CMS leadership to pretend that there would be no transition problems with the transition of frail and impoverished people from Medicaid to Medicare coverage?
- Analyze why a majority in Congress are opposed to allowing Medicare to offer a standardized drug benefit to compete with the for-profit plans.
- Trace the contracts offered to consultants, ad agencies, pr firms and technology firms in the development of Part D - how much was spent, and what were the bidding processes in awarding contracts.
- Compare 1966 roll out of Medicare with 2006 roll out of drug benefit.
- Consider how residents of other industrialized nations get prescription medicine.
- Where do candidates for midterm elections stand on allowing the Medicare program to buy in bulk and negotiate good prices? Where do they stand on offering a drug benefit within the Medicare program so that people could use their Medicare card to get their prescription drugs?
Medicare Private Health Plans
- For the first time, beginning on July 1, 2006, people will be locked into their Medicare private health plans. Currently people disenroll from their plan when their doctor or medical center leaves the plan's network, or when they cannot get access to a specialist. How is lock-in affecting people in Medicare private plans?
- Private health plans are being paid more than the government would have paid if someone were in Original Medicare. Why are private plans being overpaid given that they are not saving the Medicare program money? Is that sustainable?
24-Month Medicare Waiting Period
- People who can no longer work and have been deemed disabled by the Social Security Administration must wait five months for their first Social Security Disability Income payment and then an additional 24 months for their Medicare coverage to begin. How are people managing in the 24-month waiting period? Are they going without health care? Are they going without medications? Is their condition getting worse? Is the state's Medicaid program shouldering their health care cost? If they worked for a long time and made a decent salary, then their disability income is larger and they cannot qualify for Medicaid; are they being penalized? Where does your elected official stand on the 24-month Medicare waiting period issue?