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Modiified: April 15, 2008

 

THE BILL

Important Websites

Our Partners in Advocacy:

Gray Panther Sacto. Monthly Meetings: 2nd Tuesday ever y month, Hart Senior Center

Steering Committee Meetings:
4th Tuesday of every month, Hart
Senior Center

Officers
Joan B. Lee, Chairperson
(916) 332-5980
Marge Cumming, Secretary/Programs
Lola Young, Treasurer
Dr. Karl Stoffers, Environment
Terry Terry, Disabled issues
Mary Lou McHolland, Historian
Joyce Westergaard, Hospitality
Linda Roberts and Karen Raasch (CIDs), Housing issues
Nell Ranta, Labor/wage issues
Joan B. Lee, Newsletter Editor
John Bernier, Newsletter Asst. Editor
Peter D'Anna, SS/Medicare Advisor
Jim and Doris Sanford, Transportation advisors
Edie Poole, Pat Naylor, and Jean Mellberg, Members at Large
Beverly Crosby, Computer assistant
Margie Metzler, Program Coordinator and Webmaster, www.gpcal.org



Gray Panthers California

Note: Please see our new page, devoted to single-payer healthcare issues!

Medicare Part D Project

Healthcare Issues for Seniors, starting with Medicare Prescription Drug Plan

As of 2007, we are adding other components to our presentation, including the Uninsured and Underinsured in America, discussions of the plans proposed in California for healthcare and other prescription drug and healthcare-related issues.

This page will continue to feature Medicare Part D issues, while the other Healthcare issues now have their own page.

Our latest presentations:

To contact your local State Health Insurance Assistande program (SHIP in many states, HICAP in California) download this document.

Want us to provide a presentation for your group? Call us,
(916) 921 -5008, or e-mail margiemetz@hotmail.com

Important Articles

Medicare Rights site: Medicare Part D Appeals Process: http://www.medicarerights.org/partd_appeals_manual.pdf

 

Blue and Eighty-two

By Selma Calnan

I never thought I’d live to see
A plan as bad as Medicare D
a plan endorsed by AARP
when hatched and passed in 2003.
Yet here we’re stuck in 2006
with something Congress cannot fix
a crazy plan that seems content
with Administrative encirclement.
I phoned and phoned the whole day through
and reached-- at last--the chirpy crew
that works from script and cannot stray
from what they have been trained to say
I asked ‘her’ name to note the scene.
He answered “Justin,--I’m nineteen!”

©July 2006
Selma Calnan

Medicare Part D: How can we fix it?

It was created through legislation, so it must be solved by legislation. We need legislation that:

  • Allows seniors to receive prescription drugs directly from Medicare
  • Requires Medicare to negotiate with drug companies: reduce confusion, and money saved could eliminate subsidies to insurance companies and close the donut hole.
  • Waives premiums when there is no coverage.
  • Donut hole: counts all drug costs incurred, not just expenses for those on the insurance plan’s formulary. Or… (better) Eliminates the donut hole
  • Eliminates the lifetime penalty for seniors until the whole plan is overhauled. They currently face up to a 7% penalty
  • Liberalizes the assets test so more are eligible for extra help. (60% of those who applied were ineligible due to the stringent test.)
  • Increases funding to provide counseling and education to beneficiaries and caregivers.
  • Revisits the income-based premium structure that “means tests” Medicare for the first time
  • Provides for easier enrollment If Dr. prescribes it, you can have it
  • Eliminates co-pays for duals
  • Provides a system for resolving issues “at the counter”
  • Provides open enrollment any time the plan makes changes to formulary
  • Provides a single standardized appeals process, widely publicized
  • Monitors plans and sanctions them if they do not comply
  • Makes prices public

Why haven’t these solutions been suggested? Many have… over 85 bills have been proposed, in both the House and the Senate, but not one has been brought forward for a vote! Go here to see what they are and who proposed them: http://www.gpcal.org/documents/fedleg1.pdf

Now we have a new Congress, the 110th! The House has already voted for price negotiations by Medicare. Next step is a similar Bill by the Senate. President Bush has promised to veto it. Urge him to sign it!

Medicare Part D Update, January 2008
 Margie Metzler
Download and print

Coverage and Affordability

  • The Medicare Prescription drug benefit should be available to all Medicare beneficiaries without any penalty, regardless of income and health status.
  • Premiums, caps and co-payments must be affordable.

What’s new in ’08?

  • Doughnut hole coverages have changed. Most companies still give no coverage, and some that do now cover only generic drugs.
  • Formularies may have changed.
  • Co-pays may have changed.
  • Deductibles: the maximum allowed has gone from $250 to $265.
  • Premium changes. Average is still $31 per month, but Humana was $5.41 and is now over $15 per month.
  • There are more plans available (19 companies, 47 plans in 2006 vs 23 companies, 55 plans in 2007)
  • Two companies (Marquette National Life Insurance company and PacifiCare) have dropped their plans

Seniors still need help from Congress! (But it is a new Congress...)

  • The problems with the program were caused by flawed legislation; the only cure is legislative change!
  • Over 100 bills have been proposed in both the House and Senate, but not one was brought forward to a vote in 2006!

What immediate changes do our seniors want and deserve?

  • Waive premiums for any month a senior is not receiving Medicare prescription coverage. Those in the "donut hole" should not be required to pay for "goods not received".
  • Count ALL drug costs incurred in the donut hole, not just expenses for those on the insurance plan's formulary, provided by an in-network pharmacy. Every out of pocket cost should count towards catastrophic coverage.
  • Allow seniors to receive prescription drugs directly from traditional Medicare, not through an intermediary insurance company. This would reduce confusion and offer a simple, one-step plan with affordable drugs.
  • Require Medicare to negotiate the lowest prices, like the Veterans Administration. Money saved in this manner would eliminate subsidies to insurance companies, and could be used to help close the "donut hole" in the current plan.
  • Liberalize the assets test so more are eligible for extra help without a coverage gap. Sixty percent of those who applied for the LIS (Low-income subsidy) were ineligible due to the stringent test, even though they were extremely low income persons.
  • Eliminate the lifetime penalty for seniors until the whole plan is overhauled.

Margie Metzler
Program Manager, Medicare Part D Project
(916) 921-5008
margiemetz@hotmail.com

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Families USA Report: Medicare Privatization: Windfall for the Special Interests

Families USA has just released a new report, Medicare Privatization: Windfall for the Special Interests. Go here for the report: http://www.familiesusa.org/assets/pdfs/medicare-privatization-oct.pdf. Or, call Margie Metzler, (916) 921-5008 and we’ll send you a hardcopy. The basics of the report are as follows:

Back in 2003, when the so-called Medicare Modernization Act was being debated in Congress, we warned that this latest round of Medicare privatization contained severe flaws that would hurt consumers and taxpayers while lining the pockets of special interests. With nearly two years of hindsight, we can safely say we were right: The MMA has been a major disappointment for consumers and taxpayers, but a windfall for private insurance and drug companies.

We've laid out the extent of the MMA's failures in a new report: Medicare Privatization: Windfall for the Special Interests. The report chronicles the failures of the MMA in three key areas: Medicare Advantage overpayments, subsidies to regional PPOs, and drug prices.

Among the key findings:

  • Under the MMA, Medicare has been significantly overpaying private plans under Medicare Advantage. In 2005, Medicare overpaid private plans by at least 7% per beneficiary, costing taxpayers $2.7 billion. In 2006, overpayment reached 11% per beneficiary, costing taxpayers $4.6 billion.
  • Under the MMA, Congress set aside $10 billion for an unnecessary subsidy (or "stabilization fund") to regional PPOs. This year, however, 88% of beneficiaries have access to a regional PPO, before the so-called "stabilization fund" was even tapped--no subsidy was necessary.
  • Medicare Part D drug prices are substantially higher than the prices obtained by the Department of Veterans Affairs (VA), which negotiates prices on behalf of consumers. For all of the top 20 drugs prescribed to seniors, the lowest price charged by any Part D plan was higher than the lowest price secured by the VA. Yet Congress refused to let Medicare negotiate directly with the drug companies, as the VA does.
  • Bottom line: this report shows that, unfortunately for consumers and taxpayers, the MMA has not even come close to meeting the high expectations set for it by Congress. Consumers are getting hurt and taxpayers fleeced, while insurance companies and drug manufacturers are raking in money faster than they can count it. Congress needs to move away from this deeply flawed privatization model, and instead focus on strengthening Medicare.
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Contents and Articles

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Materials used in Medicare Part D Meetings throughout California:

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Our Grant!

Gray Panthers of California has won a grant from the California Wellness Foundation for advocating and various training and development activities regarding the mess known as Medicare Part D. Activities will include at least the following:
• Attend CMS, HICAP and State of California official meetings
• Provide outreach and training to organizations whose members are affected by Part D
• Create and develop educational and advocacy materials
• Get stories from people adversely affected by Part D
• Keep a project database
• Attend meetings, hearings, advocacy sessions etc.
• Encourage others to become activists and advocates!

In 2007, our grant was extended for three more years, and expanded to include other healthcare issues such as helping those who are uninsured or underinsured. More on these issues on this page.

Let me know if you'd like to join us! (or call 916-921-5008).

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What are we doing about this mess?

• Educate

    • Website
    • Create informational materials
    • Meet with anyone who will listen

• Roar! (Advocate)

    • Form coalitions with other senior groups: other Gray Panther groups, OWL
    (Older Women's League)     , CARA (California Alliance for Retired Americans),
    Health-Access    , CCS (Congress of Califonria Seniors), NCPSSM (National
    Committee to Preserve Social Security and Medicare)    , etc.
    • Form Coalitions with other activist groups
    • Form Coalitions with Pharmacist groups (Pharmacists Planning Services,
    Inc., PPSI    )
    • Attend meetings of all sorts
    • Write, call, talk, e-mail, etc.
    • Donut Postcards
    • Collect horror stories

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How Can You Help?

    • Write, call, talk, e-mail, etc.
    • Send postcards, letters, etc.
    • Letters to the Editor
    • Letters to Legislators (Federal and State)
    • Tell us your horror stories
    • Testify in Congress, in writing, in the Capitol
    • Give us more ideas!

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Upcoming Gray Panthers Meetings

Gray Panthers General Meeting: Tuesday Sept. 11, 1:00 pm, Hart Senior Center, 27th and J St.
For more information, call 916-332-5980.

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Joan Lee came up with the doughnut/hole concept as seen below. PhRMA Got the Donut, We got the Hole! Download a copy of this for yourself, on our Documents page! Or, contact us for postcards.Info for sending postcards (what you can say, where you can send it...)

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Medicare Cartoon

More Medicare Part D Cartoons....

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Contact Information

Gray Panthers of Sacramento
P.O. Box 19438, Sacramento, CA 95819
For more information contact
Joan B. Lee, President, at (916) 332-5980
Email: joanblee@sbcglobal.net
Website: http://www.gpcal.org/
Meetings: Steering Committee, 4th Tuesday of the month, 1-3
Monthly Meetings: 2nd Tuesday of the month, 1-3
Both, Hart Senior Center, 915 27th Street, Sacramento, CA 95816Medicare Part D Grant and Program:
1121 Wayland Avenue
Sacramento, CA 95825
Contact Margie Metzler, (916) 921-5008 or margiemetz@hotmail.com

This program and this website operate under a grant from the California Wellness Foundation (http://www.tcwf.org/)
 
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