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Why is Medicare Part D So Confusing?

why medicare part d

In Arizona there are 25 stand-alone Part D drug plans available to people on Medicare. I usually deal with the best-known plans, Humana and AARP MedicareRx, because they seemed to cover almost all prescription drugs in past years.  This seems to be changing for 2011, and this makes selecting a Part D plan more confusing than ever.

Last weekend I met with a couple who have both chosen to stay with Medicare and get a Medicare supplement.  They need to pick a stand-alone Part D drug plan, which is a bit complicated because the husband uses several inhalers which are very expensive.  He also takes Micardis for his blood pressure along with two other drugs. The wife doesn’t take any prescriptions, so I thought the Humana Walmart plan, with a low premium, would get her into the Part D system for a small cost.

For the husband, I first checked my old standards, Humana and AARP MedicareRx (which is actually UnitedHealthcare).  As it turned out, the Humana Walmart plan, which has been widely advertised, does not cover Micardis.  More surprisingly, the AARP MedicareRx plan does not cover the Proventil inhaler the husband needs.

My next step was to go to where I put my client’s prescriptions into the Plan Finder which generated a list of Part D plans he could consider.  The plans were listed in order from the lowest premium to the highest, and they ranged from $28 to $80 per month.  I noticed that most of the plans had a notation that said they did not cover all of his prescriptions.  Some plans had a $310 deductible, one had a $150 deductible, and some had no deductible.  Co-pays from plan to plan were varied, from 25% for all drugs to $85 for tier 2 drugs and then 33% for tier 3.  An $85

co-pay for a tier 2 drug? That company must tier their drugs differently than the plans I know.

I was totally confused by the choices and information provided by the Plan Finder .  My clients asked for my advice on which plan they should choose, but  I had no clue what to tell them.  All I could say was that I don’t understand why there are so many plans, each with a different formulary (list of drugs covered), different deductible, and different co-pays for each drug level.

Why is Part D so complicated?

In 2010 there are over 1,500 Part D plans offered throughout the country. Why?   What value is provided by hundreds of insurance companies each offering several Part D plans?  Has this saved Medicare money?  Has this made drug coverage selection easy for seniors? Who came up with this concept – and why?  Why not have one or two plans administered by Medicare (which contracts out the work to the private sector)?  Are insurance companies making a profit from Part D drug plans?

I gave my clients a list of Part D plans from the Plan Finder and pointed out two plans I thought they should look into.  I don’t represent those plans, so I suggested they call the plans directly, or they could call Medicare to ask for help in picking plans that would work for each of them.

My clients were shaking their heads in dismay and confusion.  We had determined that the husband’s prescription costs might add up to three hundred dollars or more per month, so finding a plan that could save them some money is very important. I apologized for not being able to help them further with their drug plan selection.  And I repeated my question, “Why is Part D so complicated and confusing?”

Category: Insurance

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