THE BLOG

Feds' Decision to Boot Medicare Drug Plan, A Good Start

05/11/2010 05:12 am 05:12:01 | Updated May 25, 2011

The Federal government ejected a big insurance company from the Medicare prescription drug program today--an unprecedented move and a shot in the arm for health care reform advocates. My question: Why stop there?

The Centers for Medicare & Medicaid Services (CMS) said it booted New York-based Fox Insurance after it found that the company wrongly denied drug coverage to plan members. But even when Medicare Part D insurers play by the rules, seniors face daunting challenges selecting a suitable plan, and they must wrangle with complicated rules that govern drug coverage.

Seniors shop for Part D plans during an annual window that runs from November 15 to December 31st. Last year, I researched articles on how to shop for these plans for my newspaper column and CBS MoneyWatch.com.

My takeaway: this is a segment of health care crying out for a simple, single-payer approach--like the one we have with basic Medicare.

The Part D program is much more complicated than it needs to be. Individual insurance plans are revised from year to year, and companies routinely add and subtract drugs that are covered. That means seniors need to review their plan choices at least once every couple of years--even if the medications they take haven't changed.

Sometimes a drug appears to be included in a plan, but deeper digging shows that there are restrictions on its use that require seniors to jump through all kinds of hoops to get covered.

And the premium costs can vary tremendously. For the CBS MoneyWatch story, I tested the case of a healthy 76-year-old California man shopping 47 plans available in his area; the annual premiums that were quoted varied from $1,077 to $3,370.

Computer-savvy seniors can use the reliable shopping tool at the Medicare website to guide their shopping. Others now turn to an array of companies that have sprung up who will help consumers shop for a small fee, or to non-profit agencies such as the State Health Insurance Programs (SHIP).

Part D was a created as a privatization initiative during the Bush era, and many health reform advocates have argued that it's inefficient and should be rolled into the government-run basic plan. The current state of the health care reform debate shows that this kind of change isn't in the cards. But let's hope CMS at least keeps cracking down on abuses by insurance companies.