Medicare Part D? D for DONT even try to figure it out???

i am losing my mind! i have spent at least 8 hours of late helping an elder relative sort through her new prescription drug options under Medicare Part D. I've got a 5 page spreadsheet going, with at least another 6 pages to go, and I have concluded that it's mathematically impossible to make sense of it all!

I don't even know where to start ranting... perhaps the fact that you can't compare plans because they don't provide comparable benefits. one plan pays 75% of drug costs up to $2250. on another plan you pay a co-pay of $5, $10, $25, or $40 dollars per scrip (depending on what tier it is) until the total drug cost (what you pay plus what the insurance company pays) equals $2250. But of course, there is no information on how much the insurance company pays, so you can't figure out exactly when you'll hit the $2250 barrier.

after the $2250 barrier, you reach "the gap" also known as "the donut hole" where you have no scrip coverage at all. of course, you still have to pay your premium, so in effect, while you are in the gap you are paying MORE than you would if you had no coverage at all!

now eventually ... if you manage to pay out of pocket more than $3600.00, then you get coverage again. but here's the way it works for my relative, who only gets a little over $800 a month in social security and has diabetes, high blood pressure, high cholesterol and asthma.

In January she has to pay her $250 deductible before getting any coverage. So between her part d premium, her deductible, and her copays she pays $389.00 for $617 worth of drugs.

February and March, her deductible met, she pays $191.26 for the same $617 worth of scrips. But come April she meets the $2250 threshhold. So she loses all coverage half way through the month. She's out of pocket $344.

May, June, July, and August she's in the gap...the donut hole! She has no coverage at all, but she still has to pay her premium. So she is paying $653 for $617 worth of drugs!!!

She then has 4 months of coverage before the new year, when she starts all over again with her $250.00 deductible.

But that's just one plan from one company. To figure out which plan is best, i have to take each plan, create a new worksheet, plug in every drug month by month, figure out what part of the month's drugs they cover, which months they don't cover, and add it all together.

After I've done this about 10 times, I'll be able to see which plan is most cost effective for her? NO! It can't be that simple.

I'm basing all my calculations on a particular box chain's retail price. But some plans have their own mail order scrip plans. They publish what your co-pay is for the drugs, but not how much they pay toward your scrip. And it matters how much they pay. Because once you hit a total of $2250 drug cost (determined by adding your co-pay PLUS what they pay) you have no coverage in the gap. Soooooooo, how much they pay for their share toward your scrip determines how soon you'll reach the $2250 barrier.

AAAAAAHHHHHHHHHHHHHH!!!!

to make things even more complicated, some plans charge higher premiums, but cover generic drug costs when you are in the gap. To figure out whether the higher premium is worth it, you have to know how many of your drugs are generic. OK, so maybe if i have enough generic drugs every month, maybe the higher premium is worth it. But the less you pay out of pocket in the gap each month, the longer it will take to reach the $3600.00 out of pocket threshold for coverage to kick back in on your brand name drugs. So you are paying a higher premium to get generics paid in the gap, which in turn makes it take that much longer for your more expensive brand name drugs to be covered again.

In my relative's case, without them covering her generics in the gap, she doesn't get out of the gap until September. I've yet to figure how much further out her brand name coverage will be if she chooses to pay the higher premium to get coverage on her generics in the gap. There is no standard formula for any of this. It depends on how many of your drugs are generic compared to brand name and how much the generics retail for.

When all is said and done, i'll be surprised if she gets a discount of 33% below retail costs on her drugs for the year. And she had at least that much of a discount under her old Medigap plan with far less confusion, hassle, and overhead expense.

It's appalling to me that the same people who wouldn't even look at Hillary's health proposal in the 1990s because it had too many pages with words on them, are the ones who championed this debacle. Every congress critter who voted for Part D should be required to sit in a Medicare office all day every day working through this shit one on one with each and every person who can't figure this shit out!

I suppose I should not be surprised. As a friend said recently, it's as if the pharm execs, the insurance execs, and Grover Norquist got together in a room to figure out how to fuck the old and the sick.