Aspects of Need Addressed: Medical, Financial
My son's pharmacy called the other night. The pharmacist wanted to know the details of my son's new Medicare Part D drug plan. Even though he is 24 years old, my son participates in Medicare Part D, and Parts A and B well, because he has been declared disabled by the Social Security Administration because of his schizophrenia.
I took the call. "What are you talking about?" I asked.
"The insurer needs to know your son's Medicare number," responded the lady pharmacist.
"Wait a minute. His prescription drug company already knows his number. Who is asking for this?" I countered.
"Humana, the plan administrator," came the answer.
"What? His plan is with Fox Insurance, not Humana!
"Well," said the pharmacist, "it seems that Medicare has changed his prescription drug plan."
Now I was worried.
Medicare Changes My Son's Plan, But With Good Cause
What happened? Fox Insurance apparently ran afoul of the Medicare system, and so Medicare apparently disqualified it with immediate effect from participating as a Medicare Part D provider, as explained in the recent press release of the Centers for Medicare and Medicaid (CMS). It is the first time in its young history that the Medicare Part D program has banished one of its approved providers.
Actually, I'm pleased by this action. I appreciate that a CMS audit has ratted out Fox. My son's interactions with Fox over the past year proved it to be a squirrely outfit. Good riddance to it.
But the change now requires my son to begin anew the process of selecting a new prescription drug provider. That means having to hassle with the clunky Medicare website.
Clicking around in Medicare.gov
Medicare has a reasonably serviceable website. It is clunky to the extent that it doesn't easily loop back and forth, but requires a rigid linear approach. Several times in processing my son's medications information, I had to start the process over at the beginning, entering in his ID and password again and again. But eventually we got it worked out.
The challenge for my disabled son is to find a prescription plan that does two things: keep costs down (to zero, if possible, since he is technically indigent) and find a plan formulary that includes all the medications he needs (including the controversial benzodiazepines he needs to reduce anxiety caused by his schizophrenia).
After he listed all the medications he currently needs and could possibly need to address psychosis, depression, anxiety and ADHD, Medicare.gov researched all its providers and came up with 45 possible plans for my son's consideration. That looked encouraging. But a closer look revealed that only seven plans has no required premium payment. But none of these included all the required medications. As it happened, only one of the 45 suggested plans, Aetna Medicare Rx Plus (PDP) included all my son's medications in its formulary. But it also required a monthly premium of $7.90. That may seem a pittance to a regular person. It is not inconsequential to an SSI and SSD recipient living on $695 of monthly revenue and monthly rental expense of $388.
Well, we have to check one more thing: would NJ Medicaid cover the premiums that a Medicare Part D plan might require. I suspect it will, since my son is deemed totally disabled. But this will require a call to NJ FamilyCare which administers NJ Medicaid, which does not maintain a comparably serviceable website.
So, it is not easy for the psychiatrically disabled when Medicare has to change your drug plan...
My son's pharmacy called the other night. The pharmacist wanted to know the details of my son's new Medicare Part D drug plan. Even though he is 24 years old, my son participates in Medicare Part D, and Parts A and B well, because he has been declared disabled by the Social Security Administration because of his schizophrenia.
I took the call. "What are you talking about?" I asked.
"The insurer needs to know your son's Medicare number," responded the lady pharmacist.
"Wait a minute. His prescription drug company already knows his number. Who is asking for this?" I countered.
"Humana, the plan administrator," came the answer.
"What? His plan is with Fox Insurance, not Humana!
"Well," said the pharmacist, "it seems that Medicare has changed his prescription drug plan."
Now I was worried.
Medicare Changes My Son's Plan, But With Good Cause
What happened? Fox Insurance apparently ran afoul of the Medicare system, and so Medicare apparently disqualified it with immediate effect from participating as a Medicare Part D provider, as explained in the recent press release of the Centers for Medicare and Medicaid (CMS). It is the first time in its young history that the Medicare Part D program has banished one of its approved providers.
Actually, I'm pleased by this action. I appreciate that a CMS audit has ratted out Fox. My son's interactions with Fox over the past year proved it to be a squirrely outfit. Good riddance to it.
But the change now requires my son to begin anew the process of selecting a new prescription drug provider. That means having to hassle with the clunky Medicare website.
Clicking around in Medicare.gov
Medicare has a reasonably serviceable website. It is clunky to the extent that it doesn't easily loop back and forth, but requires a rigid linear approach. Several times in processing my son's medications information, I had to start the process over at the beginning, entering in his ID and password again and again. But eventually we got it worked out.
The challenge for my disabled son is to find a prescription plan that does two things: keep costs down (to zero, if possible, since he is technically indigent) and find a plan formulary that includes all the medications he needs (including the controversial benzodiazepines he needs to reduce anxiety caused by his schizophrenia).
After he listed all the medications he currently needs and could possibly need to address psychosis, depression, anxiety and ADHD, Medicare.gov researched all its providers and came up with 45 possible plans for my son's consideration. That looked encouraging. But a closer look revealed that only seven plans has no required premium payment. But none of these included all the required medications. As it happened, only one of the 45 suggested plans, Aetna Medicare Rx Plus (PDP) included all my son's medications in its formulary. But it also required a monthly premium of $7.90. That may seem a pittance to a regular person. It is not inconsequential to an SSI and SSD recipient living on $695 of monthly revenue and monthly rental expense of $388.
Well, we have to check one more thing: would NJ Medicaid cover the premiums that a Medicare Part D plan might require. I suspect it will, since my son is deemed totally disabled. But this will require a call to NJ FamilyCare which administers NJ Medicaid, which does not maintain a comparably serviceable website.
So, it is not easy for the psychiatrically disabled when Medicare has to change your drug plan...
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