DR. HOOK- Medicare muddle: Drug plans bedevil seniors

Some senior citizens suffer. My parents are in their 70s. My mother still can't use a VCR– not that it matters, because now they have a DVD player– which she can't figure out either. They have cell phones– but for emergency use only– and they can't figure out how to set up their voice mail.

   I just bought my parents CD ROMs to learn how to use the computer. It took a while for my father to understand that I couldn't email the CDs to him. My father can use the computer, but he has had his computer rebuilt at least six times because of viruses or accidental deletions of vital data. 

   Comedian-actress Wanda Sykes recently dished on the government for telling senior citizens to use the Internet to learn about Medicare Part D. Her comment was something like, "Are they insane? You don't want a bunch of old folks on the Internet passing around viruses. They don't know what they're doing on the computer."

It took me over a year to teach my father how to attach a file to an email. Still he can email me without a message or attachment. Blank. Kind of Zen Buddhist. So is Medicare Part D something else to make senior citizens suffer?

   Medicare D is a prescription program for those with Medicare B or who are eligible for Medicare A. (It is like algebra: (A+B) + D = A + (B+D) – never mind.)  It started January 1 of this year, and already the premiums and out-of-pocket expenses are set to increase on this January 1. It has been impossible for me to completely figure out Medicare D because there are so many insurance companies that contract with the Federal government, and each one has different prescription formularies (a list of medicines they allow with certain prices) and different rules. Most of my patients who have Medicare D or want to have Medicare D are frustrated and dissatisfied.

   One of my patients gave me her Insurance X prescription drug plan booklet for the 2007 annual notification of change. On the cover of the booklet are smiling people who look thrilled about the jacked-up prices– they must be high on a Medicare D pill on their formulary.

  Okay, remember, many senior citizens don't know how to pay at the gas pump. This booklet, which is unclear if not downright confusing at times, explains that there are three different drug programs: standard, enhanced, and complete. Each has a different monthly premium, and all become more expensive on January 1, 2007. The complete program goes from $58.18/month to $76.30/month, a 31 percent rate hike. Happy New Year!

   The standard plan has a $265 deductible– meaning Medicare D doesn't help pay for medicines until someone spends $265– but enhanced and complete don't have a deductible. Depending on whether an in-network pharmacy or Medicare's mail-order pharmacy is used, buyers have different co-payments– and that depends on if they use their chosen generic medicines, preferred medicines, yadda, yadda, yadda.

   Now there's a "donut hole" in Medicare D. Effective in 2007, after a patient spends $2,400 on medicine, she has to pay 100 percent of the cost of the next medicines until the total costs reach $3,850. I love this– Medicare calls coverage after $3,850 "catastrophic coverage," 

This is so Hurricane Katrina, and they treat it almost the same! After $3,850, the coverage resumes– depending on what tier medicines are used and under which program.

   I've decided that I'm not going to get older. As of today, I pledge, "On my honor as a citizen, I shall neither give nor receive diseases and will lie about my age. Also, I will always know how to email and use an iPod."