The Medicare & Medicaid Center

It stands to reason that the most vulnerable individuals in the United States who have some of the most extensive health problems and have paid into Social Security and Medicare while they worked for years, should not have to worry about how they will be able to get their medication.  In their minds – and most of the rest of the nation’s – they have paid their money dutifully, month after month and year after year, and they were told that they wouldn’t have to worry when they got older and retired.  They have been thinking that Medicare would take care of them and they would have the medical treatment – and medication – that they need to live as full a life as possible with their medical symptoms controlled as much as possible.

Unfortunately, for individuals who are in this situation and happen to have a very low income, it is not working out that way.  What has happened is that with the “new and improved” Medicare prescription coverage, things have changed.

The new Medicare drug plans were introduced three years ago.  At that time, numerous health insurance companies made bids to provide prescription coverage for low-income Medicare recipients because Medicare paid for part of the premiums, therefore the company was reimbursed, theoretically making money, not losing it.

Companies started realizing that they were not making the money on low-income individuals – especially those with serious or chronic illnesses – so they began bidding higher rates so that they would not get chosen to supply this coverage.  Last year 1.2 million people had to be moved from one plan to another due to lack of companies providing prescription coverage.  This year, the number will be even higher because there are even fewer companies offering low cost prescription coverage for low-income Medicare beneficiaries. 

As a result, many of these Medicare enrollees could be left without enough coverage.  They could be in a position where not all of their prescriptions are covered, yet they are among the sickest among us, and they cannot afford to be without their medication because it will seriously compromise their health and could lead to fatalities.

Studies have been done showing that this is the case, however, Medicare says that there will still be several choices of companies and prescription plans for low-income Medicare beneficiaries.  The government automatically assigns these individuals to a plan that should cover their needs. 

If you are on a limited or low income and have prescription drug coverage you can contact Medicare and/or your prescription plan and ask what will be happening for 2009.  You are allowed to change plans at any time during the year.  Make sure that you are covered.  If you are not sure, contact your local Office on Aging, Medicaid Office or talk to your doctor’s billing office to get your questions answered.