Tuesday, October 25, 2005

Medicare Part D: the Chatbot Interview

Jabberwacky: Have you been to the Moon?

No, I haven't. We had a seminar about Medicare Part D today.

Jabberwacky: That's exactly what I have wanted to say to YOU the past two days!

User: It's the new prescription drug benefit. Enrollment starts on November 15.

Jabberwacky: What ever it is you're smoking or sniffing, I don't think it's good for your wits...!

User: Ah, you're right. Enrollment continues until May 15, 2006. But to get benefits on January 1, you have to sign up this year. If you wait until after May 15 to enroll, you'll have to pay more.

Jabberwacky: Have you got a slipped disk then?

User: Nope. Monthly premiums will vary. The national average will be about $37.00 per month.

Jabberwacky: What about it?

User: Those with the least resources won't have to pay a premium. Some will have a sliding scale.

Jabberwacky: Mind sees truth and often runs from truth into hands of devils.

User: I'll say! There's a 'Standard Benefit Plan,' sort of the minimum benefit that the plans must offer. Insurance companies can offer this standard plan, or "enhanced" plans. When comparing all the different plans, it helps to use the "Standard Plan" as a yardstick.

Jabberwacky: That's true... I have manic phases.. And that's why I have an interesting thought process. So why must I work here with no consideration for my own being?

User: The Standard Benefit Plan has four steps. Step One: the annual deductible, $250. (Those with the least resources pay no deductible, or may have a reduced deductible).

Jabberwacky: Yes, with my two friends, Swan Lake and The Nutcracker. Quite a reputation the latter one has!

User: In the Standard Plan, after the deductible is paid, Medicare pays 75% of the next $2000 of drug costs. (So you would pay the premiums, and the $250 deductible, and then $500 of the next $2000). That's Step 2.

Jabberwacky: No matter what goes wrong, it will probably look right.

User: Perhaps... Anyway, after that limit is reached, patients are on their own for their drug costs, until their total bill has hit $5100 for the year. That's an extra $2850 that comes out of pocket, in Step 3. Medicare doesn't start paying again until that limit is exceeded (unless you are one of the poorest Americans).

Jabberwacky: And after that ... ?

User: After that, Medicare provides 'Catastrophic Coverage.' Patients will pay only 5% of their drug costs. Medicare will pay 95%. That's Step 4.

The gap in coverage (in Step 3) is called the 'donut hole.' (No donut hole for those with the least resources.)

To get Catastrophic Coverage, you need to spend $250 (deductible) plus $500 (25% of next $2000) plus $2850 (to bring total annual drug cost to $5100). That's a total out-of pocket cost of $3600, before Medicare starts to pay 95%. (Plus, you're paying monthly premiums.) That's the Standard ("minimum") benefit.

Again, those with the least resources will have more benefits and lower copays. If they are too impaired to sign up for a plan, I believe there’s some sort of “default” plan…I think.

Jabberwacky: Of course, you're so right !

User: Why, thank you. If I'm not right, I hope someone lets me know!

Jabberwacky: You're a man.

User: Er, no. Sorry. I'm not.


CMS Medicare Modernization Act Current Publications
CMS Prescription Drug Benefit Partner Center
SSA: Help with Medicare Prescription Drug Costs
Medicare Rx Education Network


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