My wife and I recently became eligible for Medicare’s prescription drug coverage, known as Medicare Part D. I am a retired lawyer who specialized in complex cases and Barbara has worked as a primary care doctor and associate professor at Harvard Medical School for many years. We assumed that choosing a plan would be a straightforward and easily accomplished chore. We couldn’t have been more wrong.
The odyssey — which it truly became — began as soon as we logged into the Medicare web site that “facilitates” drug plan comparisons. Our first inkling of trouble afoot was the abundance of choices, 25 of them, in Middlesex County, Massachusetts, where we live.
The website gives consumers numerous variables to evaluate: tier level, drug costs (before and after meeting deductible, in and after the “coverage gap”) and co-pays. It also lists deductibles and premium costs for each plan. We dutifully tried to prepare a spread sheet to more easily compare five plans, but then thought about trying to find answers to this question: What is the relationship between tiers, copays, and listed drug costs for four different medications?
I got some answers by chatting online with Medicare. The Medicare chatterer said I should ignore the drug tier and copay information and just look at the list of drug costs. The lawyer in me prompted me to ask this: “Why does Medicare list the drug tier levels and the co-pays on the first pages of the site if that data has no relevance to the consumer?”
“I don’t know,” the chatterer tonelessly replied.
Back to the Medicare website. We chose three prescription drugs we ordinarily use, such as Symbicort, plus several others we use less frequently, such as an inhaler for allergy season. But we had to abandon the latter because the site does not allow users to learn the cost of a medication used only once or twice a year.
To resolve the cost issue, I called two companies to explore the details of their coverage.
The conversation with Company One was a disaster. The representative was not very knowledgeable and it was difficult to communicate with him. We asked about Shingrix, the new shingles vaccine, and even after spelling it three times couldn’t get a clear answer. As we talked, the Company One representative disappeared for a few minutes at a time to talk to a supervisor, but would not let me talk directly with her.
I was finally told that getting Shingrix from Company One would cost $295 for each of the two vaccinations. The representative also told me, after several delays and numerous questions, that Symbicort, an inhaler, would first cost $365 and then $48 after the deductible was satisfied.
We had initially looked at Company One because its monthly premium was lower than the others, even though it received a rating of only 3.5 stars on Medicare’s comparison website. My phone call, along with what appeared to be higher costs for our medications, led me to call Company Two.
That company’s representative was easy to communicate with and answered all of my questions in about 15 minutes — a far cry from the 2.5 hours I spent talking with Company One. I learned from Company Two that the initial Shingrix shot costs $147 and the follow-up shot cost $37.
We quickly understood why Company Two got a 5-star rating on the Medicare site, and why the difference between 3.5 stars and 5 stars is substantial.
By this time, we had spent close to ten hours trying to understand and then choose a Medicare prescription drug plan and had examined only two companies.
We chose Company Two because the thought of exploring more companies was too painful and Company Two’s representative was clear, knowledgeable, and pleasant to talk to.
We knew we weren’t making a completely informed choice: We hadn’t compared the costs for all 25 companies and were relying on a good experience during a single telephone call with an individual in a company’s sales division. Would the experience be just as good if an issue with a medication arose later? We hoped so, but had no data to support that inference.
When we began to explore Medicare Part D, we wondered if people with few resources could navigate the world of Medicare and its drug programs. Our conclusion is that no one, no matter what resources they have available, can make an informed choice because the system is so convoluted.
All of us need a better system. Ideally, there would be one reasonably priced plan and subsidies for those who might struggle to pay for their prescription drugs. If the ideal can’t be realized, then reducing choices to facilitate the ability of participants to make decisions would be a helpful first step. If 25 companies want to bid for participation, then a state agency should select the best five or six plans and let Medicare recipients choose among these few survivors.
Reducing choices, however, is only a minor improvement. The present system confuses everyone — rich and poor, those with a lot of formal education and those with little — and doesn’t serve the interests of elderly patients.
We need a system for choosing Medicare Part D plans that is straightforward and easy to navigate, not one that is inscrutable, frustrating, and impenetrable.
Michael Altman was an equity partner in several Boston law firms and a law professor before retiring.