HEALTH CARE/Joan Retsinas

Santa Stalled in Medicare-Limbo

Poor Santa. He'll be late making deliveries. Poor children, waiting for presents. Poor adults, waiting for our treats. Come Dec. 25, we'll all be waiting, because Santa hasn't left the North Pole.

He's doing Medicare Part D paperwork.

Santa, who is more than 250 years old, has been on Medicare since its inception. He was looking forward to medication insurance. He is fat. He is hypertensive (mark the ruddy cheeks). His cholesterol tops 300 from eating all those chocolate chip cookies. He is asthmatic from sliding down sooty chimneys. Plus, stuck in the North Pole, overseeing elves, he gets the January blahs. He takes a sack-full of medications.

Santa thought Uncle Sam was giving him a holiday gift with Medicare Part D. Part D was supposed to pay for his medications.

But first Santa must sign up.

Since Nov. 15, he's been struggling over various decision-algorithms, designed to guide him through the process. Identify your state (but what if he winters someplace sunnier than the North Pole? What state does he count as his residence?). Identify your medications (but what if they change?). Identify what you spend now on medications (but how do you calculate costs if you already have some insurance for medications? Can you keep your old insurance?). Then calculate your new costs, under your state's plans. Medicare has blessed at least two in each state, up to more than 20 in some. Although all plans cover a basic set of drugs, they vary -- hence, Santa must scrutinize the fine print, especially if he takes an uncommon drug.

Santa will need a calculator to estimate medication costs under Part D. It has a $250 deductible -- as well as a "doughnut," a euphemism for a gap: From $251 to $2,250, you pay 25% of costs; from $2,251 to $5,100, you pay the total tab. After $5,100, Medicare will kick in, picking up almost the whole tab. Finally, add the plan's premium (average: $386/year). Then compare your status quo costs with costs under the best of the Part D plans.

Santa may be better off without Part D. He may want to wait until his drug costs mount. Or he may want to wait until after he has recuperated from this holiday trek. If he delays, though, he'll pay a penalty when he signs up later (1% of the average premium cost for that year, added to his premium for each month he delays. And since he can sign up only during open-enrollment months, he will have a hefty surcharge tacked onto his premium if he delays too long).

Of course, if Santa's income is low enough and his assets meager enough, Uncle Sam might offer Extra Help. Santa will need to file an application. If, while doing the calculus, Santa comes upon a truly great deal, he should beware of scams: The AARP, as well as a slew of attorney generals, have issued scam-alerts.

For questions, he can call Medicare's 800 number, assuming he gets through to a person, and assuming that person knows the answer. Or he can log on to the frequently asked questions on a few Web sites: The ever-updated Medicare site has 528 FAQs; the Medicare Rights Center has 101. No wonder Santa hasn't gathered the toys: He's surfing those sites. But the more he surfs, the more he spots questions he hasn't known enough to ask, like: What if he wants to switch plans? (Answer: he can, but only at certain times.) Can the pharmaceutical companies raise prices? (Answer: of course.)

A zillion promotional pamphlets have tumbled into Santa's mailbox, crowding out the letters from children. So this year Santa will be late. If you've been good, you'll eventually get your goodies. But if you are one of the politicians behind Medicare Part D, expect a lump of coal.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, Dec. 1, 2005

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