Disadvantages of Medicare Drug Coverage

Medicare Part D is the prescription drug portion of Medicare. Its purpose is to help senior citizens who had not previously qualified for prescription drug coverage to be able to afford their prescription drugs. Medicare Part D is a great benefit in some ways to many senior citizens. However, disadvantages exist as well.

Confusion

• Because there are so many different Medicare Part D plans from which to choose, many senior citizens are confused and do not know which plan will best suit them. Not only that, it is also hard for doctors and pharmacists to keep track of which medications are covered under each plan and which are not.

  Medicare Part D has proven to be especially confusing to people on Medicaid, according to an abstract on Medicare Part D from Samford University. Under Medicaid, recipients were provided with some medication coverage. However, with the implementation of Medicare Part D, recipients can receive more prescription drug benefits if they enroll in both programs. People enrolled in Medicaid became accustomed to how that program worked and the change proved to be overwhelming in many cases, according to the Samford University abstract. If people on Medicaid do not enroll in a Part D program, however, the Center for Medicare and Medicaid Services automatically enrolls them in one. This led to some people not getting the medication they needed because the plan they were enrolled in did not cover their particular medication.

Exclusions

• Many widely used prescription drugs are excluded from Part D plans. Putting people on randomly assigned plans could cause problems if they now have coverage gaps. In addition, doctors are spending much of their time requesting exceptions on non-covered drugs so that their patients can get the right medications. Many times, especially for patients who are on multiple prescriptions, a specific medication is the only option because certain medications do not always work together.

Coverage Gap

• Another issue regarding Medicare Part D is referred to as the "doughnut hole." Medicare Part D only pays a certain amount for drug coverage each year. This amount varies with each plan. In a typical plan, as of 2009, Medicare will pay $2,830, and then coverage would stop and would not kick in again until out-of-pocket costs reach $4,550. When recipients go into the doughnut hole, they pay 100 percent for their medications. Some people never reach the doughnut hole, some reach it and stay in it until the next year starts, and others regain their coverage again during the year. Some people cannot afford their medications while in the doughnut hole and stop taking them, which can prove to be very dangerous.