Prescription Drug Coverage
(Part D) Stories
In December 2005, the Medicare Rights Center launched a project to learn directly how people with Medicare are experiencing the implementation of the Part D drug benefit.
The submissions began pouring in. People from every corner of the country have shared their experiences with Part D. Many contributors told us similar stories of leaving the pharmacy without drugs, paying more for Part D drug coverage than they expected, and having trouble finding anyone to help them get their medications. Others are still waiting to hear about their application for Extra Help.
The following stories show that problems have continued into the fourth year of Part D. These stories represent some of the most commonly reported problems we have seen.
Thank you for sharing your stories. We are using your experiences to tell Congress and the administration in Washington what they can do to fix the problems with the Medicare private drug benefit. As promised, all submissions are being kept anonymous unless the Medicare Rights Center obtained specific permission.
Please read below to see what's going on across the country. The stories below do not represent the views of the Medicare Rights Center. They are the testimonials of real people with Medicare, caseworkers, and family members who submitted their stories, written in their own words. If you would like to share your experience with Part D, please click here.
Read people's stories by clicking on a topic below.
Doughnut Hole
Trouble Getting My Medicine
Problems with Extra Help
Enrollment Problems
Paying More
Can't Afford My Medicine
Problems with Premium Deductions
Doughnut Hole
Aurora, CO
I have a Medicare Advantage Prescription Drug Plan and have already fallen into the doughnut hole. We haven't even finished up with the first quarter of the year 2009. My drug now costs me over $800.00 for a 30-day supply. It is an antibiotic that has no generic or competitors. So now I have to use my credit card and pay over 15% interest on the drug plus my monthly Medicare Advantage plan premiums, which provide no coverage during this time. I will have to take this drug for the rest of my life or until my credit card is maxed out; whichever happens first.
(Submitted March 7, 2009)
Endicott, NY
My husband went on Medicare two years ago and I am still working as a SHIP [State Health Insurance Assistance Program] counselor. I see firsthand what the Part D doughnut hole does to the people with Medicare I counsel as well as how it has affected my husband and me. People going into Medicare are grateful to have the coverage until you sit down with them and go over the drug plans available under Part D. When they realize they will go into the doughnut hole in the 4th or 5th month and will have to pay out of pocket, they are devastated! We are fortunate to have a State Pharmaceutical Assistance Program in New York that covers medications through the doughnut hole, but not everyone qualifies. In the case of my husband and me, we don't qualify because I am still working and we make too much money. But every August we have to take $810 out of our savings account for several months to cover his medications. We have always paid our way in life and I don't expect or want a handout, but I never knew I would be spending my hard-earned savings on medications in my old age! The doughnut hole is horrendous and devastating for those who cannot afford to cover their meds from savings.
(Submitted February 12, 2009)
Morristown, NJ
My husband, who is 74 years old, has had Part D for two years. In each of those years he fell into the doughnut hole at the end of September, even though we used a mail order pharmacy to save money. Whoever devised this plan certainly didn't have senior citizens' best interest in mind.
(Submitted March 19, 2009)
Trouble Getting My Medicine
Brandon, FL
I believe my Medicare Advantage Prescription Drug Plan is dealing in deceptive practices. In December 2020 I logged on to the Medicare Prescription Drug Plan selection web tool for 2009 and entered the five drugs that I use. The web tool came back with a large number of plans that carry the drugs that I use. I selected a plan and enrolled online. They mailed me the proper paperwork and I signed up for the plan. During the first week of this year, I mailed my five prescriptions to them. They called to tell me that one of my drugs was not covered, even though the Medicare web tool indicated that they do cover all the drugs I needed. This is the classic bait and switch plan. The web tool said that they covered all of my drugs, yet when I sign on the dotted line they decline coverage. I had to buy the drug on my own. It costs $202.00 for 90 pills. In this free trade country the same prescription would cost half as much from Canada.
(Submitted March 29, 2009)
Problems with Extra Help
Northport, AL
I work with SHIP [State Health Insurance Assistance Program] in Alabama. In January of 2009 we were bombarded with callers who were dual eligible that were reassigned into PDP's [prescription drug plans] with a premium below the benchmark for our state yet the reassigned plans were very expensive. In other words, the plans are below what the LIS [Low Income Subsidy, also known as Extra Help] premium rate is but the reassigned plans did not cover the beneficiary's medications well. For example, one client had been reassigned to a plan that would cost him $8,039 for the year; another had been reassigned to a plan that would cost them $9,297. These people are on LIS and cannot afford this. I went to Medicare Compare and ran a comparison and found a plan that would cost them $200 or so for the whole year, which is appropriate. I enrolled them in the new plans, but the problem is that they do not go into effect until the following month. I wish there was a way during the Annual Coordinated Enrollment Period to help duals get a plan that covers their medications well so it will be an easier transition for the new year.
(Submitted February 13, 2009)
Enrollment Problems
Indio, CA
My wife and I are insurance brokers who devote nearly all of our time in the individual health insurance business and the majority of that time is spent in the senior market throughout California. We have been doing this for the last 20 years after spending 15 years being primarily in the group insurance business. We really enjoy what we are doing.
When the government standardized the Medicare Supplemental plans it made things much easier for the consumer. We thought it was a very good thing. But Part D is a totally different story. Why the policy-makers didn't follow the same simplified plan-standardizing concept is something we can't figure out. As it is, it's way too confusing for the consumer to figure out. It can be confusing to us at times. It is easy for us to understand why bad choices are being made by consumers. We have found that the people that are publicized as being available to help the consumer are not as informed as they should be, especially when it comes to plan selection.
(Submitted March 13, 2009)
Paying More
Pinckneyville, IL
My partner and I both enrolled in a Prescription Drug Plan from Walgreens in 2006. This plan fit our needs exceptionally. The plan covered our medications very well at a very minimum co-pay. This past fall, we were forced to change plans because the PDP raised the premiums on their plans. We both switched to different plans. I researched over the internet and could not find any plans close to the one we previously held with the old PDP. Although our premiums remain low, our co-pays for our medications have risen significantly! We have gone from approximately $25/month in co-pays to close to $50/month in co-pays!
(Submitted March 12, 2009)
Greenfield, MA
Part D is INSANE. Whoever put this together ought to be strung up. I am fairly savvy with a computer but I could not for the life of me figure out what the best deal was for me. Last year I ended up in the donut hole and I wanted to avoid this. All the prices/co-payments have gone up so much that it is like a trap. I have relatively simple prescriptions, and not that many of them. It is not benefiting the average citizen as much as it should. In fact, it stinks!
(Submitted March 12, 2009)
Can't Afford My Medicine
New Baden, IL
In January of this year, when going to refill some of my prescriptions it was a startling shock when I was expecting to pay about $18.00 to $20.00 for my meds. I almost fell over when informed it would cost $317. Whereas before there was no annual deductible, now it was $295. All the brand-name drugs went up to $22 and the rest were also more, plus now I must pay $24.90 monthly to the plan. I have stopped taking one brand of medicine that would cost $63 for a refill. Since I must take two different doses of this medication it would cost $126 a month just for this one. Because of the 5 percent raise we got in January I no longer qualify for extra help.
(Submitted March 30, 2009)
Problems with Premium Deductions
El Dorado, AR
My wife has been enrolled in the same Prescription Drug Plan (PDP) for the past two years. Today we received an un-itemized request for payment of $999.10 due to "an error on the PDP's part". CMS rejected the company's request for a deduction from her benefit, the company did not send us a coupon booklet with which to make payments and the balance has been accumulating for two years. This is not a trivial sum for a retiree. We have no recourse. I consider this a monumental bungling by both the PDP and CMS.
(Submitted February 27, 2009)