BOHICA: BIDEN'S MEDICARE PART-D BENEFITS
There is no doubt that the progressive communist democrats want to enact the most extensive power grab in history by nationalizing the healthcare industry, destroying private healthcare insurance, and implementing a single-payer government system that will decide who gets healthcare and how much they are eligible to receive. Like the socialist healthcare systems in Britain and Canada, the result will be a catastrophe of denials, delays, and death.
"I believe the solution — and I actually feel very strongly about this — is that we need to have Medicare for All."—Kamala Harris
This is from UnitedHealth Group, the largest healthcare insurer in the U.S. by revenue and the number of members enrolled in its health plans.
What follows is an explanatory video…
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Hello. As a Medicare provider with over 45 years of experience you can count on, UnitedHealthcare understands that Medicare coverage is personal and changes to your coverage can affect your life. That’s why we want to keep you in the know about some changes brought by the federal government impacting all stand-alone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage in 2025. Let’s get started. We’ll cover three big updates. Removal of the coverage gap, a lower maximum out-of-pocket amount for prescription drugs, and a new prescription payment plan option. First, good news. In 2025, the coverage gap, also called the donut hole, has been removed. There are now three Part D prescription drug coverage stages. An annual deductible stage, initial coverage stage, and catastrophic coverage stage. If a plan has a prescription drug deductible, members will be responsible for paying the full cost of their drugs until they reach this amount. Then, in the initial coverage stage, they will be responsible for paying co-pays or co-insurance. Once the member and others on their behalf have paid a combined total of $2,000 for Medicare-covered medications, including any amount toward the deductible, the member moves straight into the catastrophic coverage stage, where they will pay $0 for Medicare-covered Part D drugs for the remainder of the plan year. See? More coverage, no gap. In 2024, for all Medicare members no matter what insurance provider they were enrolled with, the Part D out-of-pocket max was $8,000.
In 2025, the out-of-pocket max is lower than ever. Once a member and others on their behalf have paid a combined total of $2,000, they’ll pay nothing for Medicare-covered Part D prescription drugs for the rest of the plan year. However, while the goal is to lower prescription drug expenses, these changes could result in higher deductibles or premiums in 2025. This means members may pay more earlier in the year during the deductible stage, but could see an overall savings compared to prior years with the lowered out-of-pocket maximum. Also for 2025, there’s a new optional program called the Medicare Prescription Payment Plan. Instead of paying all your out-of-pocket costs when you fill your prescriptions at a network pharmacy, you can spread these payments out over the plan year with monthly bills. It’s important to know this program does not lower prescription drug costs. The payment amount may change each month until you reach the $2,000 out-of-pocket max, so while monthly payments may be more manageable, they may also be less predictable. Your plan sponsor may contact you if you’re likely to benefit from the program. For any questions, or to find the right UnitedHealthcare plan for you, chat with a Medicare plan expert live on UHC.com backslash Medicare. No matter the changes, UnitedHealthcare offers reliable coverage you can count on for your whole life ahead. |
What they don’t say is the killer…
Notice they don’t talk about your insurer’s classification of tiered drugs, the possibility that lower-cost medications you receive are deliberately pushed into a higher-cost tier. They also don’t discuss the price differential between prescriptions filled at a local pharmacy and those fulfilled by a centralized mail-order system.
Insurers’ manipulation of Medicare Part D covered drug tiers has become a growing concern for many beneficiaries. Insurers often categorize drugs into different tiers, each associated with varying cost-sharing levels, which can significantly affect patients’ out-of-pocket expenses.
While this tiering system is intended to help manage costs and ensure access to a wide range of medications, some insurers have been accused of strategically placing certain drugs, particularly high-cost or specialty medications, in higher tiers to discourage their use or shift more costs onto consumers.
This practice can make essential medications unaffordable for those on fixed incomes, undermining Medicare Part D’s primary goal of providing comprehensive and affordable prescription drug coverage.
The lack of transparency in how drugs are tiered and the potential for formulary changes throughout the year further exacerbate the issue, leaving many beneficiaries vulnerable to unexpected and burdensome costs.
Don’t expect greater oversight and regulation as vote-seeking politicians continue to solicit campaign funding from insurers, and former employees of insurers are appointed to oversight commissions.
Bottom line…
The insurers will always have the upper hand, and the greatest decision is how to keep those multi-million dollar executive bonuses flowing.
In recent years, lobbying expenditures by Medicare insurers, particularly those involved with Medicare Advantage plans, have been significant. In 2023, health insurers spent approximately $180 million on lobbying activities, with a substantial portion of this focused on protecting the profits and favorable regulatory environment of Medicare Advantage plans. These efforts have been aimed at influencing policies related to Medicare reimbursements and regulatory oversight.
The insurance industry, represented by powerful groups like America's Health Insurance Plans (AHIP), has been particularly aggressive in lobbying against any changes that could reduce payments to Medicare Advantage plans. This includes efforts to prevent the federal government from cutting overpayments that have been identified by watchdog groups and the Medicare Payment Advisory Commission (MedPAC).
The financial clout of these insurers ensures they have a strong influence on legislative decisions, often to the detriment of cost-saving measures that could benefit Medicare recipients and taxpayers(Center for Medicare Advocacy, Medicare Rights Center).
In 2023, UnitedHealth Group's top executives received substantial compensation packages, reflecting the company's strategic focus on retaining and motivating its leadership amid a competitive and complex healthcare landscape.
The CEO, Andrew Witty, earned a total of approximately $23.5 million. This includes a base salary of $1.5 million, stock awards worth $15 million, and other forms of compensation. The company's CFO, John Rex, and COO, Dirk McMahon (who retired in April 2023), each received total compensation of about $16.1 million. These packages comprise base salaries, stock options, non-equity incentive plans, and additional compensation.
The CEO-to-median-employee pay ratio at UnitedHealth Group in 2023 was 352:1, highlighting the significant pay disparities within the company (Becker's Payer, DistilINFO Publications, Salary.com).
The manipulation of drug tiers remains a critical issue in the ongoing debate over the fairness and effectiveness of Medicare Part D.
As always, the devil is in the details.
We are so screwed.
--Steve
“Nullius in verba”-- take nobody's word for it!
"Acta non verba" -- actions not words
“Beware of false knowledge; it is more dangerous than ignorance.”-- George Bernard Shaw
“Progressive, liberal, Socialist, Marxist, Democratic Socialist -- they are all COMMUNISTS.”
“The key to fighting the craziness of the progressives is to hold them responsible for their actions, not their intentions.” – OCS "The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius “A people that elect corrupt politicians, imposters, thieves, and traitors are not victims... but accomplices” -- George Orwell “Fere libenter homines id quod volunt credunt." (The people gladly believe what they wish to.) ~Julius Caesar “Describing the problem is quite different from knowing the solution. Except in politics." ~ OCS