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If I were the Medicare czar ...

Why does the federal government and the media refer to an administrator of a department as a czar? We have the drug czar, car czar and a whole multitude of other czars over the past number of years.

A czar was a ruler in Imperial Russia, who ruled with far greater power than does an administrator in the massive bureaucracy called the U.S. government. I just don't get it.

That said, I often daydream about ... What if I were the Medicare czar? So what follow are the changes I would implement if I had the power.



1) Expand the Medicare Part D annual open season to Oct. 1-Dec. 31.

It is ludicrous that the Centers for Medicare & Medicaid Services and every senior organization recommends and expects people to review their drug plans each year and only allows a six-week period to do so. Not only that, but when you throw Thanksgiving, Christmas, other religious holidays and New Year's into the mix, on top of weather conditions in many parts of the country, it is an impossible situation for those who are trying to assist the public.



2) Create a standard formulary.

CMS has created a Medicare-approved formulary about which drugs may be covered. This formulary should be a list of the drugs that must be covered.

Some companies have a different formulary based upon which plan a member enrolls in. I even found a drug that was listed as a generic with an $8 co-pay, but when you entered the extended release version, it jumped to a Tier 3 drug with a $50 co-pay. However, the client could buy twice the number of the generics (at a higher drug list price than the extended-release version) and still pay the $8 co-pay. Crazy.



3) Medicare providers

A Medicare provider should accept all Medicare plans, both traditional Medicare Supplements and Medicare Advantage plans. This inclusion is necessary if these plans are to be truly successful long term.



4) Guaranteed conversion

Under current rules, once a person has been enrolled in a Medicare Advantage plan for more than 12 months, he or she can switch back to traditional Medicare at the open season in November and December each year.

However, that does not give people the guarantee to purchase a Medigap plan, and so they then would be health underwritten. In effect, many people whose health is not great will be trapped in the Medicare Advantage system without recourse.



5) Compensation

Last November, Medicare announced how much an insurance company could compensate an agent for helping clients to enroll in Medicare plans. If a person already was in a drug plan and wanted to switch to another, the maximum commission allowed was $25. In previous years the level was closer to $50 per enrollee.

The workload involved in running a person's drug list through the Medicare.gov Web site (which is wonderful), explaining their options, completing paperwork, submitting the paperwork, data entry, record keeping and then providing 12 months of service throughout the year is impossible for an annual payment of $25.

If the commission structure of the PDP plans is not altered I, like most other agents I have talked to across the nation, will be advising seniors to seek assistance from the local SHIBA (Statewide Health Insurance Benefits Assistance) offices, or calling 800-MEDICARE, placing another tremendous burden upon those wonderful folks.

Well, I feel wonderful for sharing some of my thoughts with you. I get many comments on my articles and so I am moving into the 21st century with a "blog."

I didn't know what a blog was until my sister-in-law Jodie Coulson told me I needed one. It is basically an online journal where I can put forth ideas and writings and you can read them if you choose to.

It is still in the embryonic stage but is improving each week. I invite you to check it out the next time you are online. My blog can be found at www.philcastell.wordpress.com, As always, I welcome feedback about any subject mentioned in these articles.

Phil Castell is an independent insurance agent in Sequim. He can be reached at 683-9284 or PhilCastell@msn.com.











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