Sherrod Brown sidesteps the issue

COMMENTARY

By John Olesky (BJ 1969-96)

In a March 14 commentary on the BJ Alums blog I wrote how Aetna Medicare/Beacon Journal sidestepped the effects of Obamacare reducing prescription donut hole brand-name co-pays from 100% to 50% -- by charging me five times as much BEFORE I get into the donut hole for some drugs. In my case, Aetna/BJ charges me $180 more for my co-pays on 9 months of 1 prescription drug than it did last year. Once I hit the donut hole, and the 50% discount kicks in via Obamacare, Aetna/BJ will be charging me $150 less for my co-pays for the remaining 3 months. Thus, Aetna Medicare/BJ actually makes MORE money in 2012 than in 2011, despite the reduction.

Well, I emailed Senator Sherrod Brown, D-Ohio, explaining the situation.

His reply:

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Dear Mr. Olesky:

Thank you for getting in touch with me regarding the Medicare Part D coverage gap (also known as the “donut hole”).

Most Medicare prescription drug plans have a coverage gap or “donut hole.” After you and your plan have spent a certain amount of money for covered drugs, you are stuck having to pay all costs out-of-pocket for your drugs (up to a limit). The “Explanation of Benefits” notice, which you should receive every month in the mail from your drug plan when you fill a prescription, will tell you how much you’ve spent on prescription drugs and whether you’ve entered the “donut hole.”

In 2009, roughly 156,000 Medicare beneficiaries in Ohio hit the “donut hole” and received no extra help to defray the cost of their prescription drugs. Thanks to our new health reform law — the Patient Protection and Affordable Care Act (PPACA) — Medicare beneficiaries who hit the “donut hole” in 2010 were automatically mailed a one-time tax-free $250 rebate check, as long as they were not already receiving “Medicare Extra Help.” Ohio Medicare beneficiaries — more than 97,332 Ohio seniors — received their $250 check in 2010.

In addition to the rebate checks, our new health law will continue to provide additional discounts for seniors on Medicare in the years ahead. In 2011, Medicare beneficiaries who enter the “donut hole” will receive a 50 percent discount on their brand name prescription drugs. This discount will increase each year until 2020, when health reform will completely close the “donut hole.” The nearly 185,000 seniors who hit the "donut hole" have saved almost $95 million last year. In addition, effective January 2011, preventive services (such as colonoscopies and mammograms) will be free for Medicare beneficiaries. There will no longer be copayments or deductibles for these types of services.

If you have any additional questions about the rebate checks, or any other Medicare issue, please visit www.medicare.gov or call 1-800-MEDICARE. Thank you again for getting in touch with me regarding this important issue.

Sincerely,

Sherrod Brown
United States Senator
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Notice that Senator Brown, or his office people, sidestepped the issue of Aetna/BJ defeating the spirit of the Obamacare requirement to only charge me 50% for brand-name drugs when I hit the donut hole by charging me more for brand-name AND some generic drugs BEFORE I hit the donut hole. As their bean-counters figured out, Aetna/BJ is out less money in 2012 with Obamacare than in 2011 without Obamacare. And Obamacare advocates get to brag about "saving" me the 50% co-pay on brand name drugs after I hit the donut hole.

Everybody wins, except us.

Click on the headline to see my original commentary on this bait-and-switch-like tactic to obey the new law but get the old, even better returns financially for Aetna/BJ.