Some non-profit hospitals now offer Medicare plans to persons on Social 
Security Disability.  On the surface, the list of physicians and low-cost 
prescriptions may appear superior to benefits under Medicare Part A and Part 
B.
 
Let's look at a typical "pharmacy benefit", where prescriptions for generics 
cost five dollars and brand name drugs cost ten dollars with a $500 per year 
maximum.  Doctors may not realize that the pharmacy is 'billing' the Plan(s) 
at far more than average wholesale cost plus 13 percent (varies by 
participating pharmacies)...so that the patient doesn't get 50 prescriptions 
per year...but only as many as the near retail costs for medicines will allow 
until the $500 for that year is reached.
 
Perhaps even more restrictive to specialists is having to get "authorization" 
from the Plan's Medical Director(s)...to do procedures or surgeries, even 
after a second opinion indicates the physician or surgeon should be able to 
proceed.
 
It is encouraging to see healthcare "plans" becoming available to disabled 
Medicare receipients under 65 that cost upwards of $600/year vs. $350/month. 
I'd prefer physicians/specialists having less red-tape, so the patient can 
get the best care and treatment that is necessary.
 
Harry 
--- DB 1.58/003132
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