Medicare Needs Fixing

Medicare overall is very well received by seniors but there are some holes that need plugging. These are 4 of the most egregious ones and we know there are others but these need addressing.

  1. Drug prices-This is a very large issue that needs addressing but our political leaders aren’t doing anything to help the average American with the cost of these drugs. The process to fix this is very easy but Congress can’t seem to make it happen. Pharmaceutical companies lower costs for a drug sold worldwide but in America, the prices for the same drugs are higher. Said another way, Americans are paying for drugs for the world. This needs to stop. The simple solution is to pass legislation that these Pharmaceutical companies cannot sell their drugs in this country for any more than the average price sold worldwide. Many will tell you that Pharmaceutical companies would then have to eliminate R & D for new drugs. That is simply not true as the development will continue because these companies want to continue to make money. It’s called greed! Not developing newer, more effective medications is simply a scare tactic to keep drug prices where they are in America. HIGH! Let’s examine how innovative these companies really are: two companies in the US are already developing a vaccine for the Corona Virus. Certainly, changing the pricing is only part of the issue. The cost to bring to market these new and innovative medications is high and very time-consuming. THE FDA needs to shorten the time these medications take to come to the market. Reducing the time will save money and lower the overall cost. I’m not suggesting shortcutting the process which would increase the risk that these medications won’t work. Surely, there could be a compromise to shorten the time to market. After all, these processes have been in place for years and could be updated to reflect the current R & D climate. Americans are not allowed as a general statement to buy drugs outside the US and have them shipped into the country. This is happening all the time as Americans are tired of the high drug prices but is a band-aid approach that needs legislation to fix it. Some of these drugs are stopped at the border while others slip through.
  2. COBRA coverage is not creditable according to Medicare-Due to the long-standing belief that since you are paying the entire cost of your insurance on while on COBRA, it is therefore no longer a group benefit. This is Medicare deciding to ignore federal statues about COBRA which clearly states that a company cannot treat a former employee any differently regarding insurance benefits; which means you must have the same coverage whether an employee or ex-employee. That makes it very clear that you must have the same coverage whether you are employed or an ex-employee. This applies to companies with more than 20 employees only. I have been working on correcting this since 2015 with my then Congressman, Dr. Joe Heck. Since he is no longer in Congress others have stepped up and introduced legislation to correct this. My trade association (NAHU) National Association of Health Underwriters has been lobbying Congress as well since 2015. To date, it hasn’t happened and that is a shame as seniors on COBRA are being fined for life for not taking Part B. The cost is astronomical for those seniors and could be avoided if Congress would do the right thing and change the law to eliminate Medicare from ignoring federal statute with this egregious rule. Consider if a senior is not on Medicare but on COBRA, they are not costing Medicare anything for medical services. So why is Medicare fining them for not taking Medicare? This makes no sense to this blogger.
  3. Observation Status-This is where you go to the ER and told that the hospital can’t admit you but wants to observe you for a day or so without admitting you. Original Medicare or with a supplement doesn’t cover this expense. Why, can’t say. MAPD plans are now starting to cover this for a small copay. I advise all my seniors with just Original Medicare or with a supplement to tell the hospital to admit me or I’m going home. Is it the best approach? No, but it eliminates a large hospital bill. Should be addressed.
  4. Pre-surgical procedures-When you need surgery, in most states, it is a requirement (for your own protection) that you have a recent chest X-ray, blood work and an EKG. Medicare doesn’t cover that. If you are lucky and it’s near the first of the year and your annual preventative exam is due, you can get away without paying for those charge as they are written off against the preventative exam. Not the best approach but worth doing to save over a $100 foe those services. My question is if it’s a requirement to have the surgery, why isn’t it covered by Medicare. Think about how much money these services cost is probably the reason why they are not covered. If you are on Medicare and only have social security this means choosing to eat for have the procedures done prior to surgery. This should be addressed and fixed.


These are four of the biggest issues that Medicare recipients face daily. CMS should be addressing these issues but I am afraid they are not. Maybe too much work and not a lot of time to consider fixing these issues. Drug prices are the biggest issue and need addressing but afraid that Congress is the only body to correct this issue. Until t do, Americans will be paying higher prices for the same medications sold cheaper anywhere else in the world.

The Barend Agency Inc.

Len Barend, broker.



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