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There are bills in the House and Senate to allow CMS to set-up 1 or more PDP plans under Medicare and to require negotiations with pharma on drug prices. That will force out the insurers in no time since they can't compete with Medicare's efficiency.
Were it done right in the first place we would have:
- Rx as part of Part B - if you want Part B you get Rx plan (that forces almost all people into the plan)
- Only one plan that reduces the extra cost of selection (probably 20% of the cost)
- Allow negotiations with pharma (reduces cost by 25%)
With these changes there is no deductible, no donut hole, and still reduced premiums and cost to taxpayers.
In my firm Rx plans were generally assigned to younger actuarial students because they were relatively easy to design. Everyone involved in the design of Part D knew what they were doing - intentionally designing about the worse plan that they could to hurt the finances of Medicare, irritate taxpayers and participants with cost, and confuse participants (and while it lasted to make billions for insurers and pharma).
People should be in jail for their part in this fiasco - AARP also had a big hand in it and they also made a fortune off royalties.
Those changes should reduce the paperwork waste and confusion enough to eliminate the "gap". Hope at least that much gets done.