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Healthcare Q&a

Drug plans may change

October 05, 2009|James Oliphant and Kim Geiger

WASHINGTON — Some reader questions on the national healthcare debate:

How can we be sure that there will be no rationing of healthcare or pharmaceuticals under the bills being considered in Congress?

Democrats argue that there is rationing in the current healthcare system, in part because insurance companies can rate consumers on the basis of preexisting medical conditions or drop them if they get sick. Those practices would be outlawed as part of the current legislation. As for pharmaceutical coverage, it's possible that some consumers could end up with more coverage for prescription drugs than they have now.

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Why is that?

It is likely that private companies seeking to participate in the new insurance exchanges -- which would be created to help lower-income consumers -- would have to offer prescription drug coverage as part of their essential benefits package. That could mean new coverage options for people who right now can't afford such plans. At the same time, some consumers who obtained insurance through the exchanges might have to buy drug coverage they did not want or need -- if they had other options for buying low-cost drugs, for example.

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Will I have to pay more for my pharmaceuticals if I buy insurance through an exchange?

That would depend on what level of plan you chose. Under a less expensive plan, you would probably have to cover the cost of your prescription drugs until you reached a set deductible, something like $100 or $250. (This is separate from your overall insurance deductible.) At that point, your insurance would cover some or most of the cost. If you purchased a higher-priced plan, it's likely there would be no deductible, and perhaps no co-pays either.

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What about prescriptions under Medicare?

The overhaul proposals in Congress improve the drug benefit by reducing the so-called coverage gap or doughnut hole that exists for recipients of Medicare Part D, which affects about 4 million seniors each year. Under the $80-billion deal struck with the pharmaceutical industry, the prices of drugs that fall within the gap would be slashed by 50%.

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joliphant@latimes.com

kgeiger@latimes.com

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