Navigating the Medicare Maze

As part of its continuing series, "GMA Gets Answers," "Good Morning America" is taking a hard look at the insurance industry, both public and private. On today's show, Chris Cuomo looked at the enormous amount of confusion surrounding how people on Medicare get their drugs covered.

When Dorita Mahmoud's doctor told her she was suffering from a potentially fatal lung infection, she says she was willing to take on another battle with illness. What she didn't anticipate was a fight with the government to get the treatment she needed.

"Every challenge has been a learning experience," she said.

Mahmoud is no stranger to health-care battles. Throughout her adult life, she has suffered from heart and lung disease, serious sleep apnea and spinal problems, all while still caring for her daughter.


"GMA" first met Mahmoud in February, when Cuomo profiled her daughter, Vennie. The high school senior became a star student and won a prestigious college scholarship, even though she was regularly caring for her mother in a hospital or at home.

In recognition of her accomplishments, "GMA" sent Vennie and her mother to Los Angeles for the broadcast's coverage of the Academy Awards.

Just a few months after the trip, however, Mahmoud was diagnosed with pseudomonas, a serious infection in her lungs. As Mahmoud became sicker, the infection began to affect her quality of life.

"It's the little things," Mahmoud said a few weeks after being diagnosed. "I went to pull the trash can down from the top step. I had to stop and literally hold on to the railing and just stay there for a good five minutes before I could get enough air to make it back up those steps."

To treat the infection, Mahmoud's doctor prescribed an inhaled antibiotic called tobramycin. The drug, which is commonly used to cure pseudomonas, is administered through a breathing machine called a nebulizer. The treatments take about 15 minutes and are given twice each day.

But the drug, which retails for about $4,000, was too expensive for Mahmoud. So like 42 million Americans who use Medicare, Mahmoud turned to the government for assistance getting her medicine.

Medicare's Maze

While Medicare is often thought of as a single word or program, it actually takes on many forms. Over the years, efforts to streamline the program and make it more efficient have resulted in a maze of plans and paperwork.

Medicare is now made up of four parts — labeled A, B, C and D — two of which are run by hundreds of private insurance companies that contract with the government to provide service to seniors.

Critics say this expansion has lead to confusion. In Mahmoud's case, when she attempted to get her prescription filled, she could not find a provider that would supply the drug through Medicare for in-home use. Yet no one she spoke to could explain why the medicine was not covered by Medicare.

Each suggested another part of Medicare was responsible for the coverage and asked Mahmoud to call someone else.

"I have documentation of each person I spoke to each time," Mahmoud said. "I've made a minimum of 65 calls, if not more."

How confusing was the process? Mahmoud's doctor told her to call her home health-care service to order the drug. That service said it couldn't provide it and suggested Mahmoud call her pharmacist.

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