Next year for the first time, Medicare will offer prescription drug coverage. Government officials say seniors can choose from a variety of plans, each of which will offer a number of prescription drugs at significant savings. But many seniors complain the new Medicare Part D program is hopelessly complex and confusing.
In San Diego, Medicare beneficiaries are looking for answers at a center that offers free health insurance counseling. KPBS Health Reporter Kenny Goldberg has the story.
On a weekday afternoon in a Kearny Mesa office building, 83-year-old Ruth Voss has come in to talk with counselor Hersh Gottshalk. The topic: the new Medicare prescription drug program.
Hersh Gottshalk and Ruth Voss: "What coverage do you have now, Ruth? Well, right now I'm on Medicare A and B, and I have a supplement health insurance, and I found out there are 44 different programs in California, that you could get. And I'm wondering, is that true? Well, it's not true, there's actually about 60, in California."
For the next few minutes, Gottshalk describes some of the plans. He explains each one differs in terms of deductibles, premiums, and what drugs are covered. Suddenly, Voss throws up her hands.
Voss: "It looks like they got you by the short hairs. They really do, I'm serious about that. It makes you wonder some time, if they're trying to force you into something. And I know I shouldn't be worried about it, because all I can do right now is to try and find a plan for me."
This scene has been playing over and over again here at the San Diego office of the Health Insurance Counseling and Advocacy Program. HICAP Counselors have been inundated with seniors who are having trouble deciphering the new Medicare drug plan.
HICAP has set up a special call center to handle all of the inquiries. Program manager Jennifer Duncan says in the center's first two weeks, it fielded more than 11,000 calls.
Duncan: "We're triaging, pretty much, at this point. I don't think anyone could have imagined the size and the upset. You know, it's kind of like disturbing a beehive."
Seniors are certainly eager to save money on prescription drugs. After all, they take more than any other age group. But the new Medicare program offers a baffling array of choices.
For example, all plans are required to cover at least two drugs in each therapeutic category. But not every plan includes all of the specific medications a senior might take. And premiums are all over the map, too, from $5 to $51 a month in California. Duncan says seniors know they need to do something.
Duncan: "But the basic feeling of knowing what to do. They're afraid to do it, and to make a decision without knowing or getting more information. Or we get the ones who are severely disabled and can't do it."
And it's those that are most severely impaired that face the tightest deadline.
Most Medicare recipients have until next May to sign up for the plan of their choice. But the 1 million Californians who get benefits from both Medicare and Medi-Cal must decide before January 1st. These so-called dual eligibles are more likely to be disabled, mentally impaired, or in a nursing home.
Alex Azar is deputy secretary of the U.S. Department of Health and Human Services. He says dual eligibles have no need to worry.
Azar: "We are auto-enrolling them into a new part D plan, so they don't even have to make a choice. We're putting them into plans as a default choice. They can at any time change their mind and choose to go to a different plan, but we're putting them into one."
Azar says the government is trying to contact all of dual eligibles. But he says if anyone is missed, Medicare has a point of sale protection program.
Azar: "So that if a beneficiary shows up at a pharmacy, and they've not for some reason been auto-enrolled, they will still get their drugs, and we have hired a contractor who will then identify them, and enroll them into a part D plan. So from their perspective, this transition will be completely seamless."
But maybe not. San Diegan Dawn Piotrowski is a dual eligble. She's permanently disabled, has bipolar disorder, and takes five different medications. She hasn't been able to find a plan that covers all of her drugs.
Piotrowski: "You know I'm just crossing my fingers and toes that after January 1st 2006 that I'm still going to be able to take some of the medications that I'm taking now, somehow."
Piotrowski's looked at nine different options for dual eligibles without success.
A recently filed lawsuit alleges the federal government doesn't have adequate safeguards to ensure dual eligibles will get all of their drugs come January 1st. Just to be on the safe side, HICAP's Jennifer Duncan recommends seniors get a 100-day supply of their medications. That's because she doesn't thinks the new program will be running smoothly until next spring.
Duncan: "Because the pharmacies, the doctors, the individuals in the plans will all have ridden this wave for awhile and realized some of the flaws and worked out some of the wrinkles."
In the meantime, there's pressure growing on Congress to extend the May 15th sign up deadline. As it stands now, seniors who miss that date can still select a plan, but they'll have to pay higher monthly premiums for the rest of their lives. Kenny Goldberg, KPBS News.
