Prescription For A Headache?
The Press Enterprise (Riverside, CA)
San Bernardino resident Lou Frigone had heard that Medicare’s new Part D prescription drug program was confusing.
But Frigone figured he and his wife, Beverly, were set when they received an enrollment packet from his Medicare-approved insurer, promising to handle everything for them. Frigone, 73, changed his tune when he received a notice of multiple corrections to his Summary of Benefits for 2006.
“It’s almost impossible to understand,” said Frigone of the letter that lists “tiered” payments he must make for medications. He and Beverly already have co-payments totaling more than $200 a month. “I may end up paying more than before. But that’s still a big question.”
Frigone is one of millions perplexed by Medicare’s biggest change in 40 years: the new Part D prescription drug program. Starting Jan. 1, it will cover all 42 million Medicare beneficiaries. Included are elderly and disabled who now receive prescription drugs via Medi-Cal.
During enrollment through May 15, beneficiaries will have to make a decision about their drug coverage.
Many consumer health and senior advocates say Medicare Part D is long overdue. It will be especially helpful for those with low – or no – prescription drug coverage, said David A. Lipschutz staff attorney for the Los Angeles Office of California Health Advocates, a non-profit agency headquartered in Sacramento.
“But the way it’s constructed and presented is leading to mass confusion,” Lipschutz said. Rather than being administered by the federal government, the program will be offered by competing private insurers motivated by profit, he said.
“Medicare has thrown us a mighty curve,” said Helen Haaga, a retired insurance industry specialist now a volunteer for the Health Insurance Counseling and Advocacy Program (HICAP) in Rancho Mirage. “It is so difficult to figure out… That really makes me worried – especially for the cognitively impaired.”
Yet Jack Cheevers, San Francisco-based spokesman for Medicare in California, said “people shouldn’t panic” – there is plenty of time and help available for making a solid decision.
“For those with low incomes… this is a godsend and well worth some study time,” he said.
In October, federal officials acknowledged that the Medicare & You 2006 handbook had errors in the section on Part D choices available to low-incomeseniors. Cheevers said seniors can find the correct information at http://www.medicare.gov, or they can call a 24-hour number (800-633-4227). The Web site, he said, offers a tool to help sort through choices.
“We’ve tried to make it user friendly,” said Cheevers. “I plugged in numbers like a beneficiary would and got through it in half an hour.”
FRAGILE AND VULNERABLE
Nonetheless, Families USA in Washington, D.C., insists that the tool can be confusing for a population out of which 76 percent have never been online.
California has an especially large and vulnerable population among its 4.3 million Medicare beneficiaries.
About 1 million California seniors and disabled people are eligible for both Medicare and Medi-Cal.
Because 25 percent reside in nursing homes, 40 percent are cognitively impaired and 20 percent have limited English proficiency, it is extremely difficult to contact, educate or guide them, said Jeanne Finberg, directing attorney for the National Senior Citizens Law Center in Oakland.
These so-called “dual-eligibles” could end up without the medications they need, said Finberg.
“They will lose their Medi-Cal coverage overnight, with no extensions, no
exceptions,” she said.
Many, she said, will be forced to make a difficult decision between buying food, paying rent or obtaining needed prescriptions. If dual-eligibles don’t make a choice, one will be made for them automatically.
“We’re getting over 500 calls a day, and the bulk are dual-eligibles,” said Ann Kasper, director of the HICAP program in Riverside.
Lu Molberg, director of the Riverside County Office on Aging, said a big part of the problem is Medicare embraces so many different populations – each with different needs and circumstances.
“This is really an example of a ‘one size does not fit all’ program,” said Molberg.
BEWILDERING ARRAY OF OPTIONS
A major gripe voiced by many seniors is they now have too many choices.
“You take a little old lady who doesn’t know what’s going on. How is she gonna make a decision?” asked Dominic Felicetta, 70, of Rialto, who is enrolled with his wife, Louisa, in a Blue Cross Senior Secure plan.
California has 47 “stand-alone” prescription drug plans (PDPs) offered by 19 insurers, said Lipschutz. There also are about 20 Medicare Advantage HMOs offering prescription coverage in Riverside and San Bernardino counties.
The Janet Goeske Senior Center in Riverside held 12 seminars in November designed to arm the Medicare crowd with confidence and skills.
“We’ve had about 100 attend per session,” said Teresa Denham, the senior services director. “They’re starting to calm down. But we still get people coming in and asking questions.”
Some seniors such as Kay Adams, of Riverside, seem to be taking the transition in stride.
Adams, 85, found out at a seminar that her Medicare-approved HMO – SCAN – will automatically enroll her in Part D.
“It’s nice that I don’t have to fill out any forms,” said Adams.
“Right now I’m OK. But I’ll wait and see what medicines I’ll need in April and if I’m still covered.”
NAVIGATING THE MEDICARE CHANGE
Centers for Medicare & Medicaid Services; (800) 633-4227; http://www.medicare.gov; comprehensive information on Medicare Part D enrollment including formulary (drug) finder and prescription plan finder Web tools; telephone counseling 24 hours a day, 7 days a week.
AMERICAN SOCIETY OF CONSULTANT PHARMACISTS, Alexandria, Va.; (703) 739-1300; http://www.ascp.com
AMERICAN ASSOCIATION OF RETIRED PERSONS (AARP), Washington, DC; (888) 687-2277; http://www.aarp.org
CALIFORNIA ADVOCATES FOR NURSING HOME REFORM, San Francisco; (415) 974-5171 or (800) 474-1116; http://www.canhr.org
CALIFORNIA DEPARTMENT OF AGING, Sacramento; (916) 419-7500; http://www.aging.ca.gov
CALIFORNIA HEALTH ADVOCATES, Sacramento; (916) 231-5110; http://www.cahealthadvocates.org
THE FOUNDATION FOR TAXPAYER & CONSUMER RIGHTS, Santa Monica; (310) 392-0522 or http://www.consumerwatchdog.org
THE HEALTH INSURANCE COUNSELING AND ADVOCACY PROGRAM (HICAP), Riverside; (800) 434-0222 or (951) 697-6565; http://www.calmedicare.org/counseling
NATIONAL FAMILY CAREGIVERS ASSOCIATION, Kensington, MD; (800) 896-3650; http://www.thefamilycaregiver.org
NATIONAL MENTAL HEALTH ASSOCIATION, Alexandria, Va.; (703) 684-7722; http://www.nmha.org/federal/Medicare PrescriptionDrugBenefit.cfm
RIVERSIDE COUNTY OFFICE ON AGING, Riverside; (800) 510-2020 or (951) 697-4697; http://www.rcaging.org
MEDICARE RX EDUCATION NETWORK, http://www.medicarerxeducation.org
PART D PRIMER
Stressed out over enrolling yourself or a loved one in Medicare’s new drug prescription plan? The following basic guidelines from Medicare experts, counselors and senior advocates should help get you started:
CHECK YOUR PLAN TO AVOID BAD CONSEQUENCES. Many people already receiving full prescription coverage through a former employer, a union or the military may not need to switch.
Your HMO may already have mailed you a notice or a newsletter advising you are eligible for Part D and need not do anything. Even so, review the literature – or contact the insurer – to understand your benefits and costs. Make sure you don’t get dumped without your knowledge. Get replies in writing.
DO YOUR HOMEWORK IF YOU LACK COVERAGE OR WANT TO SWITCH. If your income is low, signing up for a plan may qualify you for extra financial help to defray medication costs. If your current plan has high out-of-pocket expenses, another
one may offer all – or most – drugs you need at a lower monthly premium.
COLLECT INFORMATION. Save all promotional mailings so you can compare “deals.” Look for the Medicare seal and “Approved by Centers for Medicare and Medicaid Services” notice – signs of legitimate offers.
BEWARE OF FRAUD. Safeguard Medicare, credit card and bank numbers. Do not deal with sellers who come to your door uninvited or ask for personal information over the phone.
GO ON THE WEB. Use the http://www.medicare.gov tools to find plans operating in your area. Organize them in ascending order of cost. Ask yourself how much you want to spend. Check if all drugs you or a loved one need are covered – at least the
most expensive ones.
Determine if you can afford premiums, co-payments and deductibles now and
down the line. If you take no – or few drugs – and are in good health, consider a plan with the lowest possible premium, which range from $5.41 a month to $66.08 a month.
Can you easily get a needed drug or will you need to get prior authorization, go through “step therapy” or face quantity limits?
Also check if your neighborhood pharmacy has a contract with the prescription plan you’re considering, and if mail-order delivery will be available – especially beneficial for the homebound.
MAKE A DECISION. After exploring, comparing and evaluating your options, you can make an informed choice. Remember that everyone’s situation is unique. Open enrollment started Nov. 15 and runs until May 15, after which you may face higher monthly fees. Coverage starts Jan. 1 for those enrolled by Dec. 31.
SEEK ASSISTANCE. Numerous Web sites, telephone counseling and other unbiased resources such as HICAP are available to ease you through the Part D enrollment process. If you’re not Internet-savvy, a family member or friend can help.
Public librarians also can teach you how to go online or check information for you.
SOURCES: Jack Cheevers, Medicare, California; Ann Kasper and Helen Haaga, HICAP; Lu Molberg, Riverside County Office on Aging; Medicare Rx Access Network; National Family Caregivers Association; Families USA; Foundation for Taxpayer and Consumer Rights; Jeanne Finberg, National Senior Citizens Law Center.