Prescription for confusion

Fans of the new Medicare prescription drug program say it gives seniors choices and the chance to dramatically reduce their costs.

Critics say it offers too many choices, and the resulting information overload makes seniors vulnerable to being sold a plan that’s not in their best interest.

“It’s confusing. It’s multilevel,” said Ralph DeCristoforo, a health care access advocate with the Health For All Project in Spokane. “There are 70 different plans in Washington alone for individuals to pick from.”

Enrollment begins Nov. 15 in the Medicare Part D prescription drug program. Medicare, the government health insurance plan for seniors, never covered prescription drugs until a discount drug card was introduced in 2003.

The new Part D program replaces the discount card program, and that has some seniors worried.

“I think it will hurt us badly,” said John Waters, who volunteers at the Lake City Senior Center with his wife, Joan. The couple went to their pharmacist and learned their prescriptions altogether would cost $714 a month without the discounts they now have.

“We can’t afford that,” Joan Waters said. She’s uncertain what kind of drug coverage she can get under her insurance or other Medicare Part D plans. “It’s a case of wait and see. It has a lot of seniors very uneasy.”

Such distrust is reflected in a USA Today/CNN/Gallup survey in September, which found that more than half of Medicare beneficiaries don’t understand the new prescription drug program and don’t plan to enroll.

People anxious about the change are filling the phone lines at the Senior Health Insurance Benefits Advisors (SHIBA) program offices in Washington and Idaho. In Washington, about 800,000 people need to sign up for Medicare Part D, and in Idaho, 190,000 seniors need to enroll. The enrollment deadline is May 15 and latecomers are subjected to a life-long penalty that’s tacked onto their monthly premiums.

The SHIBA Helpline is getting 400 calls a day in Washington, according to an agency spokeswoman.

Penny Wilhelm, Idaho’s SHIBA regional coordinator, is responsible for helping 52,000 people enroll in the program in Idaho’s 10 northern counties. She has a staff of two part-time employees.

Her agency has no extra money for outreach and enrollment assistance, she said Thursday. “Since everybody’s hours are up, I’m here by myself. The phones are ringing constantly.”

So she’s trying to recruit volunteers to be counselors for seniors who need help enrolling. Wilhelm and her staff are making appointments for seniors to meet with volunteers in communities across North Idaho.

Wilhelm has about 50 volunteers now, but she said she needs 50 more.

In Washington, SHIBA is scheduling public workshops and encouraging people to bring workbooks to the workshops to figure out their coverage options.

Tom Moore, director of the Lake City Senior Center, is worried that the process is so complex that seniors might make a decision before they have all the information. Already, private companies marketing the prescription drug plans are asking to make presentations at the senior center and start signing people up, he said.

He’s afraid seniors might feel pressured.

“It seems like there’s no single place to get clarity,” he said. “I’m a college graduate, and I don’t understand it.”

One of DeCristoforo’s complaints about the program is that it’s driven by the private market. The federal government has placed no price controls on the premiums or how much drug companies can charge.

“Seniors will pay 25 percent of whatever price the pharmaceutical companies charge,” DeCristoforo said, referring to the standard plan’s co-pay.

Nonetheless, Wilhelm said the new benefit is a huge improvement over the discount cards.

“It’s going to be a tremendous savings for people,” she said, sharing the story of one desperate couple who called her recently. They are on a fixed income and paying more than $300 per month for their medications. Each month, they have to dip into their savings.

Wilhelm looked up the Medicare Part D plan that’s being offered by their health insurance provider and was able to show them that under the new plan, they would be paying $52 a month on their prescriptions, plus the $30 per month premium, when benefits start Jan. 1.

“The guy broke down crying” with relief, she said. “He said, ‘I didn’t know what to do.’ This is going to save them a lot of money.”

While SHIBA is trying to walk tens of thousands of seniors through an on-line benefits planning tool (which still lacks some crucial information) on Medicare’s Web site, state Departments of Health and Welfare are preparing to help people who are dual-enrolled in Medicare and Medicaid.

People on Medicaid have their prescriptions paid by the state Medicaid program, but that will soon change. If the 17,000 “dual enrollees” in Idaho don’t sign up for a Medicare Part D plan before the end of the year, the state will do it for them.

And through the Medicare enrollment process, state agencies expect to find people who qualify for Medicaid and other assistance programs, said Tom Shanahan, spokesman for the Idaho Department of Health and Welfare.

The agency will ask the Idaho Legislature for a supplemental appropriation of $3.8 million to help pay for staff to help enroll clients in Medicare Part D and Medicaid, and to help cover the benefits of new Medicaid enrollees, he said.

“We’ll be helping these people sign up, plus anybody who walks in our doors and asks,” he said.

While the new Medicare Part D program isn’t perfect, social service workers say it’s a good start with a huge potential to help seniors.

For John and Joan Waters, who emigrated from England to Canada and then the United States more than 40 years ago, it leaves them a little nostalgic for the old country.

“Once you’re a senior (in Great Britain), you don’t have to pay for your medical care out of Social Security,” Joan Waters said. “They do look out for the seniors over there.”