Idaho Seniors Say They’re Confused About Drug Plans

By Melissa McGrath, The Idaho Statesman, Boise

Oct. 14–Idaho seniors will start enrolling in the new Medicare prescription drug program in just four weeks, but many are still confused about what plans are available and how they can sign up.

“There just hasn’t been enough information out there,” said Merle Burgener, 69, of Boise, who volunteers at the Boise Senior Activities Center.

The fact that there are more than 40 prescription drug plans to choose from in Idaho only make things more confusing, Burgener said. “We have several seniors here who absolutely won’t understand at all,” she said.

Burgener currently has drug coverage for the two prescriptions she takes with a plan she bought through AARP, but she discovered Wednesday that her coverage will expire when the new Medicare drug coverage goes into effect on Jan. 1.

If Burgener wants continued drug coverage, she must choose a Medicare prescription drug plan. But finding the one that will give her the most coverage for the least amount of money will be difficult because she isn’t sure how to find more details.

Many of the estimated 180,000 seniors in Idaho are finding themselves in a similar situation because only some health insurance companies have released detailed information about their plans, and much of the information is on the Internet, which many seniors don’t know how to access.

Leslie Adolphsen, a Medicare beneficiary who has diabetes, said seniors need clearer information about the program.

“They just don’t explain it in a layperson’s language,” Adolphsen said. “You have to do a lot of investigating on your own, and I don’t think that’s right.”

The insurance program designed to help seniors 65 and older pay for their prescription drugs, passed by Congress in 2003, is the newest addition to Medicare.

The program is voluntary, but the Centers for Medicare & Medicaid Services will penalize seniors who don’t sign up for a plan during the first enrollment period — which lasts from Nov. 15 to May 15 — by tacking on a charge to their premiums when they eventually do sign up.

The most important thing to know: Medicare prescription drug coverage is available to anyone who has Medicare, whether it is Part A, Part B or a Medicare Advantage plan, said Genii Hamilton, a coordinator with the Senior Health Insurance Benefit Advisors, who educated volunteers Wednesday at the senior center on how to help people sign up for the program.

CMS approved each plan before it was made available to make sure it met certain basic criteria: The annual deductible could be no more than $250, they must offer coverage for diabetic medications and supplies, and they must offer a specified coverage for drug costs.

After the deductible is met, the plan has to cover 75 percent of drug costs up to $2,250. When drug costs amount to $5,100, the health insurance plan will cover 95 percent of the costs.

But there is a “coverage gap” in many of the plans where seniors will have to pay 100 percent of drug costs between $2,250 and $5,100. At least six plans in Idaho will pay for part of the drug costs during this coverage gap.

The drug plans vary greatly because CMS allowed insurers to provide more coverage if they wanted.

Humana Inc.’s Standard plan, for example, costs just $6.33 a month with a $250 deductible, but it mostly covers generic drugs, Hamilton said.

Plans with higher premiums will offer lower deductibles and more drug coverage. The most expensive plan in Idaho, Prescription Pathway’s Marquette National Enhanced, costs $68.88 a month but has no deductible and covers more brand-name drugs.

The easiest way to find the right plan is to visit Medicare’s Web site on Monday, when CMS launches a new feature that allows seniors to enter the names of their prescription drugs, the dosages they take and the address of the pharmacy they prefer to visit. The site will list five plans that best suit that individual’s needs.

But having the most-useful information accessible only by computer presents a problem for many seniors who don’t own computers or don’t know how to use them, said Toni Elliott, 64, who does not own a computer but will enroll in Medicare and the prescription drug plan next year.

“I’d like to have more one-on-one information,” she said, rather than getting flyers in the mail or being told to visit a Web site.

DRUG PLAN COVERAGE

When looking at the drug plans, here are a few things to consider:

— If you live in more than one state throughout the year or travel frequently, you should sign up for a nationwide plan offered through Aetna, Cigna, Medco, Member Health, Pacificare, Silverscripts, Unicare, United Healthcare or Wellcare.

— If you have prescription coverage through retiree benefits or another insurance company, contact your company or health insurance provider to find out if you need to enroll in a Medicare plan.

— List the prescription drugs you take and compare it to the drugs covered under the individual plans.

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