Is Xanax on It? Drug-Plan Pick Raises Anxiety
By LARRY LIPMAN Palm Beach Post Washington Bureau
Nearly two years after President Bush signed into law the most sweeping change in Medicare’s history, beneficiaries can begin signing up Tuesday for coverage of their prescription drugs.
Despite recent polls showing widespread confusion about how the benefit will work and concern that the coverage choices are too complicated, administration officials say they are confident the drug program will catch on.
By the time the open-enrollment period ends May 15, beneficiaries will have a better understanding of the program and “those polls will change,” Health and Human Services Secretary Michael Leavitt said in a conference call with reporters last week.
“This is the beginning of a new era in Medicare,” Leavitt said. “We will slowly build understanding.”
Administration officials stress that there is no need for beneficiaries to enroll hastily. The drug benefit will not take effect until Jan. 1, and beneficiaries can continue signing up until May 15, 2006, without paying a penalty. But those who are eligible and do not sign up by then will pay a penalty of 1 percent a month when they do enroll. After May 15, the next enrollment period will be in November 2006.
As the first enrollment period approaches, Medicare and drug providers are flooding beneficiaries with information, and interest in the program is quickly growing.
At the Medicare Answers Prescription Savings Center in West Palm Beach, the number of inquiries has increased from about 10 a day last February to a couple of hundred a day, said Lisa Nora, the center’s coordinator and volunteer specialist.
“More and more people are starting to pay attention,” she said. “They know that they have to make a decision.”
To help them make that decision, the center – affiliated with the Area Agency on Aging covering Palm Beach, Martin, St. Lucie, Indian River and Okeechobee counties – has dozens of trained volunteers who can provide one-on-one counseling.
“We show them the necessary information so they can make an informed decision,” Nora said.
Throughout Florida, almost 450 volunteer counselors are helping beneficiaries through the Department of Elder Affairs’ SHINE program, which stands for Serving Health Insurance Needs of Elders.
Nationwide, the federal government is working with about 10,000 local organizations to provide assistance, Leavitt said. That help will be needed, experts say, because the program is so complicated.
Advocates of a drug benefit for the elderly had lobbied for years to expand the program within Medicare, but when Congress finally acted, it tossed the benefit to the private sector, with a hefty government subsidy. The result is that beneficiaries must enroll in private plans – not in Medicare directly – for the prescription- drug benefit known as Medicare Part D.
In virtually every state, beneficiaries are confronted with more than 40 competing drug plans, many of them different options offered by the same company. In Florida, beneficiaries have a choice of 78 stand-alone drug plans. In Palm Beach County, there are another 21 Medicare Advantage (managed care) plans and seven preferred- provider organization plans.
A survey of Medicare beneficiaries late last month found that more than 60 percent said they do not understand the new drug law.
The survey, conducted by the nonprofit Kaiser Family Foundation and the Harvard School of Public Health, also found that 37 percent of beneficiaries said they do not plan to enroll in a plan; 43 percent were undecided and only 20 percent said they planned to sign up for the drug benefit.
Most elderly who have not followed the issue are unaware that they have so many plans to choose from. When informed that they have so many choices, nearly three-fourths said that “makes it confusing and difficult to pick the best plan”; 22 percent said it “provides an opportunity to choose the best plan.”
Because of the confusion and delays getting information to some South Florida beneficiaries displaced by Hurricane Wilma, Sen. Bill Nelson, D-Fla., is one of several congressional Democrats pushing legislation that would delay the enrollment deadline from May 15 until the end of next year.
Critics of the drug law have argued for months that it is too complex. They also have argued that if Medicare purchased drugs directly, the way the Department of Veterans Affairs does for veterans, beneficiaries would pay much less.
A study of the prices scheduled to be charged under the drug law for the top 25 most commonly prescribed medications used by the elderly found that the drug benefit will result in average savings of 20 percent on brand-name drugs bought at a retail pharmacy and 27 percent through a mail-order pharmacy.
For generic drugs, the savings are 44 percent retail and 64 percent mail-order. The study, based on filings with the Medicare program, was conducted by the Pharmaceutical Care Management Association, the national trade organization representing pharmacy benefit managers.
Medicare has created tools to allow beneficiaries to list the specific drugs they take and find out which plan will give them the best deal in terms of cost and convenience.
The tools enable beneficiaries to compare premiums, deductibles and co-payments for each plan based on the drugs listed. They also tell them which local pharmacies will accept the various plans, or whether drugs can be purchased through a bulk mail-order or online supplier.
“It’s a wonderful tool,” Nora said. “It really gets in depth on how much you are going to save. You plug in (the information), and it’s the best thing since sliced bread.”
larryl@coxnews.com
Find help with a drug plan
To help beneficiaries wade through the various plans, Medicare has created a helpful sources that can compare costs and benefits. Those tools are available at www.medicare.gov or by calling (800) 633-4227.