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Part D? Some Say D is for 'Dreadful' Some Seniors Mystified By Intricate Workings of New Medicare Prescription Drug Plan

Posted on: Tuesday, 10 January 2006, 21:00 CST

By Marni Pyke Daily Herald Staff Writer

Part of an occasional series

A week into the federal government's new prescription drug initiative, and Bill Anderson sees it as "close to a nightmare."

Anderson, owner of Oswald's Pharmacy, a fixture in Naperville, reported pricing mix-ups, glitches with identity cards and confused customers.

It's a scenario numerous seniors and drug stores are experiencing as the Medicare Part D experiment stumbles to life.

The new plan is intended to help seniors and people with disabilities pay for their prescriptions.

As of Jan. 1, The Centers for Medicare and Medicaid Services counted more than 21 million people who signed up for the various programs offered.

While some customers bought their first drugs without a hitch, pharmacists and senior workers reported mishaps with people who hadn't received Medicare cards yet and whose benefits couldn't be confirmed.

Other stumbling blocks came with seniors who qualified for financial help from either the state or federal governments and weren't listed as eligible.

"It's not going as smoothly as predicted," said Jennifer Smith of Catholic Charities Northwest Senior Services located in Arlington Heights.

"We're getting multiple phone calls from people who show up at the pharmacy and find the amount they expected to pay according to the government Web site is different from what they're getting billed."

Part of the difficulties stem from the learning curve for people getting used to a new system. Medicare Part D is being administered by private insurance companies and many plans require a $250 deductible.

"People don't understand they're paying 100 percent until the first deductible is up," Walgreens spokeswoman Tiffani Bruce said.

Then there are those who didn't realize that certain drugs aren't on the plan they chose.

"There's a lot of confusion. January's being used as a sorting- out month," said Judith Smith with Senior Services Inc. in Kane County.

There have been some growing pains, acknowledged administrators with the Centers for Medicare and Medicaid Services.

But, "so far, since it was activated, over 28 million pills have been dispensed, so someone is getting their meds," Medicare's Bob Herskovitz said.

Officials advise seniors to bring documentation about their plans to the drug store and to avoid ordering refills at the last minute.

Walgreens' Bruce said the strain on pharmacies was lessening as the startup week wore down but that's not what Oswald's staff experienced.

"I expected Monday would be the tip of the iceberg," said Anderson Friday. He added that his staff was still just as busy sorting out problems at week's end.

Centers for Medicare statistics show about 1 million people registered for stand-alone Medicare Part D benefits.

The rest of the 21 million receiving prescription drug coverage includes 6.2 million people on both Medicaid and Medicare who are therefore automatically enrolled in Part D, 4.4 million people on Medicare Advantage plans similar to an HMO program and 3 million retired federal workers.

The remainder are retirees receiving benefits from former employers that Medicare is now subsidizing.

Still, legions of America's more than 40 million seniors have not signed up for coverage. The deadline to register without incurring a late fee is May 15.

Many seniors are bemused by the multitude of insurance plans available - 42 in Illinois.

Complicating matters is a complex benefits formula. Drug bills are subsidized up to $2,250 but then seniors with higher costs fall into a coverage gap where they must pay 100 percent of their medicine. After people have spent $3,600 out-of-pocket, the government swings back into action paying 95 percent of medication.

Retiree Franz Fauley of Hawthorn Woods, a former college teacher who ran a consulting company, says he's flummoxed by the system.

Figuring it out, "is like a root canal," he said.

Fauley faulted the insurance company he finally picked for outsourcing the information hotline.

"When I asked about where in the plan the doughnut hole kicks in, they didn't know what I'm talking about," he said.

Oswald's customer Irene Oberhelman was waiting for her daughter, a nurse, to help her sort out the plans.

"It's so complicated," the Naperville resident said.

And if there weren't enough pitfalls already, Illinois Attorney General Lisa Madigan's office is warning people about scams.

Complaints of consumers being phoned or approached at home by people offering help with Medicare Part D or trying to sell drug plan insurance are being investigated, said spokeswoman Melissa Merz

"I think every time there's a new government program," she said, "unfortunately it creates an opportunity for con artists to make money off of people."

Part D questions and answers

The Daily Herald invited readers to submit questions about the federal government's new prescription drug plan, Medicare Part D. Here are some of those queries, with answers provided by the Center for Medicare and Medicaid Services spokesman Bob Herskovitz.

We'll respond to additional questions in coming weeks. If you have a concern, just mail your inquiries to Medicare Questions, The Daily Herald, 4300 Commerce Court, Lisle, IL, 60532, or e-mail questions to mpyke@@dailyherald.com

Q. My application for Blue Rx was postmarked at the post office in Palatine on Dec. 31 and had a personal check for the first month's (January) premium attached.

How do I purchase my first prescription in January and have the drug plan get activated?

A. The drug plan must receive your application by the last day of the month to have drug coverage the first of the following month. An application postmarked by Dec. 31 probably will not reach the plan that same day; therefore, this enrollment will be effective Feb. 1.

Q. If, after a year or two, I'm not satisfied with any of the plans, can I opt to drop out of Medicare Plan D system completely?

Second, do you foresee plan fees increasing in the coming years?

A. Yes, you can disenroll from a drug plan during the annual election period, Nov. 15 to Dec. 31. Your plan can also be canceled for nonpayment of premiums.

If you no longer have Medicare drug coverage, or other drug coverage better than Medicare's, then you would be subject to the late enrollment penalty if and when you decided to rejoin a Medicare drug plan. Generally, you can switch or join a drug plan only during the annual election period from Nov. 15 to Dec. 31.

It is a little too early to predict whether the rates will increase, but we will keep the public posted.

Q. I am covered by Medicare along with a supplemental plan F (Mutual of Omaha) that does not provide for prescription drug coverage. I am fortunate at this stage that I do not have need for any prescription drugs; however, I want to sign up for the least expensive plan available to me to keep future monthly premiums down for a time in the future when I may need these drugs.

I am a resident of DuPage County. The only real low-cost plan listed was the Humana plan for $13.32 a month. Is it necessary that I purchase my supplemental plan F coverage through the same insurance carrier where I apply for Part D?

Are there any other low-cost plans available to me?

A. Medigap (or supplemental) plans and Medicare drug plans are two completely separate and distinct insurance policies. You do not have to buy each plan from the same company unless you prefer to.

All Illinois stand-alone drug plans are available for the same premium and benefits throughout the state. They aren't specific to specific counties. Other plans for less than $25 a month include: Advantra Rx Value at $20.56; Healthspring PDP at $24.78; Humana Enhanced at $20.08; Unicare Medicare Rx Rewards at $21.53; United HealthRx at $23.17; AARP MedicareRx at $25.78; and Wellcare Signature at $21.31.

There are also Medicare Advantage plans that include drug coverage (called MA-PDs) available in DuPage County, which would replace your Medigap supplemental plan and also provide drug coverage, often for less money overall. MA-PDs can offer their plan only in selected counties.

In DuPage, there are two companies offering different plans, the premiums are for both the health-care portion and drug coverage portion. They are: Healthspring Advantage Basic, an HMO, at $27; Healthspring Advantage PremieRx, an HMO, at $41; HumanaChoice PPO, three plans at $35, $46, or $50; and Humana Goldchoice PFFS at $154.

For assistance in choosing a prescription drug plan or an MA-PD, you can call (800) 633-4227 or the Illinois Senior Health Insurance Program at (800) 548-9034.

GRAPHIC: FYI

According to Medicare officials, if you have enrolled in Medicare Part D, an acknowledgment letter will arrive about a week after you enroll, followed by an identification card three to five weeks later.

If you need to go to the pharmacy before your card arrives, bring the letter from your plan, your Medicare and/or Medicaid card and additional photo identification. Save the receipts from your pharmacist.

Here are some numbers to assist you in learning more about the Medicare prescription drug plan. It's advised to call the Medicare help line during off-peak hours.

- Medicare at (800) 633-4227 or www.medicare.gov

- The Illinois Department on Aging at (800) 252-8966 or www.state.il.us/aging or www.illinois.benefits.org

- Counselors with the Senior Health Insurance Program at (800) 548-9034

Source: Daily Herald; Arlington Heights, Ill.

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