Part D works for some, not all
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With the sign-up deadline for the Part D Medicare prescription drug benefit eight days away, most seniors say they're satisfied with the program and happy with the savings.
But millions of others still haven't signed up. That includes a significant number of low-income people, who have the most to gain, other seniors who remain confounded by how the program works and still others are opting out.
In Allegheny County alone, the number of Medicare beneficiaries who lack prescription drug coverage through Part D or other programs is estimated at nearly 63,000.
If they fail to choose a plan by May 15, most of those people -- there are exceptions for low-income people, for example -- won't be able to enroll again until November, when they could face penalties.
What's baffled many seniors is the large number of choices.
The government-backed polices have different prices and cover different drugs. In Allegheny County alone, some 20 private companies are selling plans. Each is offering one to nine options, resulting in a total of more than 60 choices.
After providing coverage for a portion of the first $2,250 in drug costs, most Part D plans provide no coverage until total drug costs for the year reach $5,100. This coverage gap is commonly called the "doughnut hole."
Because the government is offering comprehensive drug coverage to Medicare recipients for the first time, "some good for seniors will absolutely come out of this," said Drew Altman, president of the Washington-based Kaiser Family Foundation.
Local consumers are divided.
Fred Bush, 57, of Wilkins, who is on Medicare due to a disability, loves Part D. It has added just $7 to his monthly premium, but saves him about $6,000 per year on his medications.
Also satisfied is Walt Speakman, 80, of Sheraden.
Mr. Speakman said Part D coverage costs him just $1 more a month than his prior Medicare HMO plan. But the new plan paid for more than $700 in drugs during the first three months of the year. His previous plan allowed a maximum of only $350 in coverage every quarter.
Part D "really does give a benefit," said Mr. Speakman, who was hopeful about cutting his drug costs when he spoke to the Pittsburgh Post-Gazette last fall.
But then there's Rosemary Arrisher, 76, who said she tried repeatedly to get advice from Medicare and other agencies before she found a Part D plan for her 55-year-old daughter, who is disabled.
"It was just so frustrating. I made dozens of calls," she said.
Eugene Dwyer, a semi-retired patent attorney from Crafton, hadn't planned to enroll, but said last week that he may change his mind before the deadline.
"It's a value judgment," he said, acknowledging that not signing up is something of a gamble. "You don't know how long you're going to be healthy."
Glitches remain
Due to widespread glitches involving Medicaid recipients who could not access their new Medicare drug benefits at the pharmacy counter, Pennsylvania and more than 20 states created backup programs to cover costs until computer problems were resolved.
The Pennsylvania program -- which has paid for more than $620,000 worth of drugs, so far -- has seen a slight increase in claims during the past few weeks, suggesting that not all glitches have been resolved.
Fran Chervenak, of the Pennsylvania Health Law Project, said that her organization is fielding fewer calls from people requesting help, but that "the people who do call have the same issues they had two months ago."
The presence of the backup plans, rather than elimination of systemic problems in Part D, may have contributed to the decline in calls, she said. Some Medicaid recipients still have not been automatically enrolled in a new plan, Ms. Chervenak said, or have had problems exercising their option to choose a plan.
Cornelia Smollin, 76, of Whitehall, who formerly received her prescriptions through Medicaid, said the change to a Part D plan raised her monthly drug costs by about $85. Two of her drugs were not covered and she decided to stop taking one of them.
One of the biggest remaining problems is the number of low-income people who qualify for subsidies to join Part D plans but haven't signed up, said Robert Hayes, president of the Medicare Rights Center. About 8.2 million people are considered eligible, but only about 4.7 million people had applied for the subsidies by last month and 1.7 million had qualified.
In Pennsylvania, 68,808 people had been qualified for the low-income subsidy by April 28, the government says. But another 350,000 or more are thought to be eligible, said Tom Snedden, director of the state's PACE program.
People aren't signing up, Mr. Snedden said, because they don't understand the program, and often can't even distinguish between between the subsidy application and the large volume of marketing material coming from Part D plans.
"Even when they get it and look at the application, it's like, 'Oh it's just too long,' " he said of the six-page form.
Last week, Mr. Hayes' group proposed a variety of changes to Part D, including automatic enrollment of those people into the subsidy program, elimination of the doughnut hole, streamlining the process of appealing denials of medications and extending the May 15 deadline.
Some changes already have been made.
A controversial aspect of Part D from a consumer perspective -- the ability of insurance companies to freely change their lists of covered drugs, called formularies -- has been modified in ways that will please many beneficiaries. The Bush administration ruled last month that if companies drop covered drugs from their formularies or impose new restrictions on the medications, they must exempt beneficiaries who are already taking the medicine during that calendar year.
Not an 'unmitigated disaster'
Even so, consumers doing last minute shopping should be careful about drug plan formularies because there are significant differences, said Jack Hoadley, a health policy researcher and political scientist at Georgetown University. A study that he led, published last month, found that the comprehensiveness of formularies for covering drugs that treat different conditions can vary considerably, as can the cost sharing that is required by plans for different drugs.
"On the one hand, it's not a rousing success," he said of the new program. "On the other hand, it's not an unmitigated disaster or failure."
While some serious problems remain, "a growing number of people are enrolling in plans and they seem to be relatively satisfied," said Tricia Neuman, a vice president with the Kaiser Family Foundation.
A poll taken last month by the Kaiser foundation found that 75 percent of seniors enrolled in Part D plans said they were either very or somewhat satisfied with the new program, while just over half expected to save money. But the same poll found 38 percent said they would not enroll.
As of April 18, about 19.7 million people had signed up for Part D, which put the enrollment about 9.6 million short of the government's target.
But government officials say a greater percentage of the 42.5 million Medicare beneficiaries actually have drug coverage when considering other sources, such as the Veterans Administration and retiree plans. Taking into account those other sources, there were about 6.7 million Medicare beneficiaries who lacked drug coverage as of April.
During the next seven days, the hunt will be on for those people, with private insurance companies taking the lead.
For its part, Highmark Inc., the region's largest health insurer, is keeping open its phone lines and Downtown customer service center until midnight on May 15 to collect any last-minute applicants. It'll be a little bit like the post office on tax day.
"There are a significant number of people who have not signed up yet, and there may be some who leave it to May 15," said Denise Grabner, a Highmark spokeswoman.
Correction/Clarification: (Published May 9, 2006) This story as originally published on May 7, 2006 about the new Medicare prescription drug benefit understated the amount of money consumer Fred Bush of Wilkins expects to save. Mr. Bush said he likely will save $6,000 on drug costs, not $600, as a result of the Part D program.
First Published May 7, 2006 12:00 am
