Posted on 11/16/2005 7:50:43 PM PST by SierraWasp
Confusion greets drug-plan sign-up
Legislators, consumer groups balk at Medicare Part D
By Kristen Gerencher, MarketWatch Last Update: 7:29 PM ET Nov. 15, 2005
SAN FRANCISCO (MarketWatch) -- A dizzying array of options in the new Medicare prescription-drug benefit is confusing many beneficiaries who don't have enough time to make the decision without incurring a financial penalty, a group of lawmakers charged Tuesday.
U.S. Sens. Richard Durbin, D-Ill., Bill Nelson, D-Fla., and Chuck Schumer, D-N.Y., along with U.S. Reps. Jan Schakowsky, D-Ill., and Pete Stark, D-Calif., announced legislation that would give Medicare beneficiaries a full year to choose a Medicare drug plan instead of the six months now allowed.
The benefit, known as Part D, is set to replace the transitional discount-drug-card program on Jan. 1 for those who enroll in one of the many private insurers' drug plans by then. The six-month penalty-free sign up period began Tuesday. Those who fail to sign up within the six months face a benefit penalty of 1% a month.
The drug benefit marks the biggest change to Medicare in its 40-year history. It's forcing many of the federal program's 42 million beneficiaries to compare their current drug coverage with the new plans and weigh which is best.
Among other factors, seniors and those who are disabled need to consider what they can afford in premium costs, deductibles, copays and coverage gaps. They also need to compare each plan's list of covered drugs to ensure the drugs they're taking and the pharmacies they buy from are included under the different plans.
"We have created a plan here that is so difficult, so confusing and so hard for average people to understand that many seniors are struggling to try to figure out what is the best plan to turn to in order to protect themselves," Durbin said during a press conference.
"It didn't have to be this way," he said, noting that the law could have created a simpler approach and given Medicare the right to bargain for bulk discounts, "just like the Veterans Administration so that, ultimately, the seniors would have been the winners."
"As it turns out, the seniors are going to be the victims -- at least for the next few months while they struggle through this terrible transition trying to figure out how many plans to choose from," Durbin said.
Bills introduced
Durbin is cosponsoring a bill called the Medicare Informed Choice Act along with Schakowsky and Stark on the House side. The bill, H.R. 3861, would extend the penalty-free enrollment period until Dec. 31, 2006 and allow beneficiaries to make a one-time change in their plan in the first year in case they make a mistake.
"Remember, we had three very rude visitors this year: Katrina, Rita and Wilma," Nelson said. "That has disrupted the lives of senior citizens in the Southeastern United States considerably."
"And in the midst of all that confusion, to add this additional burden and not give them the luxury of some additional time after what they've suffered, that would be inexcusable."
Schakowsky and Marion Berry, D-Ark., also introduced H.R. 752, the Medicare Prescription Drugs Saving and Choice Act, which would provide the drug benefit within Medicare instead of through private insurers and require the program to negotiate prices with drug companies to hold costs down.
The law that created the Medicare drug benefit expressly prohibited the program from bargaining for lower prices with drug companies. That provision remains a sticking point among critics such as Ron Pollack, executive director of Families USA, a national health-care consumer advocacy group, who sees the estimated $700 billion cost of the drug program over the next 10 years as unsustainable.
"I believe as the costs of this program skyrocket and people want to trim wasteful spending, they're going to want to revisit the way the program was structured," he said.
What seniors can do
As seniors prepare to make their selections, the Centers for Medicare & Medicaid Services is touting its Plan Finder tool at www.Medicare.gov, which is designed to help beneficiaries find a drug plan that works for them. See previous Vital Signs for more information.
But like many online and phone support tools, it's been overwhelmed and running slowly because of the demand for services, Pollack said.
The problem isn't just technical -- about 76% of seniors have never been online, he said. "Even if the tool works better as I presume it will, it still won't be helpful for most of the people in this population."
What's more, 26% of Medicare beneficiaries have cognitive impairments, 2.3 million live in nursing homes and more than 3 million seniors have visual problems, he said.
Those having trouble choosing a plan may want to visit one of the 1,100 State Health Insurance and Assistance Program offices, also known as SHIP, for help, Pollack said. Most are staffed by volunteers who can aid people in comparing plans, he said.
"Seniors will need one-on-one counseling because there's no one answer for everybody," he said. "You may even have a husband and wife and what may be good for one may not be good for the other."
People who can't find a SHIP office near them may call Families USA for a referral at 202-628-3030.
Many still uncertain
Medicare's standard benefit, which companies may deviate from as long as they offer more and not less, is structured so enrollees pay a $250 deductible upfront before insurance kicks in, plus premiums ranging from about $20 to $37 a month. Beneficiaries are responsible for 25% of costs from $251 to $2,250. After that, the plan stops paying in the so-called doughnut hole, where enrollees pay for costs up to $5,100, after which the government program picks up 95% of the tab.
Despite private insurers' sizable ad campaigns to sign up seniors, 43% of eligible Americans said they don't know yet if they will enroll in a Medicare drug plan for 2006, according to a study released last week from the Kaiser Family Foundation and Harvard School of Public Health. One in five say they plan to enroll but 37% say they don't plan to sign up.
When asked whether the new drug benefit would help them personally, more seniors say it wouldn't help them than say it would -- 49% and 39% respectively.
Consumers Union, the publisher of Consumer Reports, launched a Web site two weeks ago at www.consumersunion.org/issues/medicaredrugs that invites seniors to report aspects of their experience in obtaining Medicare Part D coverage.
So far, about 100 people have written in with vague complaints about the sign-up process, said Bill Vaughan, a senior policy analyst at Consumers Union.
"It basically is just, 'I don't understand. It's too confusing. It's not clear,'" he said. "'Why does it have to be so complex?'"
Vaughan advised frustrated seniors to be patient with the tools and keep checking back in the next six weeks. "The prices are likely to change; the accuracy of the information will get better."
Kristen Gerencher is a reporter for MarketWatch in San Francisco.
Pure unadulterated partisan caterwallering!!!
(Denny Crane: "I Don't Want To Socialize With A Pinko Liberal Democrat Commie.Say What You Like About Republicans. We Stick To Our Convictions. Even When We Know We're Dead Wrong.")
ROFLOL!!!!
The gooberment can't even give away our money without making too complicated for the greedy geezer set. Gotta love it!
They have six months to sign up....and that isn't enough time??? Oh brother.......
The new Medicare Part D coverage is causing shock waves throughout the manufacturer, wholesaler, provider and patient community. Good luck.
I reminds me of the time Rush Limbaugh was on Letterman's show and Rush was trying to pursuade Dave of the importance of good citizenship through conservatism.
"It's too hard, Rush!" Letterman protested in a whiney voice...
No. Actually, it is a convoluted mess.
Instead of a simplified copy of the VA drug program, which has been in existence for years, thus tested and proved, the Medicare Prescription program is a complex mesh of if's and but's and exceptions and conditions.
It is difficult to understand. And the dozen or so various prescription insurance plans vary in premiums, coverage, deductions, exceptions and exemptions.
The Prescription Drug program could compete with the IRS for the most convoluted confusing government documentation.
Who are you extending wishes of "Good luck," to? Me? Seniors? Everyone? Volvo drivers from the 70's?
Take your pick...
Benefit D is an unmitigated disaster. They should repeal the whole program and save those trillions of dollars. It is a total TOTAL MESS!!! Good luck to average citizens. Pharmacists & doctors can't make heads or tails out of it.
Do you like single payer federal health insurance as well, for the same reason???
You know, back in the decade when we gave our seniors their socialized medicine in America without any prescription protection because nobody needed it then...
I do not approve of this government program. Projected to cost around half a trillion dollars over the first few years, it's my projection that it will have cost us two or three trillion by 2010.
Do you have your asbestos underwear on yet??? (grin)
Actually, the complicated, tangled mess may protect us from such high costs. I certainly am not signing up any seniors in my family. There might be a method to this madness.
What tickes me off is that if you don't sign up for a plan the penalty is 1%/mo add on forever if you ever sign up at a later date.
Since neither my wife or I take any kind of drugs we are still forced to sign up for and pay for a plan.
Let them try to work with it. They will see.
And I love George Bush and pray for him several times per day!
Which means price controls and government rationing of the consequent shortages.
They get you one way or another don't they.
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