Medicare Part D series
Clip Note: In January of 2006, I was contracted to complete a four-part series on the local reaction to the initial Medicare Part D open enrollment. All four stories are included here, along with two sidebars of additional information.
Seniors frustrated by experience with Medicare Part D
By Paul A. Miller
Special to the Times
As Clara Kittle of Edgerton began reading through the literature explaining the enrollment process for Medicare’s new prescription drug benefit, Part D, she quickly recognized she would need help.
“My daughter, who is very computer literate, tried to go through it on the computer,” Kittle said. “She even had trouble with it.
“She got on the phone with the insurance company for two hours and we still didn’t know what to do,” Kittle added.
“At that point, we decided to go right to the Social Security office (in Defiance),” she said. Finally, she found some answers.
“They had all our information right there and I got signed up for Part D,” Kittle said. “I would recommend somebody trying to get signed up should go straight to the Social Security office and ask for help.”
Local seniors who discussed their experiences with Medicare Part D fell into two categories: Frustrated – or relieved not to be engaged with it.
“I worked for the postal service,” noted Harry Hutson of Bryan, “so my prescriptions are taken care of.
“I don’t have to deal with that mess.”
Other seniors are biding their time.
“I haven’t signed up yet,” admitted Steve Sito of Bryan. “I have six months of my medication already, so I’m waiting until I have to sign up.”
Eligible seniors face a deadline of May 16 to enroll in Medicare Part D. After that date, a penalty of 1 percent per month is applied.
Seniors who enroll prior to the deadline get the benefits – but are also charged premiums – immediately.
“If I’ve got enough medication for six months, why would I sign up now?” Sito asked. “If I wait, I won’t have to pay $32 a month.”
Delbert Bok of rural Defiance County said he’s not planning to enroll at all.
“No, I’m not going to sign up,” he stated. “I’m not on any prescriptions now anyway.”
Bok questioned the entire reasoning behind Medicare Part D.
“They’re just pushing drugs, and a lot of them don’t even help you,” he said.
Sito’s early investigation of the program didn’t encourage him to get the process rolling, either.
“That book they put out, I read it and read it and finally asked my daughter, who’s real knowledgeable, to read it too,” Sito recalled. “She read it and said, ‘This thing’s really screwed up.’
“There are a lot of people not signing up yet and I think that’s why.”
Since the new drug benefit uses private insurance plans in its implementation, premiums, deductibles, co-pays and specific benefits vary greatly. Forty-three approved plans from which to choose are listed by the Ohio Department of Insurance. This array of choices was cited by many seniors as a key source of their confusion and frustration with Medicare Part D.
“I guess now they’re talking about changing Part D because nobody understands it,” said Kittle. “There are just too many different plans.”
Debby Gearhart of the Bryan Senior Center has been working with seniors to assist them in choosing a plan. She pointed out the specific details of each separate Part D-approved plan also add to the muddle.
“There is a lot of confusion over plan limitations,” she explained. “You’ve got deductibles and copays, some plans have the donut and some don’t.
“You’ve really got to get into the details to figure out which plans are the best value. It depends on the prescriptions someone has and what their income is.”
According to Gearhart, an added point of confusion is the overlap between Part D prescription plans and Medicare Advantage, a managed-provider option which also may include drug benefits. However, Medicare Advantage also may affect health care provider choices – meaning seniors need to be certain their preferred doctor or health care provider is approved by the specific plan.
Because of the complexity, many seniors are taking the simplest route to enrollment they can find.
“I’m going to start right at Wal-Mart,” said Sito. “I know another guy who says he didn’t shop around much because he knew the (insurance) company had a good standard.”
However, he also recognized other seniors have run into trouble by not researching their plan provider.
“Too many people are just taking a guy’s word for it – and a lot of those guys are shafting us,” he stated.
The senior center’s Gearhart agreed.
“Some people are ruthless,” she said. “These seniors don’t understand the details and they get taken advantage of.”
At this early stage in the era of Medicare Part D, no senior stated with certainty he or she would be saving money under his or her new plan.
“It looks like I will,” said Kittle. “They give an advantage if your prescriptions are mailed in. But I also found out I can only get prescriptions here for a month.”
Gearhart noted seniors will have an opportunity to change their designated plans every November. Kittle said she may take advantage of that.
“If I’m not happy with it, I’ll change it,” said Kittle.
Senior services workers focused on education
By Paul A. Miller
Special to the Times
For Bryan Senior Center Director Kathy Snyder, the challenge of educating seniors about the complicated new prescription drug benefit, Medicare Part D, is a continuing effort.
“We had a seminar back in October where they went through the whole program,” Snyder recalled. “When they (the seniors attending) went away, they were still as puzzled as they had been before.”
Still, Snyder’s staff and the other county senior centers under the umbrella of the Department of Aging have kept up efforts to give seniors the information and assistance they need to enroll in the new federal program. Snyder noted regular visits by various experts on the benefit and the insurance plans involved, as well as an upcoming seminar with a representative from the Social Security Administration Feb. 22. The specialist will speak at the West Unity Senior Center at 10:30 a.m. and at the Bryan center at 1 p.m.
Unfortunately, the complexities of Part D and its signup procedures are creating anxiety for some seniors, Snyder added.
“For example, people on these ‘Rx’ programs are getting mail-order meds, and now they’re getting notices that this is coming to an end May 15.
“These are people on very limited, fixed incomes,” Snyder continued. “They’re scared to death.”
Senior centers in Williams County have been helping those eligible with the enrollment process on a one-on-one basis.
Barb Lingvai, director of the Williams County Department of Aging, said her office is focused on “very individualized” assistance.
“We help them go to Benefits Checkup (BenefitsCheckup.org, an online aid from the National Council on the Aging) and compare plans according to their medications,” she said. “We’re also helping people apply for extra help (through other programs).”
Debby Gearhart of the Bryan Senior Center has been assisting seniors in their efforts to investigate and enroll in Medicare Part D. She described the process she is using.
“I have seniors fill out [informational background forms] which we send in to OSHIP (Ohio Senior Health Insurance Program),” Gearhart explained. This paperwork includes listing all prescriptions currently being taken by the potential enrollee, their frequency and cost, as well as writing out the details of any current drug benefit the person receives through a private insurance plan. Income details also help in choosing plans.
“They (OSHIP) send back two or three different plans which are best suited to that person’s situation.
“From there, we call the insurance companies to find which of those is best.”
Gearhart, who has worked one-on-one with 15 or so seniors seeking to enroll, said limitations within the plans can make comparisons daunting.
“You really have to do your homework,” she stated.
Lingvai expected the initial signup period to be the busiest time for Williams County’s senior services staff, but that hasn’t proven to be the case.
“I was surprised by the number of people (getting help with Part D enrollment) in the first couple weeks of January,” she said. “I would say January was as busy as December.”
Lingvai recommended seniors call one of the senior centers in Williams County to set an appointment for personalized assistance. Other resources she cited include OSHIP, the neighborhood pharmacist – and the Medicare program itself.
“I find that the people at Medicare will call you back,” she said. “They do respond fairly quickly.”
The confusion and doubts may tempt some seniors to avoid researching Part D, but Lingvai said that would be a mistake.
“If there’s any question that they might need it (Part D), I tell them to sign up,” she said. “It’s worth a try. The help is substantial in most cases.”
In fact, Lingvai pointed out she has had some positive feedback from those who are signed up and using the prescription drug benefit.
“I’ve … had some real success stories,” she stated. “It’s just new, and anything new takes some time to get used to.”
Still, Lingvai cautions those who research the program to take their time – and don’t make any hasty decisions.
“Whoever I talk to I say not to make their decision while sitting there,” she explained. “I tell them, ‘Think it over. Talk it over.’”
Along with questions about premiums, co-pays, deductibles and the “donut,” which vary in the over 40 Ohio-approved plans to choose from, seniors need to consider the percentage covered of “most-prescribed” drugs, according to Lingvai.
“Even for a couple, one plan may be better for one person than the other,” said Lingvai. “It’s a learning experience.”
However, the publicity generated by the program’s bumpy start is beneficial, Lingvai stated.
“One good outcome of all this publicity is people are examining all their health coverage,” she said, “which it is good for folks to do.”
Pharmacists on front lines of Plan D enrollment
By Paul A. Miller
Special to the Times
When it comes to Medicare Part D, Rick Yowler has been fielding a lot of questions.
“‘What is covered?’ ‘What is not covered?’ ‘I signed up in November, why hasn’t my coverage started yet?’ ‘Is this going to save me money or not?’” repeated Yowler, a pharmacist with Ringer’s Drug Store in Bryan.
“Mostly, I hear complaints.”
As the point of contact for seniors filling prescriptions, pharmacists have been in a unique position to witness the rollout of Medicare’s new prescription drug benefit. What they’ve seen is plenty of confusion and uncertainty.
“A lot of seniors are very scared,” said Steve Rings, a pharmacist with Rings Pharmacy in Montpelier. “I think they’re afraid of not picking the right plan, and it’s stopping them from picking a plan at all.
“Their biggest concern is finding which insurance plan best suits their needs – they want to pick the best, of course.”
With 40-plus plans to choose from in Ohio, the options can seem daunting, stated Yowler. Nevertheless, he is recommending seniors get signed up.
“It’s not perfect,” Yowler admitted, “but it’s probably better than what they have now.”
“I tell them it’s important that they get signed up,” Rings said. “I’d say about 10 percent (of his eligible customers) are already enrolled.”
Like many other pharmacists, Rings and Yowler are working directly with customers to help them choose the right plans.
“I sit down with them, go to the Medicare website (http://medicare.gov/) and enter their information,” Rings explained. “Then it returns the least expensive plans based on annual costs.”
Navigating the site is not always simple (“Even that’s confusing,” Rings said), but he believes it is the best resource to use when comparing insurance plans. He said the entire online process takes about five to 10 minutes.
“The website is the best way to go,” he stated.
Yowler also prefers to use the website and recommends it to those who have internet access.
“If you call the 800 number you’re on hold 20 to 25 minutes,” he said. “But most seniors don’t have computers, so it isn’t much help for them on their own.”
Seniors wishing to investigate their options should have a complete list of their prescriptions handy. Rings pointed out cost may be the initial way to compare plans, but other factors also should be taken into consideration.
“They have Tier 1, Tier 2 and Tier 3 drugs, which are generics, preferred and brand-name nonpreferred drugs,” he explained. “It’s helpful to check out the details because the less expensive plan may have certain requirements that the person meet before they’ll cover a specific drug.”
In particular, Rings noted some plans require the use of generics where available or trying a “preferred” drug in replacement of the original drug prescribed.
“The insurance companies work out deals with the drug companies to save money on specific drugs,” Rings said.
Yowler expressed concern over the limited opportunities to change plans.
“The biggest problem I see coming is seniors sign up for a plan which covers their prescriptions, then their doctor changes their drugs and the plan they’ve picked doesn’t cover the new medications,” Yowler said. “That plan can’t be changed for (as much as) a year, and now the senior’s paying for that drug out of pocket.”
According to Yowler, approximate 25 to 30 percent of customers at Ringer’s Drug Store are seniors. For Rings Pharmacy, that number is around 60 percent, estimated Rings. With major coverage changes occurring for such a large portion of the customer base, there are also business concerns associated with Part D. Organizations such as the National Community Pharmacists Association have expressed anxiety at the possibility of mail-order pharmacies being placed at a competitive advantage over local retail pharmacies.
Rings said he is “definitely concerned” that the new program will put his business at a disadvantage – but he is hopeful that won’t happen.
“We just don’t know how it’s going to play out,” he explained. “Sure, there’s the chance mail-orders will take away more of our business, but on the other hand, people may be in a position to better afford their medications, and that will help all of us.
“Only time will tell.”
Even with the confusion over Part D and the publicity it has generated, Rings has seen positives.
“Right now, the system is just overwhelmed,” he stated.
“When you consider the uncertainty of a new program, I have been very surprised how well it’s gone.”
Most suggest simpler plan would be better
By Paul A. Miller
Special to the Times
When Congress passed the new Medicare prescription drug benefit (largely on a Republican Party-line vote), proponents argued they had finally answered calls for additional assistance for senior health care costs, recognizing that today’s treatments often utilized medications in lieu of or combined with invasive procedures. Supporters also suggested the setup, with numerous insurance plans providing the actual coverage, inserted an element of consumer choice and market competition.
As the program has been rolled out, those aspects cited as “positives” have in many cases been the target of strong criticism from the people Part D aimed to help: seniors.
“If they’re going to set up a (prescription drug) plan, they should have said, ‘This is the way it’s going to be,’” said Harry Hutson, a local senior who discussed Part D during a recent visit to the Bryan Senior Center. “They should have made it one plan, so people could understand it.”
Clara Kittle of Edgerton, who recently enrolled in Part D, also said the complexity of the program is the problem.
“They should do something to make it easier for senior citizens to understand,” she suggested. “They’re talking about changing Part D because nobody understands it.”
So far, no substantial changes have progressed beyond the “talk” phase. A bill has been introduced into the U.S. Senate which would guarantee repayment for states and other entities paying the drug costs of seniors who have temporarily lost coverage as they are transferred to the various plans. It would also require insurance companies to meet the requirements for coverage and “first-fill” of non-preferred prescription drugs already established in the original law creating Part D.
In the House of Representatives, two bills have been offered. One would delay the monthly penalty for seniors signing up after May 15 until the beginning of 2007. The same bill would also allow beneficiaries to change plans anytime in the first year of enrollment.
The second bill would require Medicare to offer a direct drug benefit and also require the federal program to negotiate with drug companies for discounts.
Pharmacist Steve Rings of Rings Pharmacy in Montpelier noted the rapid influx of new enrollees may be more than the system could handle.
“Maybe staggering the enrollment period would have helped,” he offered.
Rings, however, said he has been “surprised” by the progress so far, and believes Part D may still be looked upon as successful.
Rick Yowler, a pharmacist with Ringer’s Drug Store in Bryan, stated he believes the number of plans is the source of most of the confusion.
“First, they opened it up for 47 plans in Ohio, way too many to make easy comparisons,” Yowler said. “It would be better if they had offered two or three plans. Then people could look at them and say, ‘Sure, this plan’s better for me.’”
Debby Gearhart, a Bryan Senior Center employee who has been assisting seniors investigating Part D, agreed the benefit could have been simplified.
“Why didn’t Medicare put out one single plan and say, ‘If you want it, fine - if you don’t, fine’?” she asked.
Yowler said he has found the enrollment preparations less than impressive.
“It’s obvious they were not ready,” he said. “It’s been a nightmare.”
The criticisms aren’t likely to end after the initial signup period closes on May 15. Eligible seniors will be charged a one percent penalty for each month after May 15 they choose to enter Plan D. Enrollees also face the possibility that their prescription drug requirements will change, reducing the value of the insurance plan they initially chose. Those plans can only be changed on an annual basis.
Kathy Snyder, Bryan Senior Center director, said low-income seniors who fall along the borderline of receiving additional assistance from Medicaid are “running into trouble.”
The combination of premiums, deductibles and co-pays create a “Catch 22” for these seniors, she stated.
Steve Sito, a senior who is waiting before he signs up, has found switching from his current plan to a Part D-approved plan may improve coverage benefits – but it will also increase his premiums.
“You get it either way,” he said.
“This program was supposed to help people who needed it,” said Snyder. “That’s where they should start.”
Yowler summed up his opinion of the program this way.
“It’s a confusing system and there are too many options,” he said. “I’m just afraid it is not the complete coverage they (seniors) think it will be. There are a lot of expenses they’ll be required to pay.
“Still, it’s better than they had before.”
Contacts for assistance with Medicare Part D
Williams County Senior Centers
Bryan Center - 419-636-4047
Edgerton Center - 419-298-3564
Edon Center - 419-272-3168
Montpelier Center - 419-485-5923
Stryker Center - 419-682-2083
West Unity Center - 419-924-5447
Defiance County Senior Services
Defiance office - 419-782-3233 or 1-888-782-3233
Hicksville office - 419-542-5004 or 1-888-330-5004
Defiance Social Security Administration office - 419-782-3950
Benefits Checkup - http://www.benefitscheckup.org/
Ohio Department of Insurance - http://www.ohioinsurance.gov/prescriptiondrugs/index.asp
Medicare Part D information - http://www.medicare.gov/pdphome.asp
AARP’s Medicare prescription drug benefits page - http://www.aarp.org/health/medicare/drug_coverage/medicarerx_coverage.html
Kaiser Family Foundation’s Medicare prescription drug plan resource page - http://www.kff.org/medicare/rxdrugbenefit.cfm
Information needed to research Plan D options
*Name, address, phone, Medicare beneficiary number, Medicare effective date and birthdate.
*Medicaid information (if applicable).
*Preferred pharmacy or pharmacies, if any.
*A complete list of prescriptions for the person enrolling, including dosage, frequency and monthly and annual cost of each. Add up for total annual costs.
*Details of any prescription drug coverage already present, such as through private insurance plans, a union or the military.
*Financial information, including income and its sources; bank accounts, stocks, bonds, life insurance policies and other assets, such as real estate (other than primary residence).
*Additional assistance may be available for low-income seniors through Medicaid or other programs. Ask about these options and their eligibility requirements.
Once the above information is in hand, contact a knowledgeable family member, local senior center, Social Security office, trusted insurance agent or pharmacist for assistance in studying options. Or call the Ohio Senior Health Insurance Information Program (OSHIIP) directly 1-800-686-1578; or call Medicare directly at 1-800-MEDICARE.