As reported by The Hartford Courant, November 17, 2005.

Complex Menu for Seniors

Medicare Drug Plan Is a Lot to Absorb

By Garret Condon

Federal and state officials have warned Medicare recipients not to rush into a decision whether to participate in MedicareRx, Medicare's new prescription drug benefit. The six-month signup period opened Tuesday, and the sheer volume of choices to navigate has left many seniors so confused that people who work with the elderly predict that enrollment will be off to a slow start.

Melissa Morton, director of the state's CHOICES program, which is coordinating about two dozen staff members and more than 200 volunteers who are providing telephone and in-person help to seniors, said phones have been ringing off the hook this week, with most callers simply trying to figure out the drug scheme, not sign up.

"They're desperate for someone to help them sort through the 44 [stand-alone drug] plans," she said.

Jean Turek, 83, who works part time at Bloomfield's senior center, said a lot of seniors have called the center to say they're confused by the new drug benefit. "They just don't understand it," Turek said. "I'm a senior, and I don't understand it."

Audrey Eckert, 72, of Thomaston, has taken training to assist fellow seniors in understanding and signing up for the program. She called it "an awful mess."

More than a half-million Medicare recipients in Connecticut are eligible for the new, voluntary benefit. Now they must sift through 44 stand-alone plans and 16 Advantage managed-care plans, weighing the coverage offered against what they now have - if they have coverage - and trying to make sure that the drugs they need are part of a plan they can afford.

Medicare officials won't know how many eligible Americans jump into the pool early, because it will take weeks for that information to filter from the many private plans back to Washington.

Enrolling in the program relies heavily on the use of several online plan-selecting tools, which can be reached via www.medicare.gov. Although the number of seniors who go online rose by nearly 50 percent between 2000 and 2004, according to the Pew Internet & American Life Project, Pew's latest figures show that only 26 percent of people 65 and older go online. That compares with 67 percent of Americans aged 50 to 64, and 80 percent of those aged 30 to 49.

Mike Leavitt, secretary of the U.S. Department of Health and Human Services, has stressed the importance of family members guiding their elderly relatives through the process. However, while most people 65 and older live independently, said Dr. George Kuchel, director of the University of Connecticut Center on Aging at the UConn Health Center in Farmington, the level of support they get from family members and other nonprofessional caregivers varies greatly.

"One thing we see a lot of is older adults in the clinic here whose children live elsewhere," Kuchel said.

The number of plans and patients make it impossible to list every possible pitfall for individuals contemplating the new drug plan, but here are some tips from the experts:

For most people, there's no need to rush. The enrollment period for the drug benefit began this week, but it runs for six months. Matthew Barrett, a spokesman for the state Department of Social Services, said most Medicare beneficiaries should move slowly and carefully in deciding whether to participate in Part D and in selecting a plan. "It's a very important decision," he said. "It would be very regrettable if a beneficiary chose a plan feeling some pressure and it didn't contain the prescription drugs they're taking." (Regular Medicare recipients get to switch plans once in 2006.)

People with "creditable coverage," or drug coverage as good as Medicare Part D, can switch to Medicare Part D with no penalty at any time in the future. Those without such coverage who decide to enroll later will pay a 1 percent-per-month penalty (about 32 cents a month right now) for every month after May 2006 that they didn't sign up.

Some people don't have much time. Anyone who wants to be in on the drug benefit when it launches on Jan. 1 needs to sign up by Dec. 31. Low-income individuals eligible for both Medicare and Medicaid will be assigned to a plan, but they may need to switch to a different plan. Participants in ConnPACE, the state's low-income drug assistance program, should apply to one of the Medicare stand-alone drug plans, although the state Department of Social Services hopes to auto-enroll ConnPACE patients who fail to pick a plan by Dec. 31.

Know what you have now. Because of the "creditable coverage" issue, it's essential that Medicare recipients who have some kind of drug coverage know what it is and whether it's as good as, or better than, the Medicare plans. Existing plans are supposed to tell their members whether the coverage they now have is creditable.

Pam Meliso, senior attorney at the Center for Medicare Advocacy in Willimantic, said some people are covered by comprehensive health plans that include drug coverage. An existing plan may not allow those who are covered to switch to a Medicare drug plan without terminating the entire plan - which could mean the loss of other health benefits. So, seniors need to look before they leap.

Premiums are not the only cost. In the stand-alone plans offered in Connecticut, premiums range from $7.32 a month to $65.58. A bigger premium doesn't necessarily get patients more of the drugs they need, said Judith Stein, executive director of the Center for Medicare Advocacy. Enrollees or their caretakers have to use the online cost-computing tool to look at co-payments, deductibles, drug quantity limits, prior-authorization requirements and coverage in the so-called doughnut hole, the annual gap in coverage for people who have more than $2,250 in total covered-drug spending. She said that's a daunting task for most people.

Special rules apply to the Extra Help subsidy. Low-income people who are eligible for the so-called Extra Help subsidy must apply for it separately from the Social Security Administration. ConnPACE members must apply for this subsidy.

Whose top 100 drugs? One of the comparison points on the www.medicare.gov site is the number of top 100 drugs that are part of a given plan's formulary or approved-drug list. Stein and her colleagues found that the top 100 drugs are based on Medicare discount drug card use and may not be a good indicator of a plan's suitability for a specific patient.

Know your own drugs. Whether a person starts the process online, on the phone or in person, he or she should have a complete list of drugs, doses and the frequency they're taken. Meliso said it's important to get the spelling of a drug just right on the Medicare site.

Talk to your doctor. Patients might be tempted to sign up for a Medicare drug plan that has a generic version of their name-brand drugs before checking with their physicians about the wisdom of such a switch. "Be led by the direction of your physician," Stein said.

Several plan-selecting tools are available online at www.medicare.gov. People can also enroll by phone by calling 800-MEDICARE or the state's CHOICES program at 800-994-9422. Many senior centers and pharmacies are conducting one-on-one information sessions. State officials last week launched an enrollment bus, which will tour the state's senior centers and other locations, loaded with Internet-ready computers and trained counselors. To apply for the Extra Help subsidy, call 800-772-1213, or go to www.socialsecurity.gov.