How to navigate Medicare's confusing new drug plan

Sylvia Hayden of Bellevue, a retired accountant, considers herself pretty sharp at age 76. But when friends recently asked her about Medicare's new drug program, she had to admit: "I don't know how to figure it out either."

And at Four Freedoms House, a retirement residence in North Seattle, Marjorie Hogg, 76, thinks the program "seems like a good deal," but understanding it "gets to be kind of mind-boggling."

Fellow resident Dwight Horton, a 79-year-old retired bus driver, has already given up.

"I couldn't make heads or tails about it," he said. "I decided it wasn't any better than what I'm doing."

As the six-month enrollment period for Medicare's historic — and immensely complicated — new Part D prescription-drug program quickly approaches, the three local retirees are in good company. Beneficiaries all over the area say they are skeptical and confused.

And even many of the hundreds of advocates trained to help them agree the new federal program is not only hard to explain, but the rollout has been disorganized, understaffed and piecemeal.

Mailboxes are starting to fill up with drug-company advertising and red, white and blue "Medicare and You" booklets from the government that warn: "This year is different. Everyone needs to make a decision about Prescription Drug Coverage."

But for the 800,000-plus Medicare recipients in Washington, what decision is right for them? Should they even sign up at all? And, if so, which one of the more than 70 coverage plans approved in Washington should they choose?

The price list for drugs covered by each plan still has not been released on the Medicare Web site, so comparison of plans is difficult or impossible.

The Social Security Administration, responsible for reaching beneficiaries who may qualify for extra financial help, has received back only a small percentage of the millions of applications it has mailed out nationwide. So now the agency has hired a company to call those people to make sure they received the application and understand what's going on.

Many have said they didn't respond because they didn't qualify. But many who did reply left questions blank on the forms or provided unverifiable data, so Social Security staffers are having to individually track down beneficiaries to correct the information.

"This is going on uniformly across the U.S.," said Mike Teefy, a Social Security worker and union leader in Vancouver, Wash.

Meanwhile, the "Medicare and You" booklet contains an error that leads beneficiaries who qualify for the extra help to mistakenly believe their total premium will be covered in every plan.

While the federal agencies defend the outreach process, there's a fear that many vulnerable senior and disabled beneficiaries won't hear about the program or be so confounded they'll just throw the whole thing in the trash.

"It's a mess and I think it's going to be a bigger mess in the next two months," said Kelly Richards, the Four Freedoms House's only social worker for nearly 400 mostly low-income residents.

"I can't believe the government would put something out, and not have it complete, and expect people to buy the product."

Critical to decide

Two years ago, Congress authorized Medicare — the federal health-insurance program for people who are 65 or older, or disabled — to pay for prescription drugs through private insurance plans. Starting Nov. 15, any of the 42 million or so Americans on Medicare can sign up for any plan they want, no matter what their income.

But first comes the mind-boggling part.

The monthly premiums for plans in Washington that simply cover prescription drugs range from $7 to $65. Some plans have a yearly deductible that must be met before the plan starts paying for the drugs (the standard is $250); others have no deductible but a higher premium. Different plans cover different lists of drugs.

Beneficiaries can also choose so-called Medicare Advantage Plans, which also cover doctor visits and hospital stays.

Or they can stick with whatever prescription coverage they have now. But if they want to avoid a penalty if they switch to a Medicare plan later, they have to get a letter verifying that their current plan provides at least as much coverage as plans approved under Medicare Part D.

Deciding which plan to choose is best done by each person. It comes down to factors such as affordability, the drugs the person needs and whether a convenient pharmacy accepts the plan.

But whichever plan is best, it's critical to decide something — and on time.

Those who don't sign up by May 15 and then later decide to sign up will face a penalty. And they won't have a chance to sign up again until the open-enrollment period starting next November.

So the experts stress that signing up before May 15 will get a foot in the door, and after that, beneficiaries can switch plans without penalty at designated times.

But the experts discourage people from signing up for an offer in the mail without comparing plans.

Local, national angst

If that all sounds daunting, join the club. In addition to the local angst over Part D, a USA Today / CNN / Gallup poll taken in late September found that 61 percent of Americans age 65 or older understood the new program "not too well or not at all," and only 24 percent planned to sign up.

"People really are disappointed that the plan they've been waiting for all this time has all these different factors that they have to think about," said Jean Mathisen, manager of Senior Rights Assistance, a program of Senior Services of Seattle / King County, which has been receiving about 100 calls a day about Part D.

Social Security and Medicare spokespeople put a positive face on the outreach process, reminding that enrollment hasn't even started.

"We're not through, but we think the motion is good," said Paula Jurich, a Social Security spokeswoman in Seattle. "Do I think the game plan is a good one? Yes, I do."

Some consumer advocates agree the process is improving and panic is not warranted. But they still doubt that every Medicare beneficiary will even know about the program by the May 15 deadline.

"I don't think any state has the capacity to reach their numbers by then," said Joan Lewis, an executive in the state's Insurance Commissioner's Office who trained volunteers to help others figure out Part D.

"We've begged, pleaded and cajoled to get an extension on the date."

Now Democratic Sen. Patty Murray has joined with Democratic senators from Illinois and Florida to introduce a bill in Congress to extend Part D enrollment until the end of 2006 and provide a chance for participants to change their minds during the year.

"I think it is wrong to scare and confuse people into this decision," Murray said. "We should allow them time to make a good decision for themselves."

Meanwhile, a small army of trained outreach workers and volunteers from federal and state agencies and consumer-advocacy groups — more than 1,500 across the state — are holding hundreds of information events at churches, libraries, senior centers, pharmacies, grocery stores and fire halls.

The task takes patience, though, because some beneficiaries can be frail, unable to see or hear well, or forgetful.

The biggest push right now is to reach low-income beneficiaries who don't qualify for Medicaid or have big drug bills, along with people who are homebound or don't speak English.

The Chinese Information and Service Center in Seattle, for example, is trying to reach at least 4,000 clients who will be affected by the drug plan but don't speak English and likely aren't comfortable using computers.

"Some people believe it's going to cause them a financial burden," said Stephen Lam, director of services for the elderly at the Chinese Center. "And some welcome the idea and think it will help them."

Back at Four Freedoms House, resident Helen Natterstad disproves the stereotype that seniors are all scared and confused.

She pointed a finger to her temple. "This thing up here is working pretty good," she said.

Natterstad said she isn't satisfied with her current, private prescription-drug coverage, which is really expensive. And she understands pretty well how Medicare Part D works, thanks to outreach workers, and plans to switch to a Part D plan.

She is concerned about whether the pharmacy she uses will still deliver. But she has no big fears about picking the plan that's right for her.

"At age 94, what do I have to worry about?"

Marsha King: 206-464-2232 or mking@seattletimes.com

"Do I think the game plan is a good one? Yes, I do."

Paula Jurich