Prepping seniors for new benefits

In front of Missoula Aging Services on Stephens Avenue is a picture of an elderly woman holding two prescription drug bottles and screaming in terror.

“Volunteers needed!” reads the text on the sign. “Help seniors understand Medicare changes.”

Hoping to help Missoula’s seniors avoid the model’s anxiety, local agencies are mobilizing to answer a growing chorus of questions about Medicare’s prescription drug benefit, which takes effect on Jan. 1, 2006.

“It will cause stress,” says Annette Sontag, the director of the Missoula Senior Citizens Center.

Insurance companies began marketing the Medicare Part D plans to seniors Oct. 1. As of Sept. 30, 47 different plans were available in Montana, with monthly premiums ranging from $1.87 to $99.90.

Since July, the Missoula Senior Citizens Center has hosted monthly presentations on Medicare Part D. Presenters included staff from Missoula Aging Services and representatives of Congressman Dennis Rehberg’s office. The center plans to continue these monthly meetings through spring 2006.

Renee Labrie and Mary Dalton, state health insurance assistance program counselors at Missoula Aging Services, fielded over 100 calls in September from seniors with questions about Medicare Part D.

“I still get myself mixed up on it,” said one of the callers, 78-year-old Missoulian Rita Murray, in a typical complaint.

Missoula Aging Services also employs a group of about 25 volunteers to work one-on-one with seniors and to answer their questions about prescription drug plans. Each volunteer spent six preparatory hours studying the intricacies of the Medicare program.

President Bush signed the Medicare Prescription Drug, Improvement and Modernization Act in December 2003, a response, in part, to a 27.6 percent increase in prescription drug prices between 2000 and 2003, according to the AARP. “Drug coverage under Medicare will save our seniors from a lot of worry,” said President Bush at the bill-signing ceremony. But nearly two years after the bill’s passage, AARP reports that the retail price of name-brand drugs continues to rise at three times the rate of inflation.

Like drug prices themselves, the cost of Part D has ballooned. Estimated in November 2003 to cost $400 billion over a decade, the 10-year tab is now estimated at $724 billion. Sontag says the original bill underestimated the cost of the program.

That program “looks, smells, and acts like insurance policies,” says Curtis Hammond, the volunteer coordinator at Missoula Aging Services.

A senior enrolling in Medicare Part D would pay a monthly premium averaging between $20 and $40—a premium that would be deducted directly from his or her Social Security check. There is also a $250 deductible per calendar year.

“I’m worried about anything that takes money out of a Social Security check,” says Hammond. “It’s not like they [seniors] have unlimited resources. Even if it’s just $20, it’s $20 out of their heating bill, their grocery bill.”

Why do the premiums vary in price? Because certain plans offer extra services, such as expanded dental care, says Hammond. Still others do not charge the standard $250 deductible. And not every plan covers the same prescription drugs.

These variables complicate the details of the plan, but the skeletal benefits are constant. The average senior will get about $1,500 in benefits from Part D and will be responsible for paying about $3,600 out of pocket toward prescription drugs.

Say the terrified model on the placard outside Missoula Aging Services signed up for Part D and spent $5,100 on prescription drugs. She would pay for a year’s worth of premiums, the deductible, and 25 percent of her drug costs. Medicare, in turn, would pay for 75 percent of her drug costs until it had paid out benefits totaling $1,500. Then she would enter the plan’s “doughnut hole.” At this point, the drug benefit ceases as she pays $2,850 of her own money toward her drugs.

“I honestly don’t know how our seniors are going to figure a lot of this stuff out,” says Hammond.

If a senior did spend $3,600 on drugs, that senior would then enter the “catastrophic coverage” category of Part D, meaning that Medicare would pick up 95 percent of the pharmacy tab for the remainder of the year.

So you can be sick, but don’t be really sick, unless you’re really, really sick.

Back at the Senior Citizens Center, Annette Sontag wants to make sure seniors understand the plan early, before it ends up costing them more. After May 15, 2006, seniors who want to sign up for the plan will have to pay a penalty to enroll.

Sontag worries that the program is more complicated than it needs to be, which may discourage seniors from learning about their options.

Hammond agrees that Part D can be hard to understand. “Every presentation I go to, I come back with, ‘Why is it so hard to have a simple plan?’”

“It takes a younger mind with a little more activity to get into the depths of it,” says Murray.

Hammond also worries about fraud. He has heard about cases where scam artists try to sell fake plans to seniors in order to get their credit card numbers. With millions of seniors weighing the virtues of dozens of different plans, “the potential for fraud, it’s huge,” he says.

Not all seniors are worried about Part D.

Dick Pickens, 70, says he won’t be signing up for the plan because currently he takes no prescription drugs. He is shooting pool in the basement of the Senior Citizens Center with two friends as the Frank Sinatra song “My Way” plays in the background.

“When I can program my VCR,” he says, “I’ll worry about the Medicare.”

But for seniors like Rita Murray, navigating the labyrinthine options of Part D has already been a challenge. “You can tell there’s a bunch of lawyers in Washington,” she says.

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