Drug dilemma


A woman thumbs through a stack of paperwork as she trys to figure out her Medicare prescription options. The new Medicare prescription drug program offers dozens of options with widely different ranges of costs and benefits which has been confusing to seniors signing up for the program.

KRT
Published: Sunday, January 1, 2006 at 6:01 a.m.
Last Modified: Saturday, December 31, 2005 at 10:27 p.m.
For millions of senior citizens struggling to make sense of Medicare's new drug coverage, one pitch is enticingly simple: Don't do anything.
It's a message being pushed by private insurers eager to hang on to 5 million older Americans who already buy supplemental Medicare policies and now must decide whether to stay with them or switch to another plan.
In workshops and town hall meetings throughout California, insurance sellers are encouraging customers to indulge in the urge to avoid a complex decision.
"As members of Secure Horizons, you don't have to do anything! Yeah!" shouted Holly Ackman, a tall redhead wielding a wireless microphone at a recent workshop attended by 400 Ventura, Calif., seniors. "We know that 99.9 percent of you are going to be absolutely delighted to stay with us!"
Similar sessions are being held across the nation to enroll as many seniors as possible in the drug program's critical first year. Under the new benefit, private plans contract with Medicare to provide prescription drug coverage, with costs estimated at up to $700 billion over a decade.
Although the "don't do anything" message might make sense for some people, consumer advocates caution that others could lose out financially, and even medically, if they follow that advice.
Medicare's drug coverage options are complex, and the consequences for making a wrong choice are serious, said David Lipschutz of California Health Advocates, a nonprofit agency that focuses on Medicare education and advocacy.
"You shouldn't rely on marketers to give you completely unbiased information about your choices," Lipschutz said. "That's not to dissuade people from going to these things. But they need to supplement those sessions with information from a trusted source."
A spokeswoman for Secure Horizons, owned by PacificCare Health Systems, said the town hall meetings are intended to inform customers of new benefits. Most of those attending are already members, said spokeswoman Cheryl Randolph.
Presenters are trained in Medicare's marketing guidelines, which ban sales at the meetings. Since October, Secure Horizons has held dozens of the sessions for its 360,000 California members, Randolph said.
If people want to explore other options, "they always should," she said. "We think competition is a good thing."
The start of a recent Secure Horizons town hall meeting in Ventura was like a cross between a Veterans of Foreign Wars conference and a pep rally.
"How many veterans do we have here today?" boomed Ackman, the woman with the Oprah-style wireless microphone, to a roomful of gray-haired men and women.
"What'd she say?" asked an elderly man in a cap that read "Korean war veteran," adjusting his hearing aid.
Before he got an answer, Ackman had him and everyone else on their feet to recite the Pledge of Allegiance. A giant video screen displayed an image of the U.S. flag, flapping in the wind.
"That's great!" Ackman lauded the crowd as they sat back down. "We just don't get to salute our flag enough anymore!"
Kyal Moody, a Secure Horizons executive, took over to talk about "robust drug coverage" and added vision services in 2006. He gave a brief history of Medicare and the 2003 legislation that added Part D prescription coverage to the government-sponsored mix.
Then it was back to the day's message.
"What do people on Secure Horizons have to do to get their Part D coverage?" he asked the crowd.
"Nothing!" a few shouted back.
Moody looked over at Ackman.
"Wow! That was pretty weak, huh, Holly?" he said. "Let's try that again. What do people on Secure Horizons need to do to get their Part D coverage?"
"NOTHING!" the audience boomed in unison.
Moody looked pleased.
"You'll be hearing that a lot today," he said.
Participants seemed to struggle most with an explanation of prescription coverage. As with many of the plans being offered, drugs are divided into tiers, each with differing cost-sharing amounts.
Pharmacist Carolyn Iteen used charts to illustrate the so-called "doughnut hole," a gap in pharmacy coverage in which beneficiaries pay 100 percent of costs.
She also offered several tips for lowering drug costs, from switching to generics to ordering larger supplies by mail.
It all proved too much for Ray Burkart, 78, of Ventura.
"You'd have to be a genius to understand what she just said," Burkhart said at the end of the 20-minute talk. "I'm too old for that."
Many seniors are confused, say advocates who help the elderly navigate Medicare. The government is spending $300 million on an education campaign that offers assistance in person, by phone and on the Internet.
Medicare Today, a national nonprofit group, offers one-on-one counseling for people who need help comparing policies, said spokeswoman Samantha Rothenberger. The group does not advocate any particular plan.
"It's time-consuming," she said of the decision seniors must make. "You have to know what drug you are taking and what services you need. Then it's a question of sitting down and making some important choices."
If people pick the wrong plan, they may not be able to get a specific drug that they need, she said.
Medicare will impose premium penalties on those who fail to meet a May 15 enrollment deadline.
For Nancy Rushing, the Secure Horizons' workshop sealed the deal. She would stay with that plan, said Rushing, 73, of Ventura.
"I still don't understand it," she said of the new drug coverage provisions. "But I've been with them a long time, and when my husband died of cancer, they took care of everything. I think I'm going to sit tight."
The Los Angeles Times Jahn Ziegenholm and granddaughter Riley Rivera attend a Medicare meeting in California.
The government is spending $300 million on an education campaign that offers assistance in person, by phone and on the Internet.

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