Medicare Part D working through some kinks

July 27, 2006|by CANDICE BOSELY

It's been more than two months since the initial enrollment period for Medicare's prescription drug plan, called Part D, ended. Not over yet, though, are some of the kinks in the program.

Katrina Eversole, who became the go-to person in Washington County when it comes to Part D, is still fielding questions from people two months after the initial sign-up period ended May 15.

She's heard from people who somehow ended up enrolled in two or three plans instead of one, and others who thought they were enrolled in a plan but learned they were not.

Others she's heard from did research and believed they enrolled in the plan of their choosing but, because they are low-income, were automatically enrolled in another randomly selected plan by the government.


Mailings from the insurance companies have been slow.

Some people reported problems that Eversole was able to figure out, but could not solve because she lacked the tools or clout. Sometimes she'd contact a regional Medicare office. Other times she'd call representatives of the 47 drug plans available to Maryland residents.

"I would call people thinking I was frustrated and at my wit's end and even people with the plans would say, 'Isn't this something?'" Eversole - a health insurance advocate with the Senior Health Insurance Assistance Program who works out of the Commission on Aging's offices - said.

Part D allows people to choose from among dozens of competing private insurance plans and is intended to help people save money on their prescription drugs. Anyone eligible for Medicare can enroll in a Part D plan, regardless of income. Low-income seniors can apply for extra help.

Although nationwide there are tales of woe from people complaining that Part D is costing them more than they paid before the plan was implemented, Eversole said she has heard from very few people with such a problem.

Of course, there is the "doughnut hole."

A gap in coverage, the doughnut hole kicks in when people have reached $2,250 in coverage. After that, people have to pay out-of-pocket for their next $3,600 in drug costs, with Part D coverage then kicking back in.

A pharmacist's concerns

That doughnut hole, or gap in coverage, is especially worrisome to an area pharmacist, who asked that his name not be used.

He said a lot of his customers have reached the doughnut hole - which he said is not surprising given that two common prescriptions are not cheap. Cholesterol medication costs around $150 a month, while blood thinners for high blood pressure cost another $130 a month, he said.

"Twenty-two hundred (dollars) is not enough," he said, referring to the starting point of the gap in coverage. "I don't know who came up with that but it's nowhere near enough."

In Maryland the most popular Part D plan is AARP's United Healthcare. Twenty-four percent of the state's residents who signed up for a Part D plan signed up for that one; the second most popular one is Humana, selected by 14 percent of those who signed up for a plan, according to data supplied by Eversole.

About 10,000 Washington County residents signed up for a Part D plan; another nearly 7,000 did not have to because they have a "creditable" plan recognized by the federal government as being as good or better than Part D.

Creditable plans include those offered by Veterans Affairs; TRICARE, a plan for members of the military; and the Federal Employees Health Benefits Plan. Some plans offered by private employers also are creditable.

The May 15 deadline was a one-time sign-up date.

Starting this year and in following years, the normal period to enroll in a plan is scheduled for Nov. 15 to Dec. 31.

Many of those already signed up for a plan can change it only during that time. Low-income seniors, however, can change their plans even more frequently - on a monthly basis, if needed.

Those who have applied for extra financial assistance might not be too pleased to learn that they have to re-sign up for such help every year, Eversole said.

She was guarded in her assessment of Part D.

"There are flaws in the system that I wish they would have somehow foreseen," Eversole said.

Maryland had so many good programs in place to help people, Part D didn't provide much of a boon, she said.

Along with Medbank, which provided free medications to those who qualified, Eversole cited the CareFirst Senior Prescription Drug program and the Pharmacy Assistance Program as Maryland's beneficial programs.

Because of Part D, some people can no longer use Medbank, but Medbank is still trying to help.

Those who apply for but are denied additional Social Security assistance can bring that denial letter to Medbank and the organization might be able to provide assistance, according to Eversole.

A satisfied customer

While Eversole hears from people with problems, not everyone is unhappy with Part D.

"Everything's been doing really great," said Ron Powell, 66, of Hagerstown. "I haven't had any problems at all. None."

Powell signed up well before the May deadline and started using Part D to receive his medications in February. All of his medications but one - folic acid - are covered. Folic acid, for Part D purposes, falls into the category of vitamins and minerals category, none of which are covered.

Despite his initial anger with AARP for going along with Part D - Powell even canceled his AARP membership - he signed up with AARP's Part D plan because it was the best one for him.

His only recommended improvement for Part D is that people be allowed to receive more than 30-day supplies of medications at a time. Being forced to go to a pharmacy every 30 days can be a hassle and a burden for Powell, who said he lives paycheck to paycheck.

Still, he said he has not had to go without his medications.

"I can't say that I've had any difficulty," he said.

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