Saturday, December 10, 2005

Sacra Bee: Agency offers help with a tough choice =12-10-05

Advocates work with Medicare recipients to pick drug plan
By Nancy Weaver Teichert -- Bee Staff Writer
Saturday, December 10, 2005
Story appeared in Metro section, Page B1

With her 11 pill bottles spread out on the desk, Janice Kennaday, 66, shook her head in confusion over how to pick a Medicare drug plan to best suit her needs.
"It just confuses me," said Kennaday, who faced a choice of 47 drug plans available statewide in California. "I'm sure I'm not the only one in that boat."

But about an hour and a half hour later, she held in her hand a printout of four affordable plans that will cover all her medications and allow her to fill the prescriptions at her favorite pharmacy.

For help, Kennaday turned to the office of the Health Insurance Counseling and Advocacy Program (HICAP), a small, mostly volunteer nonprofit agency charged with helping implement the new Part D drug plan, the biggest reform ever made to the 40-year-old Medicare program.

HICAP's trained volunteers have spoken at hundreds of community events across the region and provide free one-on-one counseling to help people like Kennaday pick a drug plan.

Kennaday's experience this week illustrates that process.

In the library of HICAP's office in West Sacramento, volunteer Barbara Grossman turned on her computer and logged onto Medicare's interactive Web site. Medicare beneficiaries can enter their personal information on the secure Web site to obtain details and compare drug plans.

Many of those HICAP helps are older and disabled people who do not have a computer or do not have enough expertise to use the Web site's tools. Medicare officials have urged adult children to help their parents with the site. People also can call a Medicare counselor on the 24-hour telephone advice line.

Kennaday recently got a computer but hasn't learned how to use it. She said Medicare's phone adviser suggested she call HICAP. Her appointment was made by her in-home care worker, Diane Colfer-Moore, who is helping all six of her clients select a plan.

"I want to make sure this is the right plan for her," said Colfer-Moore. She said all of her clients "are panicking" about choosing a drug plan.

Grossman looked over Kennaday's array of bottles, checking the names, dosages and directions. She asked basic questions about Kennaday's coverage by both Medicare and Medi-Cal. She also looked over all the letters Kennaday had gotten from Medi-Cal and insurers.

It turned out Kennaday had been automatically assigned a drug plan by Medi-Cal and that she may also have signed up for a different plan over the telephone. The profusion of plans - 47 stand-alone plans and 10 managed-care options in the Sacramento region - has led to some confusion among California's 4.3 million Medicare beneficiaries.

Grossman called up Medicare's Prescription Drug Plan Finder on her computer screen and started clicking. "It's time-consuming but other than that, it's pretty simple," she said.

She conducted a general plan search using Kennaday's ZIP code and carefully entered each prescription medication and selected her preferred pharmacy.

Earlier in the day, Grossman said, she helped a client pick a plan in less than an hour. It took longer for Kennaday because of her multiple medications.

"They don't cover this one?" Kennaday said, looking concerned as she held up a pill bottle.

"They do," said Grossman. "That's not a problem."

The Web site helps compare the many factors involved. Cost is a factor, but it's more than just comparing monthly premiums. Beneficiaries should weigh deductibles, whether their drug costs are high enough to reach catastrophic coverage or if they should pay more to get coverage in the so-called "doughnut hole" - or gap in coverage.

Grossman said that while all of Kennaday's drugs would be covered by the four plans suggested, she would need to contact more than one doctor to get the prior authorization required by most of the plans.

Grossman said plans are offered by an array of private insurers and many details were not available on the promised date of Nov. 15 when enrollment started. Most of the information is available now, she said.

Comparisons are more difficult for those who aren't limited to lower-cost plans by their incomes, she said, because they have more options to consider.

Grossman said she has had trouble finding adequate information on the Web site about the cost of covered drugs, which is needed to calculate when deductibles and coverage gaps are reached.

Grossman is about as close to being an expert as anyone on the new coverage. A 68-year-old retired geriatric nurse practitioner, she has volunteered with HICAP for six years. She knows she's lucky to have her own prescriptions covered by her husband's retiree health plan.

HICAP is part of a nationwide network of State Health Insurance Assistance Programs, which offer free, unbiased information about Medicare. For more than a decade, it has helped with claims, appeals and denials of service for Medicare and other health insurance. It's partly funded by the Older Americans Act.

While Grossman was counseling Kennaday, other HICAP staff members were discussing new billing problems that they will bring to the attention of federal officials. And, another week of community events was being scheduled.

Grossman is an aggressive advocate for her clients but she talks to them in a reassuring voice to teach them how to advocate for themselves.

Kennaday left with her drug plan choices narrowed to her best options and the realization that she'll pay $20 a month in co-payments that she doesn't now pay to receive drug coverage through Medi-Cal.

Grossman encouraged Kennaday to ask her physicians for prescriptions for three-month supplies of regularly used drugs to lower her costs. Co-payments are made only when prescriptions are filled, not based on quantity, she explained.

After Kennaday left, Grossman looked at her legal pad and dialed the telephone number of her next client, who lives in rural El Dorado County.

"I'm a HICAP counselor who is 30 minutes late," said Grossman as she quickly dialed. She reassured the disabled women who had been waiting by the phone, "No, I'm not going to forget you."

Medicare drug plan Q&A
Q: How does Medicare prescription drug coverage work?

A: Anyone in Medicare can get the new drug coverage, known as Medicare Part D. Being "in Medicare" means enrolled in either Medicare Part A (which covers hospital and some home health care as well as skilled nursing facility care) or Part B (doctor visits and other outpatient care).

To get Medicare drug coverage, you must enroll in one of the private insurance plans Medicare has approved. Plans vary in coverage and payments, but the overall value of each package must be at least as good as the "standard" Medicare prescription drug benefit, which is the minimum set by law.

Q: How much will Medicare prescription drug coverage cost me and what will I get in return?

A: The standard Medicare drug benefit offers insurance that will pay some drug expenses and protect against very high costs.

The monthly premium is the amount you pay to a Medicare drug plan sponsor to purchase coverage. The amount will depend on which plan you choose. The average premium for standard drug coverage in 2006 in California is about $25. But some plans will charge less and some considerably more.

This will be in addition to your monthly premium for Medicare Part B. There are no discounts for married couples.

Additionally, there are annual deductibles and many variables that can affect your total cost per year, including the so-called "doughnut hole" gap between basic and catastrophic coverage. Your drug needs and these variables should be considered when choosing a plan.

Q: Can I wait and sign up for Medicare drug coverage later when I need it?

A: The plan is voluntary, but there may be a financial penalty for late enrollment.

With some exceptions - including those now in a former employer's health plan that provides drug coverage deemed equivalent to a Medicare plan - the penalty for signing up late is a higher premium. An extra 1 percent of the national average premium will be charged for each month's delay. The longer the delay, the higher the premium. The penalty adds up quickly, and will be charged for as long as you have Medicare drug coverage.

Those already on Medicare must sign up prior to May 15, 2006 to avoid a penalty.

- Source: AARP

About the writer:
The Bee's Nancy Weaver Teichert can be reached at (916) 321-1058 or

Janice Kennaday, 66, overcame her confusion over picking a Medicare drug plan with the help of a Health Insurance Counseling and Advocacy Program volunteer, who assisted her using a Medicare Web site.
Sacramento Bee/Anne Chadwick Williams

With the help of the Health Insurance Counseling and Advocacy Program, Janice Kennaday, 66, found four options among Medicare drug plans to cover her 11 prescriptions.

About the writer:
The Bee's Nancy Weaver Teichert can be reached at (916) 321-1058 or .

No comments: