May 15 deadline looms on Medicare drug plan

April 12, 2006|By M. WILLIAM SALGANIK | M. WILLIAM SALGANIK,SUN REPORTER

Jake Miller, 74, sat down yesterday at a table at the Lansdowne Baltimore Highlands Senior Center, spreading before him a sheaf of printouts showing all the medications he had gotten in the past year and how much he had paid. He estimated that he spends about $500 a month to fill 11 prescriptions.

Across the table counselor Omalara Agbaje of My Medicare Matters typed the prescriptions into a laptop, then showed Miller how much he would pay under different versions of the new Medicare prescription program.

"You pay $130 for Nexium," Agbaje said, pointing at her screen. "Guess what? With this plan, it's $23."

Miller signed up, along with another dozen or so at yesterday's enrollment event. Federal, state and local officials are pushing to get more seniors enrolled by May 15.

After the deadline, beneficiaries will pay a penalty of a 1 percent increase in premiums for each month delayed. For example, if a person delayed enrolling for 12 months, his premiums would go up 12 percent.

Although enrollment began in November, Miller said he waited until the approaching deadline because, "I didn't understand this. Then this lady called up and said, `You've got to make a decision soon.'"

So far, more than 6 million seniors and disabled people - 15 percent of Medicare beneficiaries -have signed up for the new plans.

Another 11 million were enrolled automatically because they had previously joined Medicare HMOs or had been covered by state Medicaid programs. And about 10 million don't need to enroll because they're covered by private employer retiree programs or by federal employee or military programs.

But an estimated 10 million - nearly one-fourth of the 43 million eligible for Medicare - still need to make a decision in the next month, according to Dan Mendelson, president of Avalere Health LLC, a Washington consulting firm.

(The enrollment totals actually leave 15.4 million unaccounted for, but Mendelson believes that more than 5 million have coverage from the Department of Veterans Affairs or from other sources not counted in the totals.)

In Maryland, enrollment is running slightly ahead of the national pace, with 17 percent - or 127,080 - signed up in the new program, 338,909 covered by or transferred from existing plans, and 241,343 not accounted for, according to late March counts from the federal Centers for Medicare and Medicaid Services.

Whether those enrollment numbers are deemed a success or a failure seems to depend on whether the person offering the evaluation was for or against the way the program was structured.

"It's going surprisingly well," said Jean W. Roesser, the state secretary of aging, one of the officials in Lansdowne yesterday for the enrollment event. "I think we're in good shape."

She said state and local officials would be making a final push between now and the deadline. "Particularly in these last 30 days, we're going all out to reach as many as we can," she said.

But a critic of the Medicare drug plan, Robert M. Hayes, president of the New York-based Medicare Rights Center, said, "By any objective or historical measure, the enrollment numbers are appalling."

When Medicare began in 1966, the government got 93 percent of seniors enrolled during a shorter sign-up window, he said.

The current enrollment drive has lagged, he said, because of "the inadequacy of the benefit itself" and "confusing and chaotic marketing."

Even critics such as Hayes, however, believe many Medicare beneficiaries would do well to sign up before the deadline.

While his organization still was working to solve a number of complaints from people who had signed up but had trouble getting medications, he said the number of new problems was declining and that his organization was focusing most of its efforts on signing up new participants. "We're clearly in the world of harm reduction," he commented.

In the end, Agbaje, the counselor, calculated that Jake Miller would pay $2,546 a year in premiums and co-payments - an average of about $200 a month compared with the $500 he estimates he pays now.

Donald Santmyer, 71, of Morrell Park, said he now pays $370 a month for five medications. But after signing up for a plan, he said, his monthly premiums and co-payments wouldn't be much more than $100. Santmyer said he was signing up so close to the deadline because he had recently retired from his job as a construction foreman.

And Ruby Griffin, of Lansdowne, who declined to give her age, said she had learned that she qualified for a moderate-income subsidy, and could expect to pay only $350 a year, instead of the $200 a month she had been shelling out.

"I feel a little relieved," she said as she finished signing up.

In Maryland, 47 prescription plans are available. Each covers different medications, has different monthly premiums and co-payments, and different networks of participating pharmacies.

Speaking in Jefferson City, Mo., yesterday, President Bush conceded that so many choices could be daunting, but defended the design of the program.

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