Many miss out on Medicare plan

Deadline passes with 3 million low-income seniors not enrolled in drug program


WASHINGTON -- A day after the deadline to sign up for the new Medicare drug program, Bush administration officials declared it a clear success yesterday, but 3 million low-income seniors who could benefit most from its subsidies remained on the sidelines.

Final numbers are not available, but early estimates indicate that months of efforts to explain the program's benefits to low-income seniors failed to persuade some of them to sign up.

"That is clearly some major unfinished business," said James Firman, president of the nonprofit National Council on Aging. "Phase One is complete, but there is a lot more to be done."

Preliminary figures released after the enrollment period ended at midnight Monday indicate that more than 38 million seniors will have prescription coverage through Medicare or another source, and administration officials said the total is expected to rise when final numbers come in.

That means that the program, despite a stumbling start, will surpass the goal of ensuring that 90 percent of seniors have some form of drug coverage, said Health and Human Services Secretary Michael O. Leavitt.

"It is one of the biggest changes that will have occurred in our nation's history in health care," Leavitt said.

Medicare Part D, considered President Bush's most significant domestic policy initiative, enables seniors to buy coverage for outpatient prescriptions through dozens of competing private insurers.

Although many seniors complained about the complexity of the program, recent polls indicate that most who have signed up are satisfied with their coverage.

"Anybody who had any doubt that seniors could choose coverage that gives them what they want at lower cost needs to look at what we did here," Medicare Administrator Mark McClellan said. "No question it has been some effort for them to get into coverage. But they are saying it has been worth the effort."

Many Democrats say the program is rife with pitfalls that make any victory celebration premature.

Some have questioned the accuracy of the administration's enrollment numbers. And senators from both parties joined to address one problem yesterday by vowing to move quickly on legislation that would waive a late-enrollment penalty for seniors who missed this week's sign-up deadline.

For many low-income seniors who have yet to enroll, a major stumbling block appears to be an asset test, advocates say.

Individuals with $11,500 or more in savings and couples with $23,000 or more do not qualify for subsidies. Some of those seniors might have modest incomes that make them reluctant to sign up for the program, which requires monthly premiums and regular co-payments.

AARP has called on Congress to eliminate the asset test, but Republicans and Democrats haven't agreed on the issue.

For middle-class seniors who have signed up, a problem looms that could be significant. It is called the "doughnut hole," a coverage gap intended to save the government money. Those whose drug costs for a year reach $2,250 must pay the next $2,850 themselves, after which Medicare pays 95 percent of further drug expenses.

Nearly 40 percent of seniors might be in danger of falling into the gap, and by some calculations it will start to be widely felt about Labor Day. The coverage gap could anger seniors and turn the prescription program into a political issue in the election campaign.

"The big issue about this program no longer has to do with who has enrolled; the issue is how it's going to work between now and November," said Robert Blendon of the Harvard School of Public Health, an expert on public opinion and health care issues.

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