Drug-plan hassle redux

Md. Medicare prescription choices rise to 56

terms, prices change

November 12, 2006|By M. William Salganik | M. William Salganik,Sun reporter

The hundreds of thousands of older Marylanders who struggled through last year's first sign-up for Medicare's new prescription coverage faced a daunting task: sorting through 47 private plans with different monthly premiums, different co-pays, different lists of covered drugs and different networks of participating pharmacies.

Now the message to those seniors who are breathing easy after all the hassle is: You need to do it all over again. And there are even more plans, 56, this time around.

Medicare reopens prescription coverage enrollment on Wednesday for a six-week period through Dec. 31. Already-enrolled seniors who do nothing will stay in the plan they're in. And while 81 percent of enrollees reported they were very satisfied or somewhat satisfied with their choice, according to a Kaiser Family Foundation survey, advocates and counselors caution against automatically re-upping.

Lists of covered drugs can change. Co-payments can change. Premiums can change - up or down.

Cigna's Cignature Rx Plus, for instance, is dropping its monthly premium by more than a third next year, from $41.98 to $26.70.

But many premiums are rising. The Humana Complete plan, one of the more popular, is boosting the monthly cost more than 41 percent, from $52.88 to $74.40. And while this year it provides so-called "doughnut hole" coverage for both generic and brand-name drugs, next year it will pay only for generics.

"Absolutely do it over again," said Arnold J. Eppel, director of the Baltimore County Department of Aging.

Despite worries that overwhelmed seniors will shy away from a repeat performance, there are early signs that the message is getting out. The Maryland Senior Prescription Drug Assistance Program, which provides a $25-a-month subsidy to moderate-income seniors, drew 100 for an information session in Salisbury last week, and another 150 in Linthicum.

"It's been a steady stream," said Richard Popper, director of the program. "I wasn't sure whether I'd be hearing crickets at these things, because people were so burned out."

Lorraine Shifflett, 73, of Perry Hall, is one who was reviewing her options last week - and was delighted to find out she could save about $1,000 a year by switching plans next year.

Shifflett said she takes seven medications. Her husband was a Bethlehem Steel worker who lost retiree health benefits in the steelmaker's bankruptcy, and she had no prescription coverage until this year.

After getting telephone counseling, Shifflett said, she signed up for a WellCare prescription insurance program for 2006. At first, it worked well, but in July she hit the "doughnut hole" coverage gap - the standard Medicare drug benefit cuts off once spending hits $2,250 and doesn't resume until $5,100. She began ordering medications from Canada.

Last week, she attended an information session at Seven Oaks Senior Center in Perry Hall. With about half a dozen other seniors, she listened to a presentation by Pat Venable, coordinator of the Baltimore County Senior Health Insurance Program (SHIP). Then, she sat down at a computer with Dave Skalitzky, a SHIP volunteer, who entered her prescriptions into the Medicare Web site.

She found that her WellCare plan would cost her about $3,500 next year - the combined cost of premiums, co-payments and doughnut hole medications - but several other programs had costs in the $2,500 range. Skalitzky handed her a sheaf of printouts, and she plans to look over the materials and choose a new plan.

"I'm going to take these home," she said, "and show my son what a difference it is - it's unreal."

At the same session, Lorraine Feher, 76, was looking for a better deal than her Aetna Medicare HMO, a medical plan that includes prescription coverage, because her monthly premium will rise from $85 to $121. But after a close scrutiny of options, including potential deductibles and co-payments if she were hospitalized, she declared, "I'm sticking with Aetna."

What makes the process so complex and time-consuming is that the answer - the best plan - is different for each person, and different for 2007 than for 2006, based on the particular combination of medications taken.

Helping a couple last week, for instance, Popper told the husband that he could save money with a higher-premium plan so he could get full coverage in the doughnut hole and advised the wife to switch to a cheaper plan with less benefits because she takes fewer medications.

"It can be a Rubik's Cube," Popper said.

Popper's statewide program, local counseling programs such as Venable's, and advocacy groups such as AARP have scheduled dozens of information sessions and enrollment fairs over the next few weeks. (See box for information, and www.baltimoresun.com for full schedules.)

Based on interviews with administrators, advocates and counselors, here's a rundown on some key differences this year as well as other points to keep in mind:

What's different

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