Beneficiaries told to shop early for drug plan

Kevin Freking

WASHINGTON — Medicare officials learned an important lesson this year when it came to the new drug benefit, one they hope will lead to fewer headaches for the elderly and disabled come Jan. 1.

Going into the program’s first year, officials confidently told beneficiaries to take their time. As long as they enrolled by Dec. 31, they could expect to have insurance coverage for their medicine when they showed up at the pharmacy counter.

But those predictions proved way too optimistic. Many didn’t select an insurance plan until just days before the new program took effect. When they showed up at the pharmacy, their application had yet to be processed. Insurers and Medicare operators were swamped with angry phone calls from frustrated pharmacists and patients.

No promises of a seamless start are being made now for procrastinators. Medicare officials are asking beneficiaries to start studying their options. That way, when the open enrollment period begins Nov. 15, they can make a decision sooner rather than later.

Also adding to the urgency: For the first year, beneficiaries had six months to sign up. This time, they have six weeks.

“There are a lot of people who will have a change in drug needs,” said Leslie V. Norwalk, the acting administrator for the Centers for Medicare and Medicaid Services. “With that change, they should be taking a look and making sure that their plan still makes the most sense for them.”

About 22.5 million seniors and the disabled are enrolled in Medicare plans that help pay for their medicine. The program has been billed as the biggest change to seniors’ health care in 40 years. Under the program, the federal government subsidizes the cost of medicine. Consumers pay a portion of the program’s costs when they buy medicine as well as through monthly insurance premiums.

The government subsidy averages more than $1,000 per senior, but it’s higher for low-income beneficiaries.

Seniors will continue to have scores of plans to choose from during the program’s second year. Most will have even more options than in the first year because the total number of plans around the country will jump from about 1,400 to nearly 1,900.

Medicare officials advise people to enroll in a plan by Dec. 8 if they want to be sure they have coverage under their new plan on day one.

“That’s a concession to reality that I appreciate,” said Robert Hayes, president of the Medicare Rights Center, an advocacy group for seniors.

Hayes said Congress should consider approving a longer enrollment period for next fall’s enrollment, a sentiment being echoed by other counseling services.

To deal with the shorter time frame, Norwalk said people should compare plans on the Medicare Web site even before enrollment begins. They also can call 1-800-Medicare.

She said that if beneficiaries are happy with their plan and want to stay with it, they don’t have to do anything. The federal government will automatically enroll them for next year. Polls show a large majority of beneficiaries are satisfied with their drug coverage.

Still, consumers will want to make sure their insurer has no drastic changes in store for them next year. They’ll want to check how much their monthly premiums will cost. Besides checking whether their drugs are covered by the plan, people must check what their copays will be when they pick up their medicine.

Insurers use a variety of tools to discourage seniors from taking certain medicines. Such tools can include higher copays for certain drugs, or pharmacists must get prior approval from the plan before dispensing medicine. Drugs that had low copays this year could require a higher payment next year.

“Consider whether it’s covered and ask at what cost and subject to what restriction, and pray to God you don’t get sick and need drugs later in the year that aren’t covered,” said Hayes, who has often been critical of the program.

Low-income seniors, those who qualify for Medicare and Medicaid, can change plans any time during the year. But other beneficiaries won’t be able to change plans, Hayes said. That’s an important difference from the first year when people were given a chance to switch plans once if they found one more to their liking.

(Associated Press)