Medicare Part D: Helpful for many, a big mess for others
03-Dec-2006: Judy Speer paid almost $200 a month in January and February for her prescriptions through the new Medicare Part D prescription drug plan.
It was a lot of money, but what could she do? She needed them.
"Come March, the woman at the pharmacy said, 'That'll be $1,400,'" she said.
Speer, 65, went home to contemplate what had just happened. She had fallen into the "doughnut hole," or coverage gap in the middle of most Medicare Part D plans. Speer, of Battle Creek, went on to pay a total of $3,600 over the next three months until she got out of the hole.
Speer was lucky to have enough money in the bank to pay out of pocket for her nine prescriptions, six of which are brand-name drugs without generic equivalents. But the money had been a gift from her parents.
"I wanted my husband and I to go on a cruise, but we never did," Speer said. "I thought maybe we could tuck it away."
Since Medicare began offering the Part D prescription drug plan starting this year, there have been happy stories and horror stories.
It is now open-enrollment time for 2007, and seniors will be confronted with higher premiums, higher deductibles and the continued threat of falling into the doughnut hole. Many will have to decide if Medicare Part D is worth it.
The enrollment period, for coverage starting Jan. 1, ends Dec. 31, but experts suggest people enroll by Friday to ensure that coverage is established at the very beginning of 2007.
Medicare Part D works well for low-income individuals and couples who qualify for a low-income subsidy, or "extra help." The cut-off in annual income for 2007 for this subsidy will be $14,700 for singles and $19,800 for married couples living together.
"Because of my low income, I don't have to pay premiums," said Martha Dean, a 56-year-old woman on disability. "You know a lot of people have to pay so much a month. I guess Medicare picks that up for me. I just pay copays."
Her copays are never more than $5, and her doctor works with her to find a prescription that is on her list of covered medications.
"I looked up the cost of my prescriptions, what the actual cost would be," said Dean, of Battle Creek. "It was like $400, maybe $500 a month, and there's just no way I could afford that on my income."
While Part D works for those in very low-income households, others have been racking up credit-card debt, skipping prescriptions and burning through money saved for retirement. Many felt pressured to sign up hastily for programs that turned out to be not suited to their prescription and medical needs.
Cliff Summerhill, 65, and his wife, Lillian, 64, debated which of their medications they could stop taking in order to avoid hitting the initial coverage limit, or that doughnut hole. The doughnut hole refers to the gap in coverage when recipients have to pay 100 percent of drug costs when their drug costs for this year fell between $2,251 and $5,100. That gap will be there next year, too.
"I told her there was no way I was going to let her, and she said, 'If you're not taking yours, then I'm not taking mine,'" Cliff Summerhill said.
In the end, he stopped taking his most expensive drug for a few months so they could afford the others, which still were going onto a credit card. He is looking for part-time work to cover the cost of his prescriptions.
"It's one of the biggest messes that Bush had ever put in," said 76-year-old Albion resident Lee Winter, referring to President George W. Bush. "It about tripled our money out of pocket of what I was paying prior."
He takes three brand-name drugs.
"The doctor said he cannot take a generic drug of those or else it would cause a stroke," his wife, Betty Winter, said.
The Winters felt that they were pressured into signing up for a Medicare Part D program that has backfired, and they don't know where else to go for affordable prescription insurance.
"I'm not a person who cares to be lied to. In the word of God that I read, it's a sin," Lee Winter said. "It took more money away from us than it did us good."
Jim Brinker, whose 98-year-old mother, Emily, was pressured to sign up to avoid a late sign-up penalty, was given bad advice, he said. A year later, they still are trying to withdraw her from Part D.
"Dad left my mother with medical insurance through Kellogg's Co., which has prescription coverage," said Jim, 68. "The wizards at Medicare decided that everybody who was on Medicare and Medicaid must need a 'D.'"
Emily signed up for the 'D' and lost her prescription coverage through Kellogg.
"We were told that everyone was supposed to have this, but it's not true," Jim said. "Nobody wants to listen. It's very frustrating."
But there are people who want to listen, and there are programs specific to Calhoun County funded through the senior millage that can help the elderly find the lowest prescription costs and offer help while they suffer through the doughnut hole.
Christine Schauer, manager for Calhoun County Office of Senior Services, recommended that all seniors sit down with a trained counselor to sort out their needs and which plan would best suit them.
"Just because you were happy last year doesn't mean you'll be happy with it this year," she said.
Premiums and deductibles are going up, and brand name drugs will not be covered at all during the gap period. Michigan is one of 13 states that will have no gap plans covering brand-name drugs.
For people on brand-name drugs for which there is no equivalent, "this is going to be a big deal," Schauer said.
Calhoun County residents age 60 and older who have a low income or their prescriptions are a large portion of their income might qualify for the Senior Millage Prescription Voucher Program. People who have fallen into the doughnut hole also are eligible.
There is a 24-hour turnaround for applications, said Jolene English, Medicare/Medicaid Assistance Program counselor at Burnham Brook, 200 W. Michigan. Applicants should call Burnham Brook at 966-2566 or 800-803-7174.
The voucher program can help with prescription costs up to $600.
In addition, seniors should sit down with a trained counselor at Burnham Brook or the Office of Senior Services and compare options.
"There are some situations where we may say just stick with what you have, but there are some new plans that may be better this year than last," Schauer said.
Speer did just that.
She met with an MMAP counselor, Cheri Slayton, at Burnham Brook on Wednesday.
On Medicare's Web site, they spent some time filling in her medications, with correct doses. They fiddled with different options until they found a new plan that would save her about $400 a year. A calendar also predicted which months she will be in the doughnut hole - a new helpful feature this year.
"So far I paid $4,202 dollars (this year)," Speer said. "That's a lot out of my pocket. ... I'm still going to have to end up paying that. (But) I hope that this will be much better, whichever one I take."
Source: Battle Creek Enquirer
