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Group helps seniors with Medicare drug plan

POSTED: December 22, 2008 5:00 a.m.
TOM REED/The Times

Francis Dobbins, left, goes over some Medicare information with Nell Cato of Legacy Link. The open enrollment period for the Medicare Part D prescription drug program started Nov. 15 and ends Dec. 31.

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There’s a little more than two weeks left in the open enrollment period for Medicare Part D, the government-sponsored prescription drug program for seniors.

Of Georgia’s 1.1 million Medicare beneficiaries, about 174,000 still don’t have prescription drug coverage. They have until Dec. 31 to sign up for Part D. Those who already are enrolled can take this opportunity to switch plans if they don’t like the one they currently have.

It won’t be an easy decision. In Georgia, there are 50 different Medicare Part D plans, all run by private insurance companies. Many seniors have difficulty choosing the plan that’s best for them.

But this year, they have an incentive to shop around. Many plans will be raising their premiums significantly for 2009.

"Most people (who call us) are ending up switching this year, because there are so many changes in the plans," said Elizabeth Pyron, Georgia Cares coordinator for Legacy Link, the Area Agency on Aging in Gainesville.

Her program serves seniors in 13 Northeast Georgia counties, helping them find affordable prescription drug coverage. Ever since the Medicare Part D open enrollment period began on Nov. 15, people have been calling for advice.

"We’re fielding hundreds of calls every week, and we’re just swamped," said Pyron. "We’re not able to get to them in as timely a manner as we would like."

Volunteers have been helping to answer the phones at Legacy Link. People who would like to have an in-person consultation can make an appointment at the Legacy Shoppe, the agency’s information center at Lakeshore Mall.

"We had a big rush even before open enrollment started," said Nell Cato, manager of the Legacy Shoppe. "This year, premiums have gone up at a higher rate than ever before."

She said one of the most popular plans currently charges a premium of $24.70 a month, but that will jump to $40.80 next year.

Increases like that could pose a hardship for many seniors, but especially for those who are in the low-income subsidy program. Cato said people in this program don’t have to pay a premium, as long as the plan’s premium is not more than $30.

But with the price increases, some plans no longer fit into that low-income category. This narrows the choices for people in the subsidy program, and of the remaining plans available to them, they might not be able to find one that covers the drugs they need.

Each plan has its own formulary, or list of covered drugs. Pyron said aside from premium increases, changes in formulary is the top reason people have to switch plans.

Medicare’s consumer Web site,, allows people to view all the plans available in their state. They can sort through the plans according to price, or they can create a personalized list of all the plans that cover the drugs they’re currently taking. The program even gives an estimate of their annual out-of-pocket cost under each plan.

It’s a user-friendly Web site, but it’s only helpful if you know how to use the Internet.

"A lot of the elderly people are not computer literate," said Cato.

There is also printed material available, though it is not as easy to navigate. In October, every Medicare beneficiary was supposed to get a re-enrollment booklet in the mail.

"But many clients say they didn’t get anything," said Pyron. "Maybe they did, but didn’t know what it was and threw it away. Others are not literate and cannot understand the material."

That’s why they call for help.

"You can call Medicare directly, but most people don’t want to do that because they’re on hold for so long," said Pyron. "If you call us for assistance, please have all you information ready and written down. Have your insurance card and all your medications with you when you call."

Pyron said because of the high volume of calls, counselors are not able to sit on hold while the client tries to get all their stuff together.

Kevin Prindiville, an attorney for the National Senior Citizens Law Center, said choosing a Medicare Part D plan is often so complicated and confusing that some people avoid it, even though they could benefit from the change.

"Last year, only about 6 percent of people switched, even though 90 percent had a cheaper plan available to them," he said. "Most don’t want to go through the hassle year after year."

But Prindiville is especially concerned about people who get switched without their knowledge or consent. Nationwide, about 25 percent of Medicare beneficiaries in the low-income subsidy program are in plans whose premiums will rise above the $30 threshold next year. To prevent having to pay premiums, Medicare automatically will reassign them to a new plan.

That may sound like a convenience for the beneficiary. But Prindiville said Medicare reassigns patients without regard to what drugs they’re taking, and the new plan may not cover all their medicines.

Prindiville said people who are not in the subsidy program need to look carefully not just at premiums, but also deductibles and co-pays.

Among the plans available in Georgia, monthly premiums for 2009 range from $16.10 to $103.40. Some plans have no deductibles, while others have deductibles as high as $295.

But what’s really hurting consumers, both in Medicare and in the private insurance market, is the pricing structure for prescriptions. Instead of charging a flat fee — for example, $10 for a generic and $30 for a brand-name drug — some plans charge a percentage of the total price.

So if the customer pays 35 percent of the cost of a brand-name drug, a $300 prescription will take about $100 out of their pocket.

"Some of these plans are charging a co-pay for the brand name, plus you pay the difference between the brand name and the generic," Prindiville said. "So it essentially makes the brand name unaffordable even if your plan technically covers it."

But overall, the Medicare Part D program, now in its third year, has been a blessing for seniors. In a recent survey, 90 percent of beneficiaries said they were satisfied with their prescription drug coverage.

"Remember, prior to 2006, there was no drug coverage at all (from Medicare)," said Pyron.


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