A Dose of Confusion With New Drug Plan

Times Staff Writer

When it comes to navigating the vast bureaucracy that is Medicare Part D, Mary Larson is leaps ahead of others.

A former medical billing clerk, Larson isn’t frightened by form letters filled with medical jargon. She has a computer with Internet access and knows how to use it.

When Medicare assigned her to a prescription drug coverage plan that wasn’t suitable for her, she was able to figure out, after making several telephone calls and consulting a do-it-yourself website, one that was better.

Still, Larson, 59, unable to work since contracting hepatitis C, had nagging doubts about whether she’d made the right choices.

So this week, she made a last-minute appointment with a volunteer counselor to make sure everything was in place before the Jan. 1 start of the federal drug program.


“I made so many phone calls because nobody knew anything,” Larson told Annette Havens, a volunteer with Ventura County’s Area Agency on Aging. “If it was this hard for me -- someone who’s worked in the medical field -- what about everyone else?”

It’s a scene being replayed a thousand times a day in California as Medicare beneficiaries flood senior citizens’ centers, government offices and toll-free hotlines in search of answers and assurance that they have successfully enrolled in the new private drug coverage plan subsidized by Medicare.

Starting next week, the federal government will help pay for senior citizens’ drug costs under Part D. Beneficiaries, especially those taking a lot of medications, could potentially save hundreds of dollars a year, experts say.

Medicare recipients have until May 15 to enroll in one of the more than 50 private plans that have contracted with Medicare to provide the Part D drug benefit.

But if they sign up this week, they’ll receive the benefit immediately. So far, an estimated 21 million elderly and disabled Medicare beneficiaries out of 43 million nationwide have enrolled in a plan.

Unlike traditional Medicare HMOs, which allow patients to switch monthly, changes to a Part D plan can be made only once a year. Those who fail to enroll in any plan by May 15 will pay a higher premium if they decide to sign up later.

Trained counselors at the Center for Health Care Rights in Los Angeles are returning 80 calls a day, Executive Director Aileen Harper said this week. Requests for help are so backed up that the center is just getting to folks who called three weeks ago, Harper said.

“We are booked through January,” she said. “Most of our callers are walking into a situation that they don’t have a clue about.”

In Ventura County, more than a dozen senior citizens sat in a waiting room Wednesday to talk to Havens. A retired state employee, Havens patiently answered each person’s questions before moving on to the next.

Websites guiding senior citizens through the enrollment process are also seeing heavy traffic. The federal government’s online plan finder, at, had 8.3 million page views in the week of Dec. 11 to 17, the last period for which numbers are available, said Peter Ashkenaz, a Medicare spokesman. For the most part, those who seek help are getting it, Harper said. But she worries about the thousands of Medicare beneficiaries who have done little to make sure they are in the best plan for their drug needs and budget.

Senior citizens advocates believe the poor, who have until now had their prescriptions paid by the state’s Medi-Cal program, are most vulnerable, Harper said. Medicare assigned them to randomly selected private plans that may or may not cover the drugs they are taking, she said.

Though Medicare allows them to switch to another plan without penalty, she predicts that many are unaware that they must act, she said.

“The worry is they will walk into a pharmacy in January and find that their drugs are no longer covered,” Harper said. Beneficiaries who do seek help say they are overwhelmed by a flood of official-looking letters, confusing forms, tip sheets and advertisements that have arrived in their mailboxes over the last few months.

Typically they’ve taken a stab at comparing co-payments, drug lists and costs on their own before seeking help, said Katharine Raley, who runs a Medicare counseling service in Ventura County.

“The people who come to us don’t have questions about one or two provisions,” she said. “They’re confused about everything.”

Private insurers are holding workshops to inform senior citizens about their choices under the new prescription coverage. Pharmacies, too, are offering informational marketing.

One source of impartial information is the Health Insurance Counseling and Advocacy Program. Run by the state, its volunteers are well-versed in Medicare’s options but are trained not to recommend or endorse any product or plan.

Havens, fielding questions at a busy Social Security office in Ventura, is one of hundreds of the program’s volunteers across California who have been kept busy this holiday season.

She totes around a laptop computer and a file organizer filled with Medicare information sheets to answer questions. She’s so busy that she doesn’t take breaks between clients.

Melvin Schmidt, 74, relates how the stress of picking a new plan caused him to break out in shingles. His concern is not so much for himself, he tells Havens apologetically, as for his 78-year-old wife, Patricia, who recently suffered a bad fall in their Ventura home.

“You understand, we have tight finances,” Schmidt says as he fumbles with a stack of papers. “I just want to know, more or less, what I’m going to have to pay out of my pocket.”

When Havens assures him that his co-payments will probably be less than $3 per medication, Schmidt visibly relaxes. By the time he leaves 20 minutes later, he is thanking her profusely.

“Where would we be without people like you?” he tells Havens.

Another client, a Spanish-speaking grandmother who brought her son along to translate, doesn’t have a Social Security card with her.

Without it, Havens cannot access the Medicare website to tell the woman which insurer will pay for her and her husband’s drug benefits.

Havens arranges a telephone conference later in the day and sends the mother and son on their way. Havens’ time with Larson, the woman who used to do medical billing, goes much more smoothly.

Larson has done her homework and has decided to change the plan to which she was assigned because it requires a doctor’s signature every time she fills a prescription for insulin.

As a diabetic, that would be too inconvenient, Larson tells Havens.

“Can you imagine getting prior authorization for insulin?” she says. “I don’t want to put my doctor through that.”

With a single phone call, Havens is able to assure Larson that she has been successfully unenrolled from the first plan.

In Los Angeles County, the one-on-ones have gone much the same.

Penelope Aaron, 66, scheduled a telephone consultation with the Center for Health Care Rights, part of the Health Insurance Counseling and Advocacy Program, after she received Medicare paperwork in the mail. She tried to figure it all out, Aaron says, but gave up after a few days.

“I feel like I’m so dumb,” said the North Hollywood mother of four grown children. “I know they are simple words. But it’s like going around in circles.”

Aaron is on an $800 monthly fixed income and takes 10 prescriptions a day for blood pressure, cholesterol levels and nerve damage from long-standing back problems. She uses a walker to get to a physical therapy appointment three times a week.

A Health Care Rights counselor verified that her new coverage would pay most of her medication costs, Aaron said. But the counselor couldn’t say exactly how much she would end up paying in the new year, she said.

“They were helpful,” she said. “I just hope it works out the way they explained to me.”



New drug plan

Here are some highlights of the new Medicare drug program. For additional information, check or call 1-800-MEDICARE.

* All Medicare beneficiaries are eligible for federal prescription drug coverage beginning Jan. 1.

* Participants must be enrolled in one of dozens of private benefit plans subsidized by Medicare.

* Participants may pay a monthly premium, which varies by plan, in addition to part of the cost of each prescription.

* If your resources are less than $11,500 (single) or $23,000 (married), you may qualify for extra help.

* Deadline for enrollment is May 15. Those who sign up late face financial penalties.

Los Angeles Times