U.S. Begins Outreach for Drug Benefit Plan

Millions of elderly or disabled Americans who may be entitled to financial help through Medicare’s new prescription drug benefit will receive applications for that assistance this month, Health and Human Services Secretary Mike Leavitt said Wednesday.

About 14 million people -- a third of Medicare’s 43 million beneficiaries -- are expected to be eligible for aid to reduce the program’s premiums, deductibles and co-payments, which can amount to hundreds of dollars a year. For the poorest beneficiaries, such assistance could cover virtually all of the costs, officials say.

But the government and advocates for the elderly are concerned that many people will fail to apply for financial help.

Some may think their incomes are too high to qualify. Others may not want to fill out a six-page, 16-question application. And some may view the entire program -- which requires them to select coverage from private plans under contract to the government -- as too complicated to navigate.

“We are mounting an aggressive effort to find and reach those eligible,” Leavitt said. “Every eligible low-income person will be better off by enrolling.”

Under the drug plan, which takes effect Jan. 1, beneficiaries will pay the first $250 in costs, and Medicare will pay 75% of the next $2,000. Because of budget constraints, there will be no Medicare coverage for expenses between $2,250 and $5,100. Medicare will cover 95% of expenses above $5,100. Enrollment in the plan will begin Nov. 15.

To mount its outreach effort, the government has enlisted the help of about 100 national organizations, including AARP, the American Medical Assn. and the National Council on the Aging.

“Telling people the government is here and they want to help is a difficult message,” said Jane Delgado, president of the National Alliance for Hispanic Health. “We know people are inundated with information, but this is a matter of someone’s life and health.”

Enrollment is intended to be simple for the poorest beneficiaries. About 6 million elderly or disabled people qualify for Medicaid -- the states’ healthcare program for low-income people, known in California as Medi-Cal -- as well as Medicare. They will be automatically signed up, and their annual out-of-pocket costs for prescriptions will be just a few dollars.

Some of the biggest concerns center on elderly people whose incomes are too high for participation in Medicaid, but low enough that they could be eligible for help with the Medicare prescription drug benefit.

Broadly speaking, single persons making less than $14,355 and married couples making less than $19,245 may qualify for assistance -- but they must also meet an assets test.

Although the value of a home and car do not count toward the limit, resources such as savings and stocks do. A single person can have no more than $11,500 in savings and stocks, while a married couple’s financial assets must be below $23,000.

Medicare estimates that 7 million to 8 million people may be eligible for this assistance. To help find them, the Social Security Administration is sending letters and applications to 18 million people who, based on their incomes, may qualify.

Mark McClellan, administrator of the federal Centers for Medicare and Medicaid Services, urged beneficiaries not to be put off by the application form. It asks for information on bank accounts, real estate, insurance policies and other assets.

“The application takes a little effort, but it is well worth it,” McClellan said.

Many beneficiaries may need help with the forms. “A lot of people won’t know what to make of the notices they are going to get,” said David Lipschutz, a lawyer with California Health Advocates. “We have already received some reports of people who don’t want to buy what is being offered” in terms of eligible health plans.

Teams of local volunteers are being assembled to offer help. In Southern California, agencies on aging in Los Angeles, San Diego and San Bernardino counties are coordinating the effort. Information and assistance are available on the website www.AccesstoBenefits.org, and the Center for Health Care Rights in Los Angeles also will help answer questions, Lipschutz said.

A test mailing of applications earlier this year resulted in a 20% response rate, Social Security officials said, with another 20% responding after a follow-up call.