Weighing prescription drug program

The biggest change to Medicare in years will have a few bugs, an Orange County Council on Aging advisor says.With roughly three weeks left before Medicare beneficiaries can begin enrolling in the prescription drug program, health insurance and senior advocates are working hard to answer questions and counsel people about what plan to choose.

Because Part D is the first time a prescription drug benefit has been offered through Medicare, and because there are more than 20 companies in California approved to offer a number of plans, sifting through the information can be confusing.

“We’ve gone from 200 calls in a month to 2,000,” said Jacqueline Lauder, education and outreach coordinator for the Orange County Council on Aging. “We’ve gone from eight to 10 presentations in a month to well over 70.”

Anne Gray, a community outreach coordinator for California Health Advocates, led an informational seminar on Medicare Part D at Harbor Lawn Mount Olive Memorial Park on Thursday morning.

Mauro Mendez of Costa Mesa attended the session because he isn’t sure whether or not he should enroll in a Medicare prescription plan. He is covered under Secure Horizons insurance, but said it does not cover many of the drugs he takes.

“I’m just trying to figure out which plan is better,” Mendez said, adding that he found the session helpful, but he is still unsure whether or not he can have both plans at the same time. He said he will most likely follow up the seminar with a phone call or a visit to the Health Insurance Counseling and Advocacy Program.

Gray cautioned that one matter that can be confusing is the beneficiaries who are eligible for both Medicare and MediCal -- California’s version of Medicaid, which covers prescriptions for people whose incomes fall below poverty level. All who fall into that category will automatically be enrolled into a program if they don’t enroll on their own by Dec. 31. However, they will have the opportunity to change anytime, even after the open enrollment period, which ends May 15 of next year.

Low income beneficiaries who do not fall below poverty level have the option to apply for additional prescription drug assistance through the Social Security office.

Gray also warned that beneficiaries with an HMO should be careful about signing up for a plan, because they could be automatically dropped from enrollment by their HMO.

“Every category has a red flag that people need to navigate,” Lauder said. “People want a simple answer and you can’t give them a simple answer.”

Lauder said what the experts at the Council on Aging are most worried about is scams and the influx of marketing for the plans. Because it is a competitive market, much of the wording in commercials could compel people to sign up for a plan that does not suit them.

“What I tell people is do not sign anything until you have checked with the ... HICAP [Health Insurance Counseling and Advocacy Program] counselor or checked with the provider that you have,” she said. “The days of being a passive health care consumer are over, whether we’re on Medicare or not. They need to understand what they actually have and then work with that.... When you understand what you have, then you can navigate through the system and you can advocate for yourself.”

She said as much as people should not feel pressured into signing up, they also should not feel deterred. Eligible beneficiaries who do not enroll by May 15 will be subject to a 1% per month penalty fee, which starts accruing as soon as the initial open enrollment period is over. Lauder said the penalty is just an encouragement to get people into the insurance pool.

2006 will be a bumpy year, Lauder said, because it’s the biggest change to Medicare in many years, and there are bound to be holes and mistakes.

“There will be mistakes -- we just sort of need to navigate it and take care of problems where we can,” she said. “Whatever happens, we’ll be here to help people navigate the system.”

For more information on the Health Insurance Counseling and Advocacy Program, call the Orange County Council on Aging at (714) 560-0424 or visit www.coaoc.org.

* LINDSAY SANDHAM is the news assistant. She can be reached at (714) 966-4625 or lindsay.sandham@latimes.com.

20051022ioqcqfknKENT TREPTOW / DAILY PILOT(LA)Ann Gray of the Health Insurance Counseling Advocacy Program speaks to seniors about Medicare during a seminar at Harbor Lawn Mt. Olive Memorial Park on Thursday.