Horizon, Host: Ted Simons

May 3, 2006


Host: Michael Grant

Medicare Deadline


  • The deadline for enrollment in new Medicare drug plans is May 15th. In a special edition of HORIZON, find out what seniors need to do if they haven't yet enrolled.
Guests:
  • Lupe Solis - AARP


View Transcript
Michael Grant:
The seminars have been going on for months. Now the deadline is about here for America's seniors. By May 15 seniors need to enroll in the new Medicare drug plan or risk higher premiums. That's next on Horizon.

Announcer:
Horizon is made possible by contributions from the friends of eight, members of your Arizona PBS station. Thank you.


Michael Grant:
Good evening. I'm Michael Grant. Welcome to a special edition of Horizon. For the next half hour we're going to walk you through what you need to do to enroll in the new Medicare prescription drug plan. We'll talk with experts to find out the best way to sort through the sometimes overwhelming amount of information. First tonight, Mike Sauceda tells us about a seminar held for seniors in Ahwatukee.


Mike Sauceda:
An aid to congressman J.D. Hayworth explaining the new Medicare part D prescription drug program, which goes into effect January 1. The wide array of choices in the new plan has left many of those eligible seniors over 65 and those with disabilities with many questions about the plan.

Alma Gray:
I really don't know what to do. I'm worried about having to take a high fee each month. And the deductible worries me.

Bill Case:
It's not so much confusing as ponderous, you know. In other words, there's an awful lot to digest. It's like a little Chihuahua trying to swallow a lion, something like that. I don't think it's confusing so much. I mean, in other words, duplication or anything obscure or anything. I really don't think so. I think it's just a matter of us taking time to sort out the facts.

Ray De La Rosa:
Well, the confusion is that all of a sudden there's this plan that the program that provides Medicare prescription drug plan. But there are so many of them and they all have these charges that you've seen that they want to offer discounts; they want to offer different things. Some will cover certain drugs; some will not cover certain drugs. We have like Humana with four different plans or a certain company and you've got to go through the muck and mire to get to what you need.

Mike Sauceda:
But seniors are learning as information gets to them. Terry Jenkins of Ahwatukee said he's been to three seminars. He's already decided on a plan.


Terry Jenkins:
It came clear after a little while. There's a lot of quite helpful information being given.

Mike Sauceda:
The Medicare prescription drug plan signups started November 15 and runs through May 15 of 2006. You can sign up after May 15 but penalties may apply. You can sign up for one of dozens of privately offered plans and depending on which plan you have, you may have a deductibles. Plans also have co-pays and monthly premiums. Not all plans cover the same drugs. You can sign up for a stand alone prescription drug plan or join a Medicare advantage plan which is an overall medical plan including prescription drug coverage. Those below certain income levels can get extra help and may not pay a premium or deductible. The plan is voluntary so those with coverage from a previous employer, the military, veterans affairs or Indian tribes may be better off with their current prescription coverage. There is a coverage gap between $2,250 and $3,600 in drug costs where a patient would pay all of his of her prescription costs. That's a lot of variables for seniors to consider. But De La Rosa has a couple of tips to help you select the best coverage. He says find out which is the best plan for you based on your prescription and work backwards from there or let a pharmacist help you out.

Ray De La Rosa:
The other option is to make it a kind of a little bit easier is to go to your pharmacist. He already knows which drugs you're taking and he can tell you which plans he's contracting with. And then that way you can go backwards and say, okay. These are the plans he's contracting with. Now what are their premiums or what are their co-pays. You can actually work backwards through your pharmacist.

Michael Grant:
Here now to tell us more about the Medicare part D prescription drug plan is Lupe Solis of the AARP and Heather Daniel of the Foundation for Senior Living. Let's plunge in. We've got a lot of ground to cover. Let's first start with what kind of education efforts, for example, the AARP has going.

Lupe Solis:
Well, Michael, we're concentrating right now on people who are what we call the limited or extra help. If they meet the income guidelines and the eligibility requirements would be able to get a lot of help for no cost at all. And so we're emphasizing that out in the community, making sure that people have answered those letters that came from social security administration. Making sure that they qualify. And if they don't, we have some other avenues that they can pursue.

Michael Grant:
Okay well let's stick with that for just a minute. Who can qualify for extra help?

Lupe Solis:
Okay. In the state, anyone who's already on Medicaid, and is Medicare eligible and is a dual eligible will not have to worry about doing anything. They're going to be automatically enrolled. But there are certain other limits of income that go up to 150\% of federal poverty level which equates to $14,355 per individual or 19,245 for a couple. That could qualify for additional help. And the good part about that is that they would be paying very little premium, probably no co-pays and no gap in coverage.

Michael Grant:
Okay. Heather, Foundation for Senior Living. What's your group doing to help seniors in this area?

Heather Daniel:
Well, we get oh, between 4 and 500 calls a month. And what we can do for people if they do call if they're confused, we can go on the Medicare website for them and give them information that they might not have access to. So we can have an education and understanding about some things that they might be confused about.

Michael Grant:
Okay. I have a note here to myself: as good as. What does that mean?

Heather Daniel:
People that have plans like say for instance they're a Boeing retiree or they have coverage because they retired from a company or they have just a benefit, you know, that they have some coverage for medicine for their medical coverage. And as good as is what they're going to get. So they have a choice. They can stay with what they've got. It's as good as what Medicare part D is. They need that letter saying that their coverage is as good as. If they do not get that letter or their coverage is not as good as Medicare part D, they will be penalized for not signing up at 1\% per month continuously.

Michael Grant:
Okay. So in other words, the employer or whoever it is should be sending you that letter.

Heather Daniel:
If you do not get the letter, you need to call your either union representative if it was through an union or your H.R. department of the company and make sure that this is as good as Medicare part D.

Michael Grant:
Okay. I think we identified there on the tape piece there were like 70 plans being offered.

Lupe Solis:
Not quite 70 but yes, quite a few in Arizona. I think there are over 40.

Michael Grant:
What do you look for? That's a lot of choices to sort through.

Lupe Solis:
It certainly is. As you well know, Michael, sometimes too many options are no choice.

Michael Grant:
That's right.

Lupe Solis:
They confuse people. But I think that what's important first of all is to recognize that time first thing you need to have with you is how many prescriptions do you take, what those that you take and how many do you take. Because with that information you can certainly compare amongst the plans. You would be able to find out how much would each one of them cost you, which is more convenient for you, which is the best coverage for you. So there is a way to get through it. But it is confusing, but people should not be fearful about it. Ask the questions. There's plenty of people out there waiting to help.

Michael Grant:
Heather, there are a couple of ways to go here, are there not? I mean you can go for just a prescription plan or you could go for more comprehensive coverage that would include prescriptions, correct?

Heather Daniel:
Well, it's important, too. If you are in an HMO that's a medigap, you right now are getting some prescription coverage with your medical plan. If you do go outside of your HMO and sign up for a plan, your medical coverage will stop. You will be able to sign up for some other medical coverage but you need to understand that you will be auto enrolled if you are in an HMO.

Michael Grant:
You'll be auto enrolled.

Heather Daniel:
Correct. Into Medicare part D. And there will not-- there are many in the state, I think there's five, that there is no premium for the Medicare d or your medical coverage for the HMO. So it is free. You will have the gap, though that you can purchase an enhanced product that will take care of that gap.

Michael Grant:
Now, are some drugs covered on some plans and not covered on other plans?

Heather Daniel:
That's right. So that should be a pretty strong deciding factor in which plan you choose. Because you want your drugs to be covered. And so that's probably one of the most important factors in your choosing a plan is are me drugs covered?

Michael Grant:
In fact-- and I think this may have been touched on, is maybe a good way to approach this to kind of work backwards? Say, okay, I take these five medications. What plans offers them?

Lupe Solis:
Certainly. I would go that route, certainly. Because what you want to do is, for example, let's say that you're taking Prozamex for women and Celebrex and Lipitor, you want to start with the most expensive medication that you're taking and make sure you get into a plan that covers those. It will tell you up front. It tells you this plan for this premium covers 82\% of the formulary; 97\% of the formulary. It may even be worth it for you to buy one of the higher-priced plans if it has the coverage that you need.

Michael Grant:
And there are charts available to compare and contrast?

Lupe Solis:
There are charts available to compare.

Michael Grant:
Okay. And from whom are those--

Lupe Solis:
From Medicare.gov and you can go on the website and just look at the tools. It's called a plan compare. But if you don't have access to internet it's important to note that you can call Medicare or you can call Ship, which you will be given those numbers in the program and they will walk you through it that have the information ready, don't say to somebody, hold a second. I got to go find out. List all your information, all the prescriptions that you take. And in the case of my mother, don't confuse counseling for example for prescriptions for something that you'll be taking. It's not a prescription.

Michael Grant:
All right. That's a health food that you may not necessarily get that. Heather, where are the most confusing areas that you're finding? I mean, what are people most mystified about?

Heather Daniel:
Well, I think some people are confused about should they do this. You know, it's such a new-- it's all new to them. And some people are just leery or skeptical about whether this is going to help them or benefit them. I'd say, yes, it's going to benefit everybody. I would say at first when I first started reading the material about Medicare part D I was a little skeptical. But I think that everybody needs to sign up for it. It's definitely something that's really going to help seniors.

Michael Grant:
You mentioned before we went on the air treating it like insurance. You obviously pay premiums on insurance and you don't always get those premiums back. Is that--

Heather Daniel:
That's true. The one thing that you need to think of this is that it is an insurance program. Right now you may be on no meds. But it's important for you to sign up for this. And because in the future you don't know. 10-years from now you may be on 7, $800 a month in meds. There are many seniors right now that spend that much each month on their medications. So this is going to help everybody. It's just a win/win situation for people. But they have to sign up. You know, that's important.

Michael Grant:
So if you don't sign up by May 15, there's a penalty involved?

Lupe Solis:
There will be a penalty of 1\%.

Michael Grant:
And you mentioned what it is. But what does the 1\% apply to?

Lupe Solis:
Well, it's applied to the average of the national premium, which is around $32 this year. But remember, those could increase from year to year.

Michael Grant:
So if I'm understanding, you correct, the penalty in that case would be 32 cents per month.

Lupe Solis:
Per month.

Michael Grant:
That you did not sign up.

Lupe Solis:
Right.

Michael Grant:
Now, Heather, can you change a plan? Let's say you sign up for plan 1 in early December and say you get to next December and you say, that one didn't work too well. Can you change?

Heather Daniel:
There's an open enrollment period. For the first 5 months you're going to be able to change around some. And if you were on Access, you are going to be able to make changes. You're not going to-- you're going to be able to move around, too. If your medications change...say you sign up for this plan because you had all these medications. Well, now you're not taking those so you need to go to a different plan. Then, yes. But every year there's going to be an open enrollment for you to switch your plan.

Michael Grant:
Could you use illustratively, Lupe, the next 5 months to try out a plan?

Lupe Solis:
There's a difference, though. What Heather is talking about is those that are covered by Medicaid also, the dual eligible. Those will be able to shift from month-to-month if necessary. After December 31, if you make a choice by December 31 you will be stuck with that for the whole year. If you wait until May 31, then of course you've got more. However, before you actually start receiving a benefit you would be able to change. Let's say that you select something November 15 and by December 29 you decide, that wasn't the right one. You can still change to another plan.

Michael Grant:
Heather, let me ask you to do my work for me. We've got some screens here to give people information on where to call. So let's throw those out and why don't you just lay them out here?

Heather Daniel:
Okay. There's the senior help line, 602-264-4357. And you also can talk to somebody in benefits. They patch you right in to see if you're eligible for the Access programs. Medicare phone number is 1-800-633-4227 and the Medicare website is www.medicare.gov.

Michael Grant:
Heather Daniel, thank you so much for joining us. Lupe Solis, good to see you again. The Medicare plan faced big problems in January when part D kicked in. We'll talk with a couple of experts about those problems. But first Mike Sauceda shows us how the prescription drug plan impacts pharmacists.

Mike Sauceda:
Every day pharmacists are at the front line of a battle with problems occurring with the new Medicare prescription drug plan known as Medicare part D.

John Musil:
I know some pharmacies that have 16 hours of staff time devoted just to Medicare part D eligible patients in a day. So, that's two-full-time people in a day just handling all of these new part d beneficiaries.

Mike Sauceda:
John Musil is owner of 11 Opocathery shop pharmacies. He is also president of the Arizona Pharmacy Alliance. As patients signed up for the prescription drug plan last fall there was confusion about it. The plan started January 1 and he says there have been problems with the startup but it has gotten better since then.

John Musil:
What we experienced in the beginning of the year to where we are today, we are leaps and bounds better.

Mike Sauceda:
Musil says many of the problems are associated with the rollout of any big program. The patients experiencing the worst problems are those eligible for both Medicare and Medicaid, the dual-eligible patients.

John Musil:
One of the issues that we've dealt with is, we've got this part D benefit. We always had this part B as in boy benefit. Part B, benefit were things like patients who had a transplant or were on immunosuppressive medications. Those patients have always been in the part B bucket. The federal government was instituting the part d plan. But some of those medications may cross over. But if they are in that part B bucket before, that's where they really should stay. But some of the plans haven't figured it out, those medications, and some patients are benefiting through the part d plan. With these part b medications. So it's a very convoluted system. By April 1 all health plans are separated out part B and part D medications.

Mike Sauceda:
Another problem. Some patients are finding they are not listed on a plan even though they have signed up. To help ease the problems he says there is something patients can do.

John Musil:
The best thing for all patients to do is to call the pharmacy in advance and say, I know I'm on a part B benefit. The information that I received from my health plan was plan X, the group number that they sent me was this and my ID number is whatever the ID number is. So that the pharmacy can load that information into the computer. I recommend at least a week before they need their next refill. Because what that's going to do is get them in the queue faster than to say, well, okay, I'm coming in two hours. I'll be there. For a refill of my medication. I hope that you have all the information necessary for my part D plan.

Mike Sauceda:
He says eventually all the problems should be ironed out.

John Musil:
Please be patient with us as pharmacists. We're doing a phenomenal job with the limited resources that we have available to us. Unfortunately, some people's information just has not been inputted into the program like it should. A lot of people waited really long. There was a lot of confusion as to what part D was. Do I sign up for it? Do I not sign up for it? There was a really short period of time that patients had to sign up from when the benefit began. Patience. Within 30 days we will have this thing wrapped up. We'll have it so under control it's going to be just like business as usual.

Michael Grant:
Here now to tell us about problems with the Medicare prescription plan is David Mitchell. He is state director for the AARP. Also here is Tom Betlach, deputy director of the Arizona Health Care Cost Containment System, AKA AHCCCS. Gentlemen, good to see you both.

Tom Betlach:
Good evening.

Michael Grant:
David, we'll focus on one of the problems here for just a second. I hadn't really thought about it until the pharmacist comments there. There are a tremendous amount of communications to be made, hopefully accurately. I guess we'll talk about some that had not been made so accurately. But particularly, I mean it's one thing to say the large chain prescription operations. But particularly when you think about the number of the pharmacies that are small operations, those kinds of things. A lot of data has got to flow.

David Mitchell:
Absolutely, no question. That's where part of the problem really started was in the communication between the federal government and the actual insurance plans and then from the plans to the pharmacists. And not only the communication but particularly the computer problems have been really significant. And that's where-- at least we're beginning to see some improvement. But that's where the problems really began.

Michael Grant:
Tom, at issue, one of the prime issues that we're talking about tonight has to do with Medicaid meeting Medicare, right?

Tom Betlach:
Right.

Michael Grant:
Why don't you pick it up from there?

Tom Betlach: Sure. In Arizona we've got about 700,000 Arizonans that are eligible for Medicare, which is typically associated with senior citizens. We've also got about a million individuals in the state that are eligible for Medicaid, which is associated with lower income individuals. And about 97,000 of the Medicaid members are also Medicare. They're known as the dual eligibles.
They're eligible for both Medicaid and Medicare. And certainly one of the concerns we had as an agency and the executive branch was when these 97,000 individuals were going to be transitioned from Medicaid as the payer to the Medicare in this new system all within one night, January 1. And so this brand-new gigantic system is coming up nationally. You have 6.4 million people that are heavy utilizers. They're very fragile. We spend about $400 million on drugs. They account for half of that alone yet they're only 10\% of or population.

Michael Grant:
There was a concept here, because under Medicaid you previously would get the prescriptions. Was the concept here that by moving those eligibles to make them dual eligible on Medicare part D-- it's hard to keep all this--

Tom Betlach:
It is hard to keep it all straight.

Michael Grant:
Lined up. That it would somehow make it more efficient?

Tom Betlach:
I think when congress made this decision back in December of 2003 they were weighing different options. And certainly one of them was what to do with the dual population. And one of the things that the states have been saying is why don't you have Medicare takeover more of these services? So that was the decision that was made with regard to the prescription drugs. I think one of the things that upsets the state in all this is we don't see any benefit from that. You think by having those costs reduced by not providing us benefit anymore that would be a benefit to us. But there's a claw back payment in which we have to turn around and basically repay the federal government the portion of the cost we had been making for these members. So right now in this time period what's frustrating to states is we've had to open up the governor's authorized state only funds to help bridge the gap and deal with some of the difficulties out there and a number of other states are spending millions of dollars to help try and back fill during this transitional period before all these systems issues are resolved.

Michael Grant:
And David, what has been occurring for at least some of these dual eligible when they show up to get a prescription?

David Mitchell:
Well, what's happened is some people have come to their pharmacy and said that I've been get my prescriptions for a long time under Medicaid and all of a sudden the pharmacist cannot see a card that they should have because of some of the glitches in the computer system, their name did not appear on the computer. And so they were saying to these most vulnerable of the population saying, well, you have a $250 deductible with the Medicare part D so you have to pony up for the entire amount of your prescription. And so in fact we had people in our office in tears as a result of the fact that their needed medications were not available to them.

Michael Grant:
Because there is a different level of payment level for the dual eligibles than for the general Medicare population under the new plan?

David Mitchell:
Absolutely. Yes, that is correct. And as a matter of fact, not only has the governor and I know we in AARP were delighted to hear that the governor had authorized this half million dollars to help cover these expenses. But also there was an executive order from the president that the pharmacies were to provide at least 30-days medication for these people while some of these problems were resolved.

Michael Grant:
Thank you very much for joining us for this special edition of Horizon. I'm Michael Grant. Have a great one. Good night.

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