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Drug Coverage Confusion


Problems abound as a Medicare Part D deadline approaches.


By Alain Jehlen

As confusion over the government’s new Medicare Part D prescription drug program continues to mount, an important enrollment deadline is looming: Most people currently eligible for Medicare must sign up for Part D by May 15—or wait until the fall and pay a permanent late penalty on their premiums.

That hard-to-understand penalty clause is just one example of the complex, even bizarre provisions of this law.

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Retiree Darvin Lindquist has yet to see any savings from the Medicare Part D plan.

It didn’t have to be that way. When Congress was considering covering prescription drugs through Medicare, many experts suggested a straightforward approach: Simply cover prescription drugs through the Medicare program itself. That is, have Medicare pay for drugs the same way it now pays for doctors and hospital care.

But that solution clashed with Washington’s current passion for handing over public programs to private companies. So the law that finally passed, by the narrowest of margins, forces seniors to buy private insurance if they want to take part. There are dozens of drug plans on the market, varying from place to place, with different premiums, different lists of drugs covered, even different sets of pharmacies—and these plans can change their drug lists at any moment.

During the program’s start-up in January, computer problems were so bad that many low-income seniors and disabled people, whom the new law shifted from Medicaid to Medicare for their drug coverage, disappeared from databases. When these people tried to get essential prescriptions filled, pharmacists couldn’t confirm they had coverage. Druggists were waiting for hours on the phone without getting answers. Nearly two dozen states had to jump in, guaranteeing payments so their elderly residents could get vital medication.

In North Dakota, NEA retiree Darvin Lindquist signed up for a Part D plan and has been paying premiums since January, but he has yet to see any savings. He says the insurer tells him they’re backed up but should get everything straightened out soon. If they don’t, he’ll drop the plan: "There’s no sense in paying for something I’m not getting," he notes.

With diabetes and arthritis, Lindquist needs expensive drugs, so he and his wife drive 70 miles to Canada to buy them, often at half the cost of U.S. medications.

NEA opposed this new drug program when Congress was debating it in 2003, pointing to its huge gaps in coverage and private industry subsidies, says NEA health care analyst Carol Malone. NEA supports a bill just introduced by Senators Ted Kennedy (D-MA) and Debbie Stabenow (D-MI) to allow beneficiaries to get drug coverage the simple way, directly from Medicare. Among other improvements, the bill would eliminate the infamous "doughnut hole," which makes Part D subscribers pay 100 percent of their annual drug costs between $2,250 and $5,100.

"If this Congress won’t do it, we believe that a future Congress—one that’s more interested in being generous to seniors than to insurance and drug companies—will turn Medicare Part D into a program that can really provide security for older Americans," says Malone.

With all of Medicare Part D’s problems, she says, candidates running for Congress this year will be under pressure to take a clear position on what they would do about senior drug coverage. She suggests checking out the candidates running in your area, and supporting those who stand for simple and inexpensive drug coverage. "Time and money invested in political action now can bring us closer to old-age security for everyone," she says.

For now, many NEA retirees already have better drug insurance from their school districts, but for some NEA retirees who lack prescription drug coverage, Plan D, with all its faults, is still worth buying, says Malone.

If you or your elderly relatives are debating what to do about Part D, Malone recommends visiting the reader-friendly Web site of the Medicare Rights Center.

Photo: Nancy Kuehn

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6-May-06