Archive for Tuesday, January 10, 2006

New Medicare prescription plan remains a challenge for seniors

Complexity creates unexpected financial hardships for people enrolled

January 10, 2006


If she ever makes sense of Medicare's new prescription drug program, Sandra Zender knows what she'll need it for - stress-relieving medication.

"It's been a pretty threatening process to sign up," Zender said.

After one week in operation, the federal government's new prescription drug program still has thousands of Kansans unsure how to choose among 41 different plans, which vary according to the drugs covered, premiums paid and deductibles required.

And the complexity has created unexpected financial hardships for people who already are enrolled.

"There are just so many choices to make," said Mary Rau, a rural Lawrence resident. "They could have made it much simpler."

Confusion expressed

The confusion was manifest Monday during a meeting at the Douglas County Senior Center to explain the enrollment process. Twenty-five people attended, including Rau and Zender.

Katie Glendening, a community services specialist at the center, said Medicare recipients need to make a decision by May 15. After that, the government adds 1 percent to the monthly premium for every month an individual delayed enrollment.

For example, if a person waited two years to enroll, his monthly premium would be adjusted upward by 24 percent over the average premium. That increase would be included in every monthly bill for as long as the individual is enrolled in the program.

Mary Rau, left, and Sandy Hick, right, both rural Lawrence residents, discuss their Medicare prescription drug coverage enrollment forms after a meeting on the new coverage. The meeting was held Monday at the Douglas County Senior Center, 745 Vt., to help explain the plan and what options are available.

Mary Rau, left, and Sandy Hick, right, both rural Lawrence residents, discuss their Medicare prescription drug coverage enrollment forms after a meeting on the new coverage. The meeting was held Monday at the Douglas County Senior Center, 745 Vt., to help explain the plan and what options are available.

"That's kind of scary," said Sandy Hick, a rural Lawrence resident who attended the class. "You either pay now, or else they will really get you later."

New enrollees' problems

The program, which began Jan. 1, has been problematic even for people who have already enrolled.

A spokeswoman with the Centers for Medicare & Medicaid confirmed national reports that some enrollees have been hit with unexpected and unnecessary bills at pharmacies. Julie Brookhart said some people who have qualified for a reduced-deductible portion of the program are still being asked to pay the higher fee.

Brookhart said the agency's computer system hasn't been able to update people's eligibility as fast as people have been enrolling. She said that problem should be corrected this week, and that the agency has added personnel to help pharmacists by phone.

Bill Axcell, an owner and pharmacist at Jayhawk Pharmacy, 3501 Clinton Parkway, said he's encountering the situation two or three times a day.

"We're just going ahead and giving people the medicine at the lower price, and we figure we'll get it worked out as the system gets cleared up," Axcell said. "I don't want people leaving without their medicine."

Private insurance companies

Other pharmacists say they're also having problems with the private insurance companies that actually provide the Medicare plans. Tammy Willits, an owner and pharmacist with Lawrence-based Qualicare Pharmacy, 2336 Ridge Court, said many of those companies weren't prepared to start operations.

"We literally spent eight hours on hold and never talked to a real person," Willits said. "After the first two hours it became a matter of principle. We passed the headset around to different people so we could all get a lunch break."

Brookhart said Medicare officials have instructed the companies to add customer service staff members.

Axcell, though, suggested the bugs would be worked out of the program.

"It actually hasn't been as bad as I thought it would be," he said. "Here in another month, everything will be fine and people will be glad that they have the program."


Ragingbear 12 years, 2 months ago

AARP offers a good choice of drug coverage, and for those under 55 there is an identicle program called UnitedMedicareRX... They are my provider.

The problem I have discovered, is that none of the companies will cover all of my medications. This one happens to cover all but 2 of my lesser ones. Others would cover as few as 1 or 2 out of the 10 I take.

Patty Buchholz 12 years, 2 months ago

The comment that Medicare adds 1% per month after May, may not be accurate. The information I read at states they may add "at least 1% per month" as a penalty. I am researching this to find the maximum they may charge. It is very frustrating as I try to help my mother decide what to do. I hope we will all share the information that we learn.

Ragingbear 12 years, 2 months ago

Good luck on your research. Not only do the people at the medicare hotlines not know all the rules yet, but they keep changing them as they go along.

neopolss 12 years, 2 months ago

What is also not mentioned is the lock-in for that plan, and that the current rates are NOT a gurantee.

Ragingbear 12 years, 2 months ago

Pretty much, the government is trying to make this look like a good thing, and screw us down the road. Has anyone wondered why there is a 6 month stretch for no apparent reason on why you are not allowed to switch providers? Screwover period is why.

true_patriot 12 years, 2 months ago

The "reform" bill was cleverly designed to break Medicare. Not only can Medicare not collectively bargain for lower drug prices like private industry can, the gaps in coverage were coupled with a provision that forces private gap coverage, to make it impossible for Medicare to compete with private plans. Then, in the conference committee to resolve the House and Senate bills, the "compromise" bill emerged with even more Draconian provisions than existed in the original bills, like a new "insolvency" standard designed to create new pressures to cut Medicare spending down the road. This artificially high standard all but guarantees Medicare will be declared "insolvent" in the next few years. It also declares that when this inevitable declaration is made for two years in a row, the sitting president has to propose spending cuts and that Congress must expedite its consideration of that request.

All this while polling showed the American people were completely against this sort of butchering of the program while showering benefits on huge corporations. But it was structured in such a way that many in Congress (much less the American people) could not comprehend what was being rammed through at a hidden initial cost of $525 billion (the price tag was falsely presented at $400 billion - still a massive expenditure of our tax dollars).

I sincerely hope you successfully negotiate the maze of rules and options (there should be maybe six programs to choose from, not 60 or 70 or whatever it is!). Sharing experiences may be of great help to you, but i also hope you read more about this travesty and spread the word - if enough people understand what happened perhaps there will be enough resolve to clean house in Washington and undo some of the damage before it is too late.

A book that covers this issue and many others is "Off Center" by Jacob Hacker and Paul Pierson.

bthom37 12 years, 2 months ago


Medicare does not offer a plan. The only plans available are from private insurers, only 2 of which offer gap coverage (Humana PDP Complete and AdvantraRX Premier Plus [which only covers generics in the gap]).

Ragingbear; it's 6 months this year, but next year it will be almost the whole year where you are locked into that provider. The only people who are not locked into a plan are subsidized patients (Medicaid, SSI, and disability-receiving patients).

Also, of the people who were supposed to be auto enrolled (Medicaid + Medicare patients), a goodly number of them were not autoenrolled. So now they are supposed to be retroactively enrolled, but in the meantime they have to pay out of pocket and hope they get reimbursed.

KsTwister 12 years, 2 months ago

$250 deductible every year for them and until they spend $3,600.00 only then will Medicare pay 95%. What a sham...What a shame.I know more Seniors who will not sign up and I can't blame them. I would not either.This country needs the media to pressure the governments crooked deals.We need avocates for the people,all the people and right now there are none I think.Most Seniors are living on $7,000 a year after paying for their drugs,do the math.

bthom37 12 years, 2 months ago


Not every plan has a $250 deductible.

Go to and click on the compare plans link. You'll learn a lot.

And just to clarify: I'm not saying I'm a huge fan of this new benefit. I just think people who hear only a little bit about it will think it is significantly worse than it is.

hip_gma 12 years, 2 months ago

I spent hours researching for my mother. I found the key was having web access to medicare's web page and a list of all her current Rxs. The trick tho is as a person's Rxs change, coverage may or may not cover new Rxs in a given year. No paper information comes close to giving you info provided on the web as the web does the "work" for you. Then there's the gap coverage too that you have to watch. If you're still struggling with deciding, start with the internet and a list of current Rxs and dosages. Hopefully you won't waste as much time as I did.

KsTwister 12 years, 2 months ago

Some don't have a deductible,yes. But they don't cover as much either.But consider this. Medicare is already taking medicare payments out of seniors checks.Now add an additional amount for the drug plans---which compared to 5 years ago gives them less than they used to get. Can't wait for the time everyone else will walk in their shoes. lol.Also notice how some of the drug companies themselves are offering the plans. Sounds like the fox watching the chickens.And to boot some companies are cutting peoples retirement benefits or upping the cost of certain benefits.Keep working people it will take all the taxes you can give to take care of all the poverty this country creates for itself.

bthom37 12 years, 2 months ago


Yes, they're taking more money out of people's SSA checks. However, in theory*, they're saving more than they're paying, so this becomes a net increase in income.

And yes, a lot of companies are taking the opportunity to drop drug coverage from retirement benefits, even though Medicare is willing to subsidize retirement plans that do cover drugs.

*Note: does not apply to everyone. Some people who were using pharmaceutical companies 'cheap drugs' programs are now paying more, since the companies are stopping those programs.

bthom37 12 years, 2 months ago

PS: KsTwister

Which Medicare-approved drug plans are being offered by pharmaceutical companies?

KsTwister 12 years, 2 months ago

You would know this already if you checked it out. Let me give you a hint. Look for script in the name.

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