Medicare questions pour in - East Valley Tribune: Get Out

Medicare questions pour in

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Posted: Sunday, January 1, 2006 5:06 am | Updated: 4:01 pm, Fri Oct 7, 2011.

Today’s launch of a landmark Medicare drug plan has thousands of Valley seniors and disabled residents calling for help.

Phone lines created to provide free help navigating the dizzying array of Medicare-subsidized private plans have been jammed, and officials and volunteers are working over the New Year’s weekend to try and answer questions.

"The calls are coming in unbelievably," said Ann Marie Grande, manager of the benefits assistance program at the Area Agency on Aging. "I’m on vacation this week, but I’m still doing enrollments."

But the vast majority of Medicare recipients are greeting the changes with a great big yawn. Program participants have until May 15 to make their choices, which include more than 80 private plans in Arizona.

Most of the 42 million seniors or disabled Americans who qualify for Medicare either haven’t decided whether to enroll in the new Part D prescription drug benefit or won’t need to bother because their employers or former employers provide coverage that’s just as good or better. About 5 million already have drug coverage through Medicare’s managed care plan.

And more than 96,000 of Arizona’s oldest, poorest and sickest residents were automatically transferred to a Medicare drug plan from the Arizona Health Care Cost Containment System, the state’s alternative to Medicaid.

In Arizona, dual-eligible residents have been accustomed to receiving their drugs through AHCCCS. All of them should have been assigned to Medicare drug plans last fall, but local and federal officials are worried some could fall through the cracks.

"If everything doesn’t happen the way it’s supposed to, those are the ones who are going to go without, because they don’t have the money to pay for (prescriptions)," Grande said.

The government has set up contingency plans to account for those who were missed, either because of inaccurate data or new enrollment in one of the programs, allowing pharmacists to enroll them on the spot if they have proper ID. Also, because some of their drugs will not be covered, pharmacies have agreed to provide a one-month supply of the medications and be reimbursed by the government.

But a recent General Accounting Office report questioned how well those plans will work in practice, and state health officials say there’s no way to be sure until the program begins.

Some dual-eligibles may be enrolled in plans that don’t cover the same drugs their doctors have prescribed and require them to use a new pharmacy.

"I wouldn’t want to be a pharmacist," Grande said. "If they just did it on their own and didn’t get help before they signed up, the pharmacist is going to be the one to get all the questions."

And they probably won’t have all the answers at first.

"We’re here to help, but I think a lot of frustration is going to be vented on us because it doesn’t appear we know what we’re doing," said John D. Musil, owner of the Apothecary Shops and president of the Arizona Pharmacy Alliance.

Although pharmacies have been training for the new law, Musil said there are many unknowns. He expects to get customers who don’t know to which plan they’ve been assigned, are unaware their drugs aren’t covered, are aghast at the prospect of switching to a new medication and balk at the new co-pays that accompany each drug.

"Literally, it is walking in the dark and being blind," Musil said. "I would prefer that people not come in and mob the store . . . but it’s going to happen."

He urges patients to call their pharmacies and get switched over to the new plan weeks before they need a refill. If costs are prohibitive or you discover some drugs aren’t covered, make an appointment with your pharmacist to find out what the alternatives are, he said.

Medicare/AHCCCS beneficiaries can switch plans up to once a month, while everyone else can do so annually, beginning next Nov. 15. Those who don’t enroll before May 15 will incur late penalties of 1 percent of their premium for each month they wait.

Bernadine Hoffman and her husband had been paying about $500 a month for their medications, so she enrolled them in a plan endorsed by AARP that covers their drugs and offers no deductible. She knew that the so - called "doughnut hole" coverage gap would probably kick in, requiring them to pay for all their drugs above $2,250.

"My big question was, how long until I get to the doughnut? I got two separate answers because I called two separate times," said Hoffman, a retired nurse with the county’s long-term care system. "This whole thing is set up so that you have to be an actuary to do it. And it’s just unwieldy. It’s just ridiculous."

Hoffman of Scottsdale is a volunteer for the state health insurance assistance line. She’s confident Medicare drug coverage will save her family money, but worries about those who may have acted too hastily or were automatically enrolled in plans that don’t meet their needs.

AHCCCS members also will have monthly co-pays of $1 to $5 for each medication.

"They’re mad," she said. "One man was very abusive on the phone about this. One man was practically in tears," she said. "It’s hitting some people very, very hard. They don’t have a lot, and some of them are very, very sick."

Hoffman urges people to take their time and make sure the plan they choose covers their drugs, but not overanalyze every last variable for the dozens of plans that may apply to their situation.

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