Jean Newman is hardly afraid of challenges. The 73-year-old Cuban native came to the United States as a teen, worked for years as a substitute teacher and volunteered in the Israeli army well into her 50s.
But when it comes to the new Medicare prescription drug benefit, she is at a loss.
“The whole thing is so confusing. It might as well be in Chinese,” Newman said.
Millions of senior citizens will become eligible for the benefit Jan. 1, but but many don’t know whether it will save them money, or which private insurance plan they should choose among the dozens that have bombarded their mailboxes with ads in recent months. Many don’t know how to apply or whether they are even eligible. And many are asking: Will the medications I need be covered?
The clock is ticking. Those who fail to sign up by May 15 may not get coverage until 2007.
Not surprisingly, the people who seem to know the most tend to be the more educated and more affluent — the ones least likely to need the new coverage.
About 42 million people are eligible for the Medicare drug benefit. As of mid-December, nearly 20 million were enrolled in some form, but the vast majority of them were automatically switched over from other benefit programs, including Medicaid. Only about 1 million had joined voluntarily.
Newman spends about $150 a month on Prozac and the thyroid supplement Levoxyl. She applied for the low-income assistance but was rejected. Now she is unsure whether she is eligible for any of the coverage. (She is).
“There’s a thousand different forms of confusion, but almost everyone’s confused,” said Robert Hayes, head of the Medicare Rights Center, a consumer group.
The government has touted its Web site, www.medicare.gov, where senior citizens can compare plans on spreadsheets, and it has urged people to consult their families and their doctors.
Hayes said its unrealistic to expect doctors to shoulder the burden of explaining the plans. “In an ideal world, which is long past in this economy, physicians could sit down and become experts and counsel their patients. That doesn’t happen today because there’s so much time pressure on every doctor,” he said.
Federal and local health officials and insurance companies have tried to provide workshops on the new program.
The Philadelphia Senior Center has hosted about a dozen workshops and seminars over the past couple of months, but not many people have been enrolling in the program, said executive director Tamara Moreland. She said she suspects they prefer to keep their current coverage. “I hope it isn’t that they don’t understand it,” she added.
Philadelphia senior center counselor Gloria Mack said she herself was confused by the training she received on the program. “Oh, my God,” Mack recalled thinking. “I’m confused, and I’m not a senior.”
At the Clairemont Friendship Senior Center in San Diego, confusion ran high even after Medicare officials held a briefing there in November. Several elderly people said their private insurers automatically signed them up for a plan, but they did not know whether they were getting the best deal.
“The government should have just said, ‘You pay so much and all your drugs are covered,”’ said Dorothy Morrill, 70, whose PacifiCare Health Systems Inc.’s SecureHorizons plan signed her up for coverage with a $44 monthly premium.
Nearby, at Allen Pharmacy in San Diego, owner Roger Fetterly said he worries that some of his customers will find that their plan does not cover the drugs they need.
“We have a group of people who either don’t open their mail or open and don’t read it,” Fetterly said. “They just don’t know anything about what’s going on.”
Others say they are not good with computers or do not want to burden their children by asking for advice.
Those who have done their homework are finding that the new program doesn’t always offer advantages.
Benefits and drawbacks
Mark Silverstein, 66, of Philadelphia, enrolled in one of the prescription plans because he was told his current Medicaid program would no longer be offered after Jan. 1. He called Medicare, told a representative which medications he takes, and was signed up for a plan that he said would cost him $15 a month.
But then Silverstein found out that his medicine might be covered by the Veterans Administration because he served in the Army. Silverstein said he is going to look into that option.
Kirk and Suzette Brookshier of Prescott, Ariz., were excited about the new program at first because they have no prescription drug coverage. The more they looked into the program, however, the less attractive it seemed.
Kirk Brookshier said the copay would be exceptionally high because four of the six drugs they take are among the most expensive.
“I think the thing’s a total farce,” said Brookshier, 72, a retired owner of a tire store.
In Tucson, Ariz., Jerry Lacker said he has enrolled in the program but found the gap in its coverage puzzling. Many plans cover annual drug purchase of up to $2,250, but then senior citizens must pay the full cost of the rest of their drugs until they have spent $3,600, at which point Medicare kicks back in.
Lacker, 75, a one-time East Coast business owner, said the coverage is sort of an insurance policy in case he needs more medicines down the road.
“I don’t know whether it’s going to be beneficial in the short-term, but I bought it because of the long-term,” he said. “It’s hard to really understand how it’s going to function until you use it.”