How Part D Plays in the Heartland

By: Barbara Basler; Source: AARP Bulletin Date Posted: 2006-03-09 10:22:00-05:00

Rob Wilkinson's office is in a squat concrete building out on Wisconsin state Highway 51, not far from the Rock County jail. Even though it's on the very edge of Janesville—a small, gritty factory town surrounded by farmland—scores of county residents have been making the pilgrimage to see Wilkinson, driving into the parking lot clutching brown paper bags full of their medicine bottles.

All of them—the half dozen or so who come to his door each day and the 20 to 50 others who phone—are looking for help with Medicare's new prescription drug coverage.

"It's a good benefit," says Wilkinson, a retired Janesville police officer trained by the state to guide county residents through the complexities of the program. "But it's so hard to figure it out. People are confused by it. And they're afraid of it."

But every day more of that confusion is dispelled, federal officials say, and the mechanics of enrollment are improving, too. New enrollees, they say, are unlikely to experience the turmoil that dogged the system when the drug coverage took effect in January.

Beneficiaries in Wisconsin, like others across the country, are living through the problems—and payoffs—of the new benefit.

Paul Ponath, a 65-year-old retired meat cutter who lives in Sun Prairie, a suburb of Madison, 60 miles from Janesville, says he's signed up for a plan. And he and his wife, who takes a number of medications, expect to save $2,300 a year.

"But it cost me my best goose-hunting buddy because we fought over it," he says, leaning back in a snug booth in the Country Café. "He said the figures I got were impossible. But I went to some counselors, some pharmacists—I even drove down to the insurance company and talked to them in person. And it worked."

Harry Schazkter, a dapper 93-year-old who was at the Madison Senior Center for an afternoon of swing dancing, says, "I really didn't understand the whole thing so I had a relative figure it out. He found me a plan that cut my bills in half."

"I'm satisfied," he adds, "but it really was a difficult decision, and I had to leave it to someone else. Why did they come up with a program I couldn't figure out myself?"

With the May 15 deadline looming for current beneficiaries to sign up for a Medicare plan, counselors, pharmacists, insurance plans and the federal Centers for Medicare & Medicaid Services (CMS) are bracing for a resurgence in enrollments as Americans scramble to pick a plan and avoid a late penalty that would result in higher premiums.

"People may not understand anything else about the Medicare Part D, but they understand there is a penalty," says Vickie Baker, a state Medicare counselor in Madison. "The penalty is out there loud and clear."

In fact, she says, even people who have employer or other kinds of "creditable" insurance plans—those that offer prescription drug coverage that is as good as or better than the standard Medicare benefit—are calling in, fearful they will be penalized.

"We tell callers to take a breath, relax," Baker says. "If you have creditable coverage, you are OK. You will not be penalized if you are dropped from that plan later and have to go on a Medicare drug plan."

Then there are those who call, literally crying on the phone, says Donna Bryant, lead counselor for the State Health Insurance Assistance Program in Madison. "You have older people with poor vision who don't have computer skills, and this whole program is online," she says. "That's very frustrating for them."

Although the Medicare hotline provides the same information as its website, some people who were reluctant to go online postponed acting on the benefit. CMS says that in January the wave of last-minute signups overloaded the computer system, and they were not processed by the time the beneficiaries went to their pharmacies. Now, a CMS official says, "those who enroll before the deadline on May 15 should be confident that they will be able to get their drugs beginning June 1, because the plans will have time to process enrollments and mail out cards."

The massive prescription drug benefit, the most important change since Medicare became law in 1965, is processing 1 million prescriptions a day. Its debut, however, was marked by computer crashes and overloaded telephone help lines that left some of the most vulnerable low-income Americans without their prescription drugs.

Acknowledging the troubled rollout, Mark McClellan, head of CMS, said last month, "We make no excuses for these problems. They are important, they are ours to solve, and we are finding and fixing them."

Since January Wisconsin has added part-time workers to its three state Medicare help lines while CMS has beefed up its national phone banks and added counselors to help callers choose a plan or fix a problem. Wait times for help lines have been reduced and computer systems improved. Information on the drug insurance program, experts say, is widely available. But they can sense the hesitation and confusion.

"I've seen people who would save $200 to $300 on Medicare stay with their insurance company because of all the uncertainty," says Gail Brooks, a case manager at the Colonial Club, a popular Sun Prairie senior center with imposing white columns and handsome carriage lamps.

Sitting near the fireplace in the center's living room, Martha Tonn, 87, a retired teacher, says, "I've come to the point where I'm just not interested in this program.

"When I looked at the pile of material I had on this—something came in the mailbox every single day—I just felt it was too much, too overwhelming," she says. "I don't take many drugs, and I'm satisfied I can take care of them myself."

Scott Procknow, a pharmacist at the O'Connell Pharmacy in Sun Prairie, says, "There has been so much negative press, we've talked to people who are ready to give up."

In fact, there had been a sudden spike in sign-ups for SeniorCare, Wisconsin's prescription drug assistance program for residents 65 or older, which is considered creditable coverage and will run through June 2007. "Some people signed up for SeniorCare to avoid the Medicare benefit," Procknow says. "They want to wait and see how it goes."

But when customers came in "and we sat down and took them through the [Medicare] process and plugged in their meds, the majority signed up," he says. "When we show them they can save money, they light up. It's like a Christmas present."

Pharmacists are doing yeoman's work, fielding queries from customers, running eligibility checks when insurance cards haven't arrived and dispensing medicines even when the plans' computers can't find the enrollee.

More than half the states, including Wisconsin, have stepped in and paid for the prescriptions of many "dual eligibles," low-income and disabled residents who were automatically switched from Medicaid to a Medicare drug plan on Jan. 1. These beneficiaries discovered that they didn't show up on their plan's computer or their subsidies were not flagged in the computer and that their copayments would be $50 to $100. Pharmacists were told to fill the prescriptions and bill the state.

Jeff Seabloom, the owner of the only pharmacy in Elcho, a tiny town tucked in the northern corner of the state, says he has had to take out a $50,000 line of credit to ensure he will be able to pay his bills until he is reimbursed.

"We are subsidizing this program now, and it's not fair," Seabloom says.

But counselors report that last month a number of pharmacists were balking, refusing to hand out the emergency 30-day supply of medicine without payment. And for "duals" still trying to sort out their enrollment plans, that can be devastating. "We had a mentally ill man who had to be hospitalized for five days because the pharmacy refused to give him his meds without a card," says Aimee McCutcheon, a lawyer who helps supervise one of the state's help lines.

At Mallatt Pharmacy in Madison, owner Mike Flint says, "We're on the phone 14 hours a day trying to process prescriptions and figure out plans. We call the plans and they put us on hold 30, 45 minutes. We listen to the music. Then we get disconnected. We call again."

Then there are the calls on behalf of his 200 or so patients in assisted living residences too ill to make the decision about a plan on their own. Flint sent their relatives and the people who hold their power of attorney letters last summer explaining the benefit, giving deadline dates and instructing them about enrollment. But he's had to telephone scores of these people a number of times because they didn't take care of signing up the beneficiaries.

"Sometimes I wind up speaking to a bank, and they say, 'You decide,' " he says. "They want me to fill out the paperwork and send it to them. I tell them that's not my job, that it's not even legal."

Flint adds, "My staff has gone to unbelievable lengths to make this work."

At the Madison Senior Center, Emily Harris, 83, glides across the polished parquet floor with her dance partner as a six-piece band plays a great brassy version of "Sunny Side of the Street." During a break, she explains that she spent hours researching plans, then signed up for one online.

"But when I went to get my prescriptions in January," Harris says, "I wasn't listed anywhere so I had to pay $200 out of pocket." Frustrated and disappointed, she then sat down with her pharmacist, who helped her through the process so she could sign up for a plan that will save her $120 a month.

"I think I've got it now," she says with a smile.

Additional Related Links

New Q&A on Rx Plans (March 2006)

New "Extra Help" Income Limits (February 2006)

Medicare Drug Benefit May Be Cheaper than Canada (January 2006)

Savings Are in the Details (December 2005)

Medicare's Drug Plans: A Better Bargain Than Expected (November 2005)

Medicare Special Report: The Basics