May 11, 2006
Drug Plan Proving Bitter Pill for Seniors
After sorting through piles of brochures, Millie Topper thought she had finally found the right Medicare Prescription Drug Benefit plan to pay for the high blood pressure medications she wanted.
But once the 77-year-old resident of Silver Spring, Md., crunched the numbers, she realized she couldn't afford the plan's heavy deductibles and monthly premiums. Grudgingly, she signed up instead for a plan that forces her to take a generic drug in lieu of the brand name she prefers.
"I don't know which way to turn," Topper said.
Her friends, she said, complain that "you'd have to be a rocket scientist to figure out the Medicare drug benefit."
It's a familiar story for Jewish officials who staff the community's elderly help lines, where phones have been ringing off the hook in advance of the May 15 deadline to enroll in a prescription benefit plan. The benefit, which took effect Jan. 1, has been financially detrimental to some Jewish seniors and helpful to others -- but bewildering to almost all.
"I haven't heard anybody say, 'Boy that's terrific,'" said Beth Hess, director of aging and disability services for the Jewish Social Services Agency. "Nobody's dancing on the ceiling with enthusiasm for this."
Its consequences are important for a Jewish community with disproportionately large numbers of seniors. A recent survey recorded 19 percent of U.S. Jews as seniors, as opposed to 12 percent in the general population.
The benefit is the fruit of the Medicare Prescription Drug Improvement and Modernization Act of 2003, which for the first time covers all Medicare beneficiaries. The government turned to private enterprise to handle the massive new entitlement, against the backdrop of escalating drug costs. Incentives were offered to private companies to administer the benefit at the lowest possible cost. The idea was to encourage profit-driven companies to compete against one another to enlist seniors, causing prices to drop.
Under the rules of Medicare's new prescription drug plan, known as Part D, beneficiaries must choose a plan offered by a private insurer. Each Part D plan -- and there are dozens in each state -- has its own "formulary," a restrictive list of drugs, pharmacies, monthly premiums, co-payments and yearly deductibles.
Finding the best and most affordable plan has Jewish seniors grousing about the maze of options. The jargon has added to the confusion.
"I didn't even know what 'formulary' meant," Topper said.
For those enrollees who stand to benefit from the new system, the immense confusion triggered by the transition has overshadowed the more affordable costs. With many seniors on multiple prescription drugs at once -- along with the ever-present prospect of needing new medications, finding the right formulary has become a tall order.
One way of searching for plans is by accessing the "plan finder" on the Medicare.gov Web site, a process many experts say can be confusing for anyone, let alone seniors who may not be computer savvy.
Some seniors pore over each individual formulary brochure they receive in the mail. But most chafe at sifting through the formularies or using the Internet to find the best plan. Many Jewish seniors have turned to their children and grandchildren for help
"What's most impressive is how active children are in trying to help their parents, regardless of how much money they have," Hess said. "Active adult children are making it a lot easier on Jewish seniors."
William Peirez, president of B'nai B'rith International's MetroNorth region, enrolled his 87-year-old mother in an AARP plan. Peirez is angry about the new system, which he says is far too complicated.
"An 80-year-old can not figure this out," he said. "It doesn't make sense. It's too difficult for me, and I'm 62 and a lawyer."
Jewish leaders and policy analysts agree that some of the biggest losers from the benefit are the indigent on Medicaid, including a number of Jews.
"There is this stereotype that all Jews have money," said Rachel Goldberg, director of senior advocacy at B'nai B'rith International. "We forget that while the average income for Jews is slightly higher, we still do have older Jews living in poverty."
At the beginning of the year, all 6 million Americans who qualify for both Medicaid and Medicare were automatically enrolled in random private plans under the new benefit.
Prior to the switch, Medicaid recipients, who are in the lowest income bracket, had received their drugs without cost. Now they are saddled with more restricted options and face co-payment costs of a few dollars each time they request a prescription.
"Many are paying more than they used to, and simply cannot afford it," Goldberg said. "What sounds like coffee money to middle-class people, if you're living hand-to-mouth, can [determine] whether or not you make your electric bill."
Goldberg and other Jewish leaders are also highlighting lower-middle and low-income seniors who come close but do not qualify for Medicaid. This group has the most to gain from the benefit but also the most to lose, they said. Many seniors lack assistance in paying for their drugs, though there are subsidies for people who pass an assets test. But poorer seniors are less likely to have access to advisers and the best information to find the right plan. Without help, many feel powerless and are avoiding the benefit altogether, experts said.
Another lightning rod for confusion and concern is gaps in the benefit structure, called "doughnut holes." If drug costs -- including out-of-pocket costs and Medicare's portion -- exceed $2,250, Medicare pays nothing, while the beneficiary must cover 100 percent, until costs reach $5,100. Then Medicare defrays 95 percent of costs.
Many Jewish seniors don't know whether it's worth spending the extra money in monthly premiums to receive a plan that will fill in all or part of the gap.
Jews who are better off financially and already receiving their drugs through separate plans are unsure whether they would fare better or worse under Part D. Opting into the benefit may result in worse or more costly coverage and lead to the termination of former plans -- but seniors also want to avoid late fees incurred if they enroll after the May 15 deadline.
Seniors "are resigned to struggling with a very complicated situation, where what's right for them can change over time," said David Gamse, executive director of Jewish Council for the Aging.