Deadline nears for drug plan

LAWRENCEVILLE - With just more than a week remaining for seniors to sign up for Medicare's new prescription drug benefit, the biggest change in the program's 40-year history is getting decidedly mixed reviews.

"It had a rough start, but it's getting there,'' said Yolanda Hallas, associate state director for AARP of Georgia.

"It's still a disaster,'' said state Rep. Ron Stephens, R-Garden City, one of several pharmacists serving in the General Assembly. "The senior citizens hate it. The pharmacists hate it.''

May 15 is the deadline in the initial six-month enrollment period for Medicare Part D, the first foray into prescription drug coverage for the federal health care program serving America's elderly and disabled.

Medicare recipients who haven't signed up by then won't be able to until the next enrollment period starts in November, and, when they do, they'll have to pay a penalty.

The program is the Bush administration's answer to years of pressure from senior citizen advocacy groups like the AARP to add a prescription drug component to Medicare. But it has been beset by criticism both philosophical and operational.

It differs philosophically from the rest of Medicare in that it is being operated by the private sector instead of the government.

Deane Beebe, spokeswoman for the New York-based Medicare Rights Center, said the drug benefit is more expensive than it needs to be because the law establishing the program prohibits the Centers for Medicare and Medicaid Services from negotiating drug prices with insurance companies.

"Medicare negotiates rates for hospital stays and doctor visits,'' she said. "This is the only piece where Medicare is prohibited from negotiating prices.''

Too many options

Allowing profit-driven insurance companies to operate the program rather than a single government agency also has led to what critics say is an overload of choices for seniors.

In Georgia, for example, there are 82 plans - 42 "standalone'' options being offered separately from other types of Medicare coverage and 40 managed-care plans that provide a drug benefit in conjunction with hospital stays and doctor visits.

"I get repeated complaints about the complexity,'' said U.S. Sen. Debbie Stabenow, D-Mich., one of a group of senators asking for the May 15 enrollment deadline to be extended until the end of the year. "Folks want the one choice they're not getting, which is to go to Medicare directly.''

To help seniors navigate those complexities, CMS and a host of partners at the state and local levels have a massive education effort under way using a variety of tools.

The federal agency has been running a toll-free hotline 24 hours a day, seven days a week since last fall. CMS also has a Medicare Web site seniors can use to help them choose a plan.

Medicare recipients who provide a list of their prescriptions with dosages and frequency can find out which plans would best suit their needs and whether a pharmacy near them offers those plans.

"What people want to look at is the cost, the coverage and the convenience factor,'' said Lee Millman, a CMS spokeswoman in the agency's Atlanta office.

The state also offers a toll-free telephone line staffed by Georgia Cares, an insurance counseling agency affiliated with the state Department of Human Resources.

CMS's parent agency, the U.S. Department of Health and Human Services, cited those efforts in announcing late last month that enrollment in the drug plan had surpassed 30 million Americans, exceeding the government's projections for the first year.

In Georgia, more than 360,000 Medicare recipients have signed up for the drug benefit, about 317,500 of them opting for a standalone plan, according to numbers supplied by Georgia Cares. And that's not counting more than 145,000 low-income Georgians who already had Medicaid coverage and were automatically enrolled in the new program.

Not enough enrollees

Those national enrollment figures, however, mean another 12 million Medicare recipients have not signed up for the drug benefit.

The program's critics say that's too many, and they're blaming the same outreach efforts the drug plan's supporters are praising.

Last week, the Government Accountability Office issued a report finding that telephone operators on the Medicare hotline are giving out wrong or misleading answers to seniors' questions.

"People are struggling to wade through this information, and Medicare is giving out wrong information,'' Beebe said. "These are the tools elderly Americans are having to rely on. ... Many are deciding to do nothing.''

Beebe and others say the continuing uncertainty over the program is reason enough to extend the enrollment deadline.

But the Bush administration and the president's Republican allies in Congress aren't likely to go along with a delay.

"We ought to leave the law as it is,'' said Sen. Johnny Isakson, R-Ga. "The last 90 days, this has gone from a lot of questions and confusion to where now, we get nothing but calls of praise ... To put it off until the end of the year

doesn't serve anyone.''