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By: Darrell Smith
The Desert Sun
June 2, 2004
Jim Knudsen remembers the Depression, and joked how his mother could get more gravy out of a half-pound of round steak than anyone he knew.
Now 74, Knudsen, an outreach worker at the Cathedral City Senior Center, sees other seniors doing a different type of stretching, cutting their medications in half to make them last longer or skipping doses altogether to save money.
It's a reality for cash-crunched seniors forced to make choices between food, rent and medications.
A new Medicare discount prescription card plan, which went into effect Tuesday, is designed to provide seniors, the disabled and those with low incomes relief from high prices.
But the plan continues to confuse the seniors it is supposed to help and frustrate counselors whose job it is to help answer their health-care questions.
"Even the people who are working on this on a daily basis are having problems understanding it," said Sharron Marsh, outreach coordinator for the Health Insurance Counseling and Advocacy Program, which provides health care assistance to seniors and others in Riverside County.
The Department of Health and Human Services approved 48 drug discount cards to all Medicare beneficiaries, giving those on Medicare price breaks on their prescriptions and an additional $600 in credits to low-income seniors to help pay for their medicines this year and in 2005.
But as Medicare patients struggle to navigate the new system of drug discount cards, some experts warn that even more bewildering choices are ahead when the full package of prescription benefits takes effect in less than 18 months.
The discount cards are intended as a temporary measure until prescription drug insurance under Medicare begins in 2006.
In theory, they allow individuals with no prescription drug insurance to benefit from lower prices available through group purchasing.
The administration says the cards will save their users up to 18 percent on average off retail prices for brand-name prescription medicines.
By next year, Medicare beneficiaries will have to decide whether to sign up for new prescription drug benefits, many of them offered by the same insurance companies and pharmacy benefit managers that are sponsoring the discount cards now.
But the decision will be much more significant for some 41 million elderly and disabled people on Medicare because of complex rules governing which drugs are covered and who's eligible for certain subsidies.
"This is the largest benefit expansion in Medicare's history, but there is a great deal of uncertainty about whether the benefit is well-designed to provide beneficiaries with access to needed medications, while providing protection from high out-of-pocket costs," said Marilyn Moon. Moon is an economist specializing in Medicare issues for the American Institutes for Research, a nonprofit corporation that analyzes social science issues.
In the near term for seniors, searching for the right card to cover all or most of their medications can be a challenge, Marsh said.
"There seems to be a tremendous amount of confusion" about the plan, she said. "There hasn't been a great amount of education on behalf of the government."
Beyond the dozens of card options, Marsh said medicines can be added and dropped at the card sponsor's discretion. Moreover, information on a specific card's plan, though voluminous on the Internet, means little to those who aren't computer-savvy.
"If you don't have a (computer) background, you're out of luck," Marsh said.
Some California Medicare and Medi-Cal patients, however, are staying put with their retirement prescription plans.
Knudsen and 71-year-old Martha Lindsey, his outreach colleague at the senior center, are fortunate.
Their pension plans -- Knudsen's from an industrial chemical distributor, Lindsey's from Los Angeles Unified School District -- offer considerable savings on their prescriptions.
"I pay $108 a month in insurance, but I get 80 percent coverage," Knudsen said. "I don't want to change anything."
Add to that, SB 393.
Enacted in 1999, the legislation enables Medicare recipients to obtain their prescription drugs at a cost no higher than the Medi-Cal reimbursement rates.
The legislation means as much as much as 40 percent coverage of prescription costs as long as patients can present their Medicare card, Marsh said.
"It's a better option than spending $30 (discount card enrollment fee) on a card you may not use," she said.
In a new report released Monday by the Commonwealth Fund in New York City, Moon said while the new prescription plan will give much-needed assistance to many on Medicare, particularly those with low incomes, it's unclear whether most patients will benefit in the long run.
"For those low-income people who are enrolled, the coverage will be quite good," Moon said. But Moon questioned whether those individuals who make $12,569 or less a year or couples who make $16,862 or less this year would be enrolled through the new program and whether people making just a bit above the threshold would get much help.
The short time frame troubled Knudsen and Lindsey at the senior center Tuesday.
"It's only good for two years, then what?" Knudsen said. "It's back to square one. It's not a solution to the problem of higher costs."
http://www.thedesertsun.com/news/stories2004/health/20040602022733.shtml
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