Ann Jonsen held up the federal government’s “Bible” of Medicare drug benefits and proclaimed herself a heretic. “We need a rewrite on our Bibles,” the 72-year-old retired nursing home administrator said.
As D-as-in-Drug Day approaches for tens of millions of U.S. Medicare recipients, obtaining the nation’s new prescription drug benefit remains a morass of private plans and confusing rules.
Last week, the U.S. Centers for Medicare and Medicaid Services sent older Americans the latest edition of “Medicare & You,” a 100-page “official government handbook” that professed to tell folks everything they needed to know about the sign-up process that begins Nov. 15 for prescription benefits.
Sitting at a table at the Colorado Gerontological Society, Jonsen, Lucia Hammer and June Robertson struggled to sort out the 18 private companies offering separate plans for Medicare drug coverage in Colorado. This was not because the women lacked knowledge. Robertson, in her 70s, works with elderly subsidized housing residents. Hammer, 65, directs the seniors ministry at Clear Creek Valley Baptist Church in Wheat Ridge.
Each woman knows older people who shop for drugs in Canada or join health maintenance organizations to get medicine they could not otherwise afford. Each knows the complexity of the government’s new Medicare opt-in drug plan threatens to keep it from helping many it was designed to aid.
“They couldn’t have made it more difficult,” Jonsen said. “The people I talk to are at sea. They needed to limit choices and make them clear. If (18 companies) is what the free market bears, explain it.”
Those who assumed the government could handle this as it handled regular Medicare, where you signed up for Part A and perhaps Part B and began paying a set premium, forgot that the majority in Congress views national health care the way the Czar viewed Lenin. So Medicare prescription beneficiaries face a plan that seems drawn with an Etch-a-Sketch.
The Colorado Gerontological Society will try to walk people down this winding road at a free Medicare prescription seminar Saturday from 9 a.m. until 2 p.m. at the Colorado Convention Center. Nov. 14 will be “Medicare Monday” in the state’s seven congressional districts. (Call 303-333-3482 for information on both events.)
“There’s no question about people needing help,” said the gerontological society’s director, Eileen Doherty.
To understand a tiny bit of the confusion, consider the “extra help” subsidy that pays some Medicare drug premiums for the working poor. By signing up, said Dougherty, some people risk losing all their existing health insurance.
“We wonder,” said Doherty, “whether we’ve done more damage than good.”
Robertson wonders how shut-ins and people with language barriers will fare.
“I literally go door-to-door in the housing project where I work,” she said.
Every Medicare-eligible American, regardless of income, qualifies for prescription drug benefits. The haves are having as difficult a time as the have-nots.
At her church, Hammer struggles to tell members where to find answers.
“We have been given copious amounts of information,” she said. “But when it comes, it’s so confusing with strict time frames.”
For all the information available, critical facts remain missing.
Formularies that list specific drugs insurance companies will pay for are difficult to come by. If a formulary covers your drugs, said Jonsen, insurers can remove those drugs with a 60-day notice. Because most Medicare recipients can change their drug benefit carrier only once a year, she added, “you’re stuck.”
Furthermore, Jonsen, Robertson and Hammer said, nobody talks about the “doughnut hole” in coverage. It forces seniors to pay 100 percent of their annual drug expenses between $2,250 and $5,100.
As the three women puzzled over Medicare’s drug-reform “Bible,” they got religion.
If socialized medicine isn’t the Gospel for America’s health care crisis, neither is this.
Jim Spencer’s column appears Monday, Wednesday and Friday. He can be reached at 303-820-1771 or jspencer@denverpost.com.
