Olin Crump got his Medicare drug benefit. The Centers for Medicare & Medicaid Services (CMS) wanted me to let you know that.
“Before I got this,” Crump said of a new government-subsidized prescription plan for senior citizens, “I was paying $60 a month in premiums (for drug coverage). Now, I’m paying $23 a month. That’s a good deal.”
It is a good deal. But sadly, it still is not a deal Crump or many other older Americans can cut by themselves.
In June, when CMS administrator Mark McClellan came to Denver to praise the Medicare drug benefit, I explained how Crump and lots of his peers couldn’t figure out a complicated system of computers, forms and fine print to get government help paying for medicines.
On Thursday, U.S. Health and Human Services Secretary Mike Leavitt appeared at Denver Health on a whirlwind tour to explain how well things are going in the Medicare drug sign-up. A CMS spokesman suggested I update readers on Crump’s situation.
Here goes: Yes, Olin Crump has gotten his Medicare drug benefit. Of course, that’s great. But because this country’s leaders insist on a labyrinth, private, profit-driven system for Medicare drug benefits, instead of a limited national program, like other Medicare programs, the Olin Crumps of this land can easily become Olin Chumps.
That’s no slam on Crump. He is a nice man and nobody’s fool. I mean him no harm. But the truth is, Crump never signed up for a Medicare drug plan. The program remains too complicated for him and too many Americans.
A nice lady named Marty Bok, who works at Denver Health, picked Crump’s Medicare drug coverage. Bok jockeyed a computer in Crump’s behalf. She entered prescription information about nine maintenance drugs Crump takes each month into a program offered by CMS. The computer analyzed this data against 43 separate Medicare drug plans in Colorado and spit out three that the machine said best suited him.
In a news conference outside his specially painted Medicare Rx bus, with the Johnny Cash tune “I’ve Been Everywhere” queued up on the sound system, Leavitt suggested that signing up for the Medicare drug benefits is as easy as a few computer clicks. It isn’t, according to seniors and those who work with them.
“It seems like there are 500” drug plans, said 74-year-old Jimmie Foshee, as he waited to sign up at Denver Health. “I don’t understand any of them.”
Lack of understanding is critical as the window for enrolling in a Medicare drug plan without a penalty begins to shut. Premiums rise 1 percent each month for seniors who sign up for a Medicare drug plan after May 14.
Time, however, is not the only thing of essence. Bok studied the fine print of each plan the computer recommended for Crump before she enrolled him.
Some drug plans, Bok cautioned, “have hoops you have to jump through.”
Hoops, she said, like limits on the number of pills insurance pays for in a month, regardless of how many pills your doctor says you need to stay healthy.
Hoops like formularies – limited lists of drugs – insurance companies cover.
Hoops like prior authorization from an insurance company’s medical staff for coverage of certain drugs.
Hoops like “step therapy,” where the insurance company refuses to pay for what your doctor thinks you should take until you try a different (read cheaper) drug that the insurance company prefers.
“We go with the (programs) that are more hassle-free,” Bok explained.
When it comes to picking Medicare drug benefits, hassle-free means health-conscious as opposed to money- making. There is nothing more important in a country that treats medicine as a business instead of a healing art.
“You can get through this if you are computer savvy and have a sense of insurance and medical terms,” said Eileen Doherty, director of the Colorado Gerontological Society. “If not, it’s a very difficult decision to make without counseling from someone with knowledge.”
Jim Spencer’s column appears Monday, Wednesday and Friday. He can be reached at 303-820-1771 or jspencer@denverpost.com.
