There are 1,854 square miles in Elbert County, and Debbie Studer’s ’88 Oldsmobile has rattled and, in the past two years, bumped over most of them.
Studer and her donated sedan are on a mission to end confusion and get the cheapest Medicare prescription drugs possible for the elderly in Colorado’s remote outposts.
As part of a fleet of federal contractors known as SHIPs – Senior Health Insurance Assistance Programs – Studer helps seniors decipher drug lists and deductible tables, calculate costs and sign onto a Medicare prescription drug plan.
The next month is going to be a busy time for Studer as Colorado’s 525,000 seniors have until Dec. 31 to enroll, re-enroll or make changes in the pharmaceutical benefit plan known as Part D.
As Part D nears its first birthday, much of the complexities in the system – the multiple plans and the coverage gap, known as the “doughnut hole,” remain.
But there are changes too.
More companies are offering more plans with more options – at higher prices.
Seven of the 10 most popular plans are raising premiums for 2007, four by at least 15 percent, according to the Kaiser Family Foundation.
The Centers for Medicare and Medicaid Services reported last month that more drugs will be covered next year.
That increase in coverage is accompanied by additional requirements that cheaper, generic drugs be tried before using some newer expensive drugs.
In Colorado, 23 companies will be offering 55 “stand-alone” plans – up from 17 offering 44 in 2006, said Liz Tredennick, head of the agency that oversees SHIP in Colorado.
Monthly premiums for those plans, which are purchased to supplement standard Medicare health insurance, range from $16.60 to $72.50.
There are about 60 more plans that are Medicare supplements or Medicare HMOs “that roll all coverage, including prescription coverage, into one little ball,” Tredennick said.
One of the biggest stumbling blocks has been the gap in coverage – the so-called doughnut hole.
After Medicare has paid $2,250 for an individual’s medications, the plan pays nothing until the individual has spent $2,850 out of pocket for drugs.
That gap is known as the doughnut hole.
Only one of the stand-alone plans in Colorado offers full coverage in the doughnut hole, while about 15 of the combination plans have some coverage, though often only for generic drugs.
“I have not met a single senior who understands it all,” said Melodie Campbell, executive director of Colorado East Community Action Agency.
Debbie Studer and her boss, Campbell, are big fans of the plan-finder – a Web-based calculator that helps compute costs and savings.
The trouble is that very few of the seniors who ask for help know how to work a computer, much less have one.
Despite the confusion and roadblocks, 90 percent of the nation’s seniors now have prescription drug coverage, according to estimates by the Centers for Medicare and Medicaid Services.
Only 53 percent of those seniors, however, are in a Part D plan.
The rest are covered by private plans, veterans benefits or other insurance, according to the Kaiser Family Foundation.
In Colorado, 540,000 seniors now have drug coverage, about 290,624 of them through a Medicare Part D plan.
That leaves about 38,000 seniors in the state without a prescription drug plan, said Mike Fierberg, CMS spokesman for Colorado.
Democrats in Congress say improvements need to be made in the program.
One of the items near the top of Democrats’ to-do list is to grant CMS the power to negotiate with drug companies for volume discounts.
The 2003 law that established the drug program expressly prohibits such agreements.
Medicare pays for drugs through the private insurers who run the coverage – and who typically pay higher prices than government agencies.
Meantime, seniors have plenty of questions about enrolling in Part D as it is.
Studer is keeping her car gassed up.
To find the nearest SHIP, call 888-696-7213.
National Council on Aging website: BenefitsCheckUp.org.
Centers for Medicare and Medicaid Services website: cms.hhs.gov.
Staff writer Karen Augé can be reached at 303-954-1733 or kauge@denverpost.com.
Questions
If I am already in a plan, do I have to reapply?
If the plan you are using is still operating and you want to continue in it, you don’t have to register. The plan, however, may raise its premiums or change the covered drugs and its co-pays. So you’ll want to check the notice that the plan sends about changes.
If I want to change, when must I enroll in a new plan?
You have until Dec. 31 to change plans, but if you want to ensure a smooth transition, it is recommended that you enroll in your new plan by Dec. 8.
Where can I find new plans?
The Medicare website, medicare.gov, will allow you to look up Colorado plans.
If I haven’t enrolled before, what do I do?
Go to the Medicare website and compare Colorado plans.
What are the key things to look for in a plan?
Among the key questions are whether the plans cover all – or most – of your drugs; which plan will have the least out-of-pocket costs; which plan allows you to get drugs anywhere in the country; and which plan has the fewest restrictions; and which provides such benefits while allowing you to remain within your budget.
