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The new Medicare drug program is anything but simple

Reuben and Claudia Beck understand complex things.

Reuben, 84, who was a sailor in World War II and an engineer for 40 years, designed conveyor systems for automobiles before retiring at age 70. Claudia, 66, a registered nurse, is a retired insurance claims adjuster who knows how to slash through red tape.

Even so, the Becks fear they have met their match in Medicare's new prescription drug benefit plan, designed to help seniors pay for medicine.

"It's just so confusing," Claudia Beck said. "And it seems the more I call, the more runaround I get."

The couple, along with 42 million other seniors and disabled citizens eligible for Medicare, will have access to a benefit that seniors have wanted for a long time.

And there's no doubt the prescription drug program will help millions.

First, however, they must survive the jungle of jargon and confusing array of options that are tripping up thousands already — and the benefit hasn't even started yet.

Medicare is the government program that provides health insurance for Americans 65 and older. It has not previously covered outpatient prescription drugs.

But in 2003, Congress passed a law that will make prescription drug coverage available to those on Medicare starting Jan. 1.

Private insurers are providing the coverage. Those eligible for the benefit can pick an insurance plan from dozens being marketed to them. Seniors generally will pay premiums and co-payments as with most insurance policies.

But the confusion begins right at the beginning — when seniors try to pick a plan. In Georgia, there are 82 plans offered by 18 companies.

Deductibles, co-payments, out-of-pocket expenses and covered drugs vary among the plans. Imagine 82 plans with, say, five variables — premium, deductible, co-payments, drug list and pharmacy choice. The variables become mathematically if not emotionally daunting.

"The new Medicare drug benefit is 10 times more complicated than the Medicare drug discount card," said Robert Hayes, president of the Medicare Rights Center, a New York-based consumer advocacy organization, "and 10 times more important."

Even after comparing premiums, co-payments, deductibles and rosters of drugs, the work will still not be complete. Seniors will also need to determine how they'll stomach what's termed "the doughnut hole" — a gap where there's no coverage after seniors rack up drug costs of $2,250.

Under most drug plans, patients will have coverage up to $2,250 in spending. But between $2,250 and $5,100, they'll generally be on their own. Medicare will pay 95 percent of covered drug costs above $5,100.

Worth looking into

Despite the difficulties, it's worthwhile for seniors to explore the new $700 billion benefit, especially those with limited incomes, those who lack drug coverage now and those with high prescription costs, experts said.

The best way for seniors to compare plans is by using Medicare's Web site or calling Medicare or a local insurance counseling service to use the Internet tool for them.

Gary Karr, a spokesman for the federal agency that runs Medicare, acknowledged "a little bit of anxiety" among consumers over the benefit. But the Centers for Medicare and Medicaid Services also emphasized there's no immediate rush to sign up, that Nov. 15 is just the starting point.

"People do have time to take a deep breath," said Dr. Mark McClellan, the Medicare agency's administrator. "They don't need to rush into a decision."

Enrollment is open between Nov. 15 and May 15. Coverage for those who enroll before Dec. 31 will begin Jan. 1.

If you wait until after May 15 to enroll, you might have to pay extra to join a plan.

The Medicare agency said seniors now can narrow down their choices based on what's important to them — premium, deductible, available drugs, or other factors.

McClellan said CMS had added thousands of customer service representatives, and that during a recent week handled more than 700,000 calls "with no or minimal delay."

The competition among drug plans has helped consumers, he said. "What we're seeing is that drug plans are coming in at a lower cost and with better benefits than were expected." Some plans have no doughnut hole or no deductible, he said.

"This benefit is really worth it," McClellan said.

Can't call everybody

The Becks have struggled to find information about the 82 drug plans and analyze which one might work best for them.

For example, the Medicare pamphlet about the program could not list all the provisions of the 82 plans listed in Georgia.

"Am I going to have to call all 82 companies?" Claudia Beck asked one day last week.

And the Becks wonder: If figuring out a prescription drug plan is this hard for them, how hard will it be for millions of others not as savvy or healthy?

Such insecurity among seniors appears to be widespread, according to Lisa Federico, coordinator of GeorgiaCares, a nonprofit insurance counseling service. Her office is receiving about 300 calls a day from seniors frantic for help. The staff can process about 80 of them, she said, creating a pileup of 220 calls a day and putting them at least a week behind.

"I've never seen anything like this, just the level of confusion this is generating," Federico said.

After some delays, the Medicare Web site (www.medicare.gov) for the drug benefit has finally opened, but still isn't fully functional, with a key piece of the "Prescription Drug Plan Finder" tool not working. It frustrates counselors trying to help seniors. The Medicare agency said the site would be completely functioning "in the next few days."

Even then, for many reasons, seniors will need insurance counseling, Hayes said.

"There will be insurers who will promote a low premium and disguise the extremely high co-payments," Hayes said. A senior can find out what drugs are covered on a plan's formulary, he said, "but people aren't being told how much they are going to pay" for the drugs.

State government retiree Robert Hauss, 75, of Athens said he feels a time crunch on his drug plan decision.

State retirees were told they must make a decision about keeping their current state drug plan by Tuesday, but Hauss said he didn't get his booklet from the state detailing the changes until Oct. 27. Other state retirees have also complained to GeorgiaCares about a tight deadline for the state plan.

On Friday, Gov. Sonny Perdue announced that he was extending the state's enrollment deadline 10 days, to Nov. 18.

Hauss, meanwhile, said his retiree health plan will be about twice as expensive as its current cost if he doesn't join a Medicare drug plan. "The state is forcing us to go into Medicare Part D," he said. "I'm not happy with the changes."

But a spokeswoman for the state agency overseeing the retiree plan denied the state was pushing people into Medicare drug coverage. "They have choices," said Julie Kerlin, spokeswoman for the Georgia Department of Community Health. "Employees make choices every time there is an open enrollment."

Hauss takes seven medications for chronic conditions, and worries that not all his drugs will be covered as they are now. "Medicare Part D plans may not have the same drug formulary as the state health plan," he said.

Hauss isn't hooked into the Internet, so he's waiting for insurance counselors to call back.

Frustration is high

In Alpharetta, Jim and Marlys Antonoff have spent hours compiling information on Medicare's drug benefit. They've neatly filed brochures and information from seven drug plans in a plastic container. They've called the insurance companies — even politicians — seeking answers.

Despite the painstaking work they have done to understand Part D, they're still frustrated by its complexity.

And they find themselves chuckling about the string of roadblocks they run into.

One roadblock: Three drug plans' phone numbers listed in the Medicare handbook are wrong, said Jim Antonoff.

Jim, 79, said he called an insurance company and asked, "Can you expedite the information to me?" And the company's representative replied, "What's 'expedite'?"

"The average person is going to have a terrible time with this," Jim said as they finally navigated the Medicare Web site.

There are things that the Antonoffs like about the new plan.

It's an insurance policy against unforeseen drug costs that can run into the thousands of dollars, Jim said.

Jim could save about $1,000 from the new benefit. And his current out-of-pocket drug costs, with no prescription coverage, reach about $5,000 a year.

Marlys, 67, could also save about $1,000.

Still, Jim Antonoff said he thought Part D could have been designed much better.

"The average person is going to be so lost, they're going to throw up their arms and say, 'The hell with it,' " Antonoff said.