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Views of Medicare Plan Mixed
By Jennifer Latson, The Olympian
August 16, 2005
The top health official in the Bush administration talked to local seniors Monday about a new Medicare plan he called the biggest improvement in public health care since Medicare itself was created, one that he promises will relieve seniors of the worry that paying for medication will empty their savings accounts.
But it was a tough sell to seniors and people with disabilities, more than 100 of whom gathered at Panorama City. Some of them will end up paying more for prescription drugs.
Secretary of Health and Human Services Michael Leavitt stopped at the Lacey retirement community to plug the Medicare prescription drug program, which will start in January.
Anyone eligible for Medicare can get drug coverage through the federal subsidized health care program. But seniors and their advocates found fault with the program, saying it doesn't do enough to help them and sometimes impedes their ability to pay for medication.
Wanda Lawton, 50, is on Medicare and Medicaid. She was diagnosed with multiple sclerosis at age 32 and uses a wheelchair.
Medicaid covers the cost of her prescriptions; she takes 14. Government subsidies cover the cost of her care at Panorama City, and she gets a monthly stipend of $50.
Although the Medicare drug coverage plan is optional in most cases, people who are enrolled in both Medicaid and Medicare will be automatically enrolled in the new Medicare program for their medication, according to June Moore, assistant specialist at the local branch of the Area Agency on Aging.
People such as Lawton, who make less than about $12,000 a year, will be eligible for an additional subsidy, paying no monthly premium and a co-pay of $1 to $3 a prescription. People not eligible for the added subsidy would pay $32 a month and have to meet a $250 deductible.
"One to three dollars doesn't sound like a lot of money, but it goes fast when you're getting $50 a month," Moore said.
A waiver for people in nursing homes would mean Lawton wouldn't have to pay the extra $1 to $3 a prescription. But people with similar disabilities who live at home, getting 24-hour care, might not be eligible for the waiver, according to Tim Smolen, a manager at the State Insurance Commissioner's office.
"It would leave me pretty poor," Lawton said.
Other people would save money, according to Moore.
"For folks who have no insurance right now, for someone who's paying $100 a month on medication, or $200 a month, they will benefit," she said.
Many will pay more
About 90,000 people in the state would pay more under the new plan: people who are on both Medicare and Medicaid, and whose medication is free under Medicaid, according to Democratic U.S. Sen. Patty Murray, who voted against the bill.
That includes most of the 1,300 seniors in Lewis, Mason and Thurston counties who use the local Area Agency on Aging.
"It's a poor plan," said Kary Hyre, the state's long-term-care ombudsman. "If there were not the huge subsidies for the pharmaceutical companies and the insurance companies, it could have been a pure and simple benefit under Medicare."
Advocates for seniors also were worried that the plan would not cover all of the drugs seniors need. Seniors can choose from several private insurance plans that Medicare is contracting with to administer the drug coverage; each plan must provide at least two medications in each of a variety of categories.
And seniors scoffed at a gap in coverage: Those who do not qualify for extra assistance will pay 25 percent of their costs after they meet the $250 deductible but will pay the full cost again after they hit a $2,200 ceiling.
Although the plan doesn't cover everything, Leavitt said, it's still an improvement over the current Medicare system.
"We've always had a gap; it just used to start at $0. Now it starts at $2,200," the health secretary said.
Lyle Knesal, 93, has both Medicare and private insurance. He's holding out until the fall to decide whether to choose the drug coverage through Medicare.
The 25-year resident of Panorama City doesn't have any prescriptions now and didn't think he got enough information from Leavitt's visit to know whether the program would benefit him.
"I won't make any decisions until I see what happens in November," when enrollment begins, he said.
Meanwhile, social workers are scrambling to help seniors figure out whether to choose the coverage, and if so, which plan is right for them.
"My job is to make sure they're enrolled in the plan that covers their most expensive medication," said Moore, of the Area Agency on Aging.
Eileen McKenzieSullivan is helping clients at the South Sound Senior Center in Olympia sit down individually with advisers at the state insurance commissioner's office.
"I think it is really confusing," she said. "There are lots of seniors that have questions and don't know what to do."
That's not the plan's fault, Leavitt said.
"People worry about this plan being too complex," he said. "This plan is relatively simple. Health care is complex."
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