Medicare hot line informs, comforts Medicare hot line benefits elderly

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Medicare hot line informs, comforts Medicare hot line benefits elderly
In a confusing time, phone workers across the U.S. explain rules, sometimes calm fears

By Judith Graham, Chicago Tribune
October 21, 2003

She has been the love of his life for most of his life. He was 21 when they met; she was 16.

Now, after 63 years of marriage, she is in a Long Island rehabilitation facility, recovering from a bad fall and disabled by Parkinson's disease.

Anthony wants his wife to come home. The son believes that's unrealistic. Mom should go to a nursing home, he insists, and dad, 87, should let go.

Madeline Augonnet, 56, is listening to the old man tell his story over the phone in a cracked voice. He didn't know where to turn, he says. So he called this hot line.

All morning, the phones at the Medicare Rights Center , a counseling program in the heart of Times Square , have been ringing:

"The insurance company hasn't paid my bill. Can you help me figure out why?"

"My mother needs home health care, but we can't get an agency to send anyone over."

"How can I afford Medicare's new premiums?"

"My doctor is leaving my HMO. Can I go back to traditional Medicare?"

All morning, three hot-line volunteers have a close-up view of the problems that politicians say they want to fix as they work on legislation to overhaul Medicare.

The government announced last week that 2004 monthly payments for doctors' care would rise 13.5 percent to $66.60, one of the largest increases in Medicare's history. The deductible for hospital care is going up as well. Also last week, lawmakers failed to agree on compromise legislation, missing one of the many deadlines Congress has set to reform Medicare before next year's elections.

It's extraordinarily hard to agree on what to do about this vast government program for 40 million elderly and disabled Americans. But here, on the front lines of the health-care crisis, there is a sense of urgency. Many people who call this hot line--the official Medicare line in New York --are sick and vulnerable. Like Anthony, many are desperate as they face the prospect of abandoning or losing those they love.

Anthony's son is advising his father to spend the $40,000 he has saved so that he and his wife can qualify for Medicaid, the government health program for the poor. Medicaid will pay for nursing home care, but you have to be impoverished to qualify. Medicare, which all Americans get when they turn 65, doesn't cover long-term care.

"I don't want to spend my money," says Anthony, who emigrated from Italy when he was young. "I saved all my life to get this money."

Retiree finds meaning

Augonnet, a retired elementary school teacher who volunteers on the hot line one day a week, listens sympathetically. But Anthony is so hard of hearing he can barely understand her compassionate responses to his many questions.

All over the country, phones at senior health-insurance counseling centers are ringing with similar queries. People are confused about Medicare. People can't afford soaring medical bills. People need to buy prescription drugs, but don't have enough money.

In Illinois , 30,000 calls came in to the state insurance department's 1-800-548-9034 hot line last year, while 700 volunteers counseled an additional 15,000-plus people in face-to-face interviews.

Especially difficult, says the acting director of Illinois ' program, Robin DiNardo, is the situation for people who are disabled and under 65. They often can't get supplemental insurance policies to help pay bills that Medicare doesn't cover, and they don't have enough money to shoulder these expenses.

At the Medicare Rights Center in New York , more than 70,000 calls came in last year. Every state has a similar effort to guide older people through a $220 billion program that has become far more complicated and confusing--not to mention expensive--over the last decade.

"There is no stability to the system," says Deane Beebe, communications director for the New York center. "Drugs are dropping off formularies all the time. Doctors are closing their practices to Medicare patients. HMOs decide to leave the program. People have to pay more, even if they're living on a fixed income. The rules of the game keep changing.

"How can we expect someone in their 80s who's sick and frightened to keep up?"

Augonnet, 56, began volunteering here a year ago, after she stopped teaching and realized a schedule of going to art galleries and lunching with friends left her feeling empty.

At first, she said, "I cried after every call. ... There are so many needy older people who are surviving, I don't know how, on not enough money, not enough health care, not enough attention."

Ignorance plagues callers

None of her callers had any idea there were government programs to help lower-income elderly pay monthly Medicare premiums for doctors' care. Most had no idea there was a New York state program to help pay for prescription drugs, or drug company programs that would offer a hand.

There is no better way to find out about this patchwork of programs and services than by calling state hot lines. Medicare mails handbooks to every member, but they aren't localized and many older people don't understand the terms used. Information is available on the Internet, but large numbers of elderly people don't have computers.

In the end, many older people seem to be looking for a human voice anyway.

Recently, an older woman was distraught when she reached Augonnet on the phone. Her best friend was dying of emphysema and lung cancer, she explained. The friend has no family and was all alone in a private room in a hospital that wanted to transfer her to a nursing home. But the friend wanted to die at home.

She asked Augonnet: Would Medicare subsidize taking her home to die and provide 24-hour care? The answer was no. Even Medicare end-of-life hospice benefits would cover only about six hours a day of daily care.

The older woman pleaded for advice.Her husband wouldn't let the friend come home with her, and she already had spent tens of thousands of dollars of her own money for her friend's hospital bills. She asked Augonnet: Do I just let her die?.

Augonnet's brown eyes glisten as she recalls her answer.

"I said, `You have already done so much, more than anyone could have done. Now, you can just be there for her.'"