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Drug-benefit
plans greeted warily: Many seniors voice suspicion, confusion about the
proposals
By
Andrea Stone
USA TODAY, June 27, 2003
Historic votes by the Senate and House of Representatives to offer
prescription-drug coverage to seniors presage the biggest change in
Medicare's 38-year history. But many seniors are lukewarm about the plans.
''I don't trust this legislation. It is totally politically motivated,''
says Mildred Fruhling, 75, of Edison, N.J., a retired health insurance
agent. ''The average senior doesn't see what a quagmire this is.''
Interviews with seniors around the country show many are confused and
suspicious about the 10-year, $400 billion proposals, which would not take
effect until 2006. If they live long enough to see a prescription-drug
benefit added to the government health insurance program for seniors and the
disabled, some expect to pay less. But others say they're better off
sticking with employer-sponsored plans or buying cheaper drugs over the
Internet or from Canada. Still others fear they'll be pushed into private
health plans in exchange for defraying their drug costs, even though the
program would be voluntary.
The Senate and House plans are complex and vary on coverage. Both call
for an estimated $420 annual premium:
* The Senate bill includes a $275 deductible. After that, Medicare
would pay 50% of costs up to $4,500. Coverage would then stop until a senior
reached $3,700 in out-of-pocket expenses. After that, seniors would pay 10%
of costs.
* The House version has a $250 deductible. After that, seniors
would pay 20% of drug costs up to $2,000. There would be no coverage
thereafter until out-of-pocket costs reached $3,500. At that point, drug
costs would be covered in full. Seniors with annual incomes higher than
$60,000 would face higher limits on out-of-pocket expenses.
Differences between the Senate and House bills will be negotiated in
July. If a deal is reached, both chambers will vote again before a single
version goes to President Bush for his signature. But already, seniors have
strong views:
* Need help, but wary. Gladys and Frank Cannon of West Covina,
Calif., spend $7,500 a year on a dozen prescription drugs. Gladys, 76, takes
medications for emphysema, congestive heart failure, kidney disease, thyroid
problems, high blood pressure and glaucoma. Frank, 77, has acid reflux
disease and high cholesterol.
The Cannons, who live on $40,000 a year from Social Security, pensions
and rental property income, have a small AARP policy that covers $1,000 of
their prescription-drug costs. The rest comes out of their pockets. Since
the couple retired from the printing industry in 1988, they have drawn down
$15,000 from their savings to help pay for drugs.
But even though the couple would save $2,000 a year under the Senate
bill, they fear they would be forced to give up their doctors and join an
HMO.
''We had an HMO salesman come to our house once,'' Gladys says. ''As soon
as I gave him a list of my medications, he said he'd get back in touch. He
never did. . . . That tells me that they didn't want me because I was
too expensive.''
''Medicare has been good to us,'' says Frank, who is thankful to the
government program for his knee-replacement surgery and the oxygen Gladys
needs to help her breathe. He also says the congressional plans are
''confusing.''
* Already covered. Eileen O'Neill is among the 28% of seniors who
have employer-sponsored drug plans. Although she takes seven drugs a day for
cholesterol, thyroid problems, high blood pressure, migraines and
depression, she spends only $105 a month in copayments.
The plan from Tokyo Marine Management, the insurance company she used to
work for, costs her $262 a month in premiums plus $15 per prescription. ''I
consider myself very lucky to have it,'' says O'Neill, 70, a widow from New
York City. The Medicare drug plan ''wouldn't benefit me. What I have is much
better.''
O'Neill has heard the fears of some critics that private employers might
drop their retiree plans if Medicare offered drug coverage. If that
happened, her drug bills would skyrocket to $6,000 a year. The Senate plan
would bring that down to $4,138. That's slightly less than she spends now,
but her private plan includes services Medicare doesn't cover, as well as
dental care.
''I know darn well that what I have is probably the best I can get,''
O'Neill says. ''I have been assured by my plan that they would never drop
me. I have to believe it.''
* Mixed feelings. Martha Bowman thinks she would benefit from
Medicare drug coverage. But she's not sure.
The retired Keene, N.H., social worker, who has no prescription-drug
coverage, used to pay $3,600 a year for medicine to treat glaucoma and high
cholesterol. That was 18% of her annual $20,000 income. Then Bowman started
buying drugs through the mail from Canada. Now she pays about a third less,
or $2,200 a year.
Under the bills being considered, Bowman would be barred from buying
drugs directly from Canada if she took part in the Medicare program. If she
went back to buying in the USA, she would pay about $150 more annually under
the Medicare program than if she continued getting her drugs from Canada
without coverage.
But Bowman, 71, who is divorced, supports the idea of a Medicare drug
plan -- if it is run by the government. ''Stability is needed,'' she says.
* No thanks. Bill Libertoff figured it out. He wants no part of a
Medicare drug program.
The former New York snack-food distributor, retired in Hilton Head, S.C.,
is relatively healthy at age 68. It costs him $400 a year to control his
high cholesterol and blood pressure because he buys cheaper drugs through
the mail from Canada. If he was required to buy from a U.S. pharmacy, his
costs would rise to $1,000. But under the Senate proposal, he would pay
$1,058 in premiums, deductibles and copayments.
''Just using the old pencil, I don't see where it's going to be good for
me,'' says Libertoff, who is among the healthy seniors Congress hopes will
subsidize those with higher drug costs. ''It would cost me more than I pay
now.''
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2002 Global Action on Aging
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