Medicare enrollment likely better in 2nd year
05-Nov-2006: Nick Sloffer spent many long hours last winter with the phone pressed against his ear.
"There were days when it felt like I was living on the phone," said Sloffer, pharmacy manager for Scott's Food & Pharmacy at 4120 N. Clinton St. Like many other pharmacists, Sloffer has logged countless calls to insurance companies on behalf of customers using Medicare's prescription drug plan, which took effect this year.
The program faced many early challenges, from confusion about various plans there are more than 40 in Indiana alone to issues with seniors and people with disabilities eligible for Medicare not receiving prescription coverage cards. Consumer groups say that an increase for 2007 in the number of plans, including 54 statewide, and changes to existing plans are going to cause more problems during open enrollment, which begins Nov. 15 and ends Dec. 31.
Still, Sloffer and others hope that because the majority of those eligible for the program having already been through the process, the enrollment will be smoother this year. But many insurers have beefed up their customer-service rolls to better respond to questions that come up.
After a "tidal wave" of calls during the last enrollment period, Louisville-based Humana added 1,000 customer services representatives to double its ranks, spokesman Jeff Blunt said.
"We had a huge ramp-up prior to when Medicare first rolled out," but the sheer volume of calls was more than anyone expected, he said.
With the initial rush over and more customer service representatives on staff at insurance company call centers, it's been easier for callers such as Sloffer to get through. That should help people get their questions answered as they re-evaluate their plans for next year, something insurance agents and consumer groups urge them to do.
"Plans are changing
don't assume anything, even if you're happy with your plan in 2006," said Deane Beebe of consumer group Medicare Rights Center. She and others pointed specifically to a Humana plan option that used to provide prescription drug coverage through the "doughnut hole," and now only provides generic coverage when consumers are in the coverage gap.
This year, most Medicare D plans have a coverage gap known as the doughnut hole that begins when the beneficiary and plans have paid a total of $2,250 for prescription drugs. Coverage picks back up after the beneficiary has spent $3,600 out-of-pocket on prescription drugs. In 2007, the gap will start at $2,400 in total drug costs which includes the deductible and will end when a beneficiary has spent $3,850 out-of-pocket.
Blunt said Humana's change was made because taking into account the plan's utilization, premiums would have been cost prohibitive. The premiums are usually figured by adding a single-digit profit margin typically 3 percent to 5 percent to expected utilization, he said. With the change, premiums on the coverage option will increase from $66.89 this year to $86.30 in 2007.
Currently, only one stand-alone prescription drug plan in Indiana offers prescription drug coverage through the gap, though 15 others including the Humana plan cover generic drugs through the gap. The SierraRx Plus enhanced plan covers all drugs on its formulary or list of covered drugs for $108.30.
But even that doesn't guarantee that an enrollee will be covered during the gap for a drug not on the formulary, Beebe said.
"Last year a lot of people didn't know what hit them when they fell in the coverage gap," she said. That's in addition to other restrictions, such as "step therapy," whereby beneficiaries must first try a generic or insurer-preferred drug before using certain expensive name-brand drugs. Insurers say this makes plans more cost-effective and ultimately more affordable to beneficiaries.
Despite the fact that her husband has hit the coverage gap, Marilyn Janson, 71, said she has been happy with the couple's Advantage Preferred Plus prescription drug plans.
So far this year they have spent about $700 on 75-year-old Ronald Janson's three prescriptions, compared with about $1,750 spent last year buying drugs from Canada.
"Going through Medicare D we are saving much, much more," she said. The Jansons' monthly premiums which cost $101 each and cover medical costs as well have been comparable if not better than previous coverage, she added.
Marilyn Janson doesn't take prescription medications, and her husband recently entered the plan's coverage gap.
She believes that the savings and the piece of mind the plans afford make them worth it.
The Jansons' story is not uncommon, but neither are reports of problems with the program and questions among seniors about which if any drug plan is right for them.
In a report released in June, more than eight in 10 seniors who are enrolled in a Medicare drug plan said they were satisfied with their plan, although almost two in 10 reported encountering a major problem, according to the latest Kaiser Family Foundation tracking survey of seniors' experiences under the new Medicare drug benefit.
The survey of 1,585 seniors, including 623 who are enrolled in a new Medicare Part D drug plan, reveals that, for most seniors, initial experiences under the drug benefit have been positive. About three in four seniors who are enrolled in a drug plan would choose the same plan again. The study doesn't account, however, for the reaction of some seniors that hit the doughnut hole in recent months.
At the time the study was conducted, a third of seniors who had used their plan had experiences that they perceived as a problem with 18 percent describing it as a "major problem," and the remainder describing it as a "minor problem."
Problems included having to pay unexpected costs, leaving the pharmacy without being able to fill a prescription, not receiving an enrollment card and having to switch drugs because one wasn't covered. Some seniors also cited having to switch from a brand name to a generic drug as a problem, though others who reported such an experience did not consider it a problem.
Last week, on Halloween, Rita Musser said "the scariest thing" about the current Medicare D program is that all the kinks have not yet been ironed out. An independent insurance agent based in Fort Wayne, Musser is a board member with the Northeast Indiana Association of Health Underwriters, and also on the organization's state and regional boards.
Among other issues, some people had coverage canceled and didn't know it, she said. Others received accumulated bills some for up to 10 months' worth of premiums after Medicare and Social Security were unable to work out an automated deduction system, Musser said. In addition, enrollment continues to be a complicated process, even for agents who have to recertify annually with insurers whose plans they are selling, Musser said.
Improvements to Medicare's plan finder have made for somewhat smoother sailing
Still, she and others remain hopeful that a year of experience will help people better navigate the prescription drug program. And Medicare officials say an upgraded Medicare plan finder at www.medicare.gov makes it easier for people to not only compare plans for 2007, but to also look at how those match up with current offerings.
"Compared to last year," Musser said, "this is going to be an easier year because we've all got our feet wet."
Source: Fort Wayne Journal Gazette