Posted At AzStarNet.com
BY : Jane Erikson
Medicare experts are encouraging seniors faced with dozens of prescription drug plan options to stay with their current coverage next year if possible and many are doing just that.
More than 50 health plans are offering the new Medicare Part D drug benefit in Pima County next year, and government officials say having all those choices is good for seniors.
But experts with Medicare, Social Security and the Pima Council on Aging say most people do well to avoid all those choices. "It's only people who don't have coverage as good as Part D who are encouraged to switch," said Stewart Grabel, ombudsman for Pima Council on Aging.
A Medicare spokesman in Washington, D.C., agrees.
"As long as what you have is as good as Medicare that's the key," said Peter Ashkenaz. "If their coverage is at least as good as Part D, and they like their coverage, they should stay put."
Those doing just that include Pat Fritscher, 78, of Tucson, who has studied her information packet from PacifiCare's Secure Horizons, the Medicare HMO she's been with for six years.
"Oh Lord, is it complicated," Fritscher said this week. "I'm inclined to stay where I am. It's just much simpler. And the simpler the better for me."
Enrollment for the new benefit started Nov. 15 and continues through Dec. 31 for coverage starting Jan. 1.
For the first time in Medicare's 40-year history, all 43 million Americans in the program will be able to join a plan that offers prescription-drug coverage. Before, such coverage was limited mostly to beneficiaries in larger communities.
Fritscher's Secure Horizons plan, like other "Medicare Advantage" plans, will include the new Part D benefit next year. The plan will cover brand-name as well as generic drugs. It also includes a "doughnut hole," or coverage gap, when Fritscher will have to pay 100 percent of her plan's negotiated price for medications.
But if her prescription costs exceed $5,100, Part D will pay 95 percent of the cost of any medications she needs for the rest of the year.
Part D offers "richer" coverage than most people on Medicare now have. But the vast number of health plan choices and all the new details from doughnut holes to late fees are putting many people into a panic.
For them, staying put seems the safest option.
"That's the sense I'm getting," said Dan Chavez, district manager for Social Security in Tucson. "We've done over 180 outreach events since May 1. Most people say they're going to stay with the coverage they have."
The experts have no enrollment figures yet.
But only 60 people showed up last Sunday for a well-publicized opportunity to meet with Medicare officials from San Francisco and get one-on-one advice on the new Part D benefit. Chavez and others interpreted that as further evidence that people are avoiding change.
"I think it's true people are staying with what they've got," said Grabel, of the Pima Council on Aging. "I also believe that this whole thing is too complicated. . . . We have doctors and lawyers and other professionals who can't figure this out."
Ann and Ron Skwartz of Tucson say they have figured it out and unlike Pat Fritscher and others, they are going to try a new plan next year. They've been with Secure Horizons for several years but now they're going to switch to United Healthcare's Medicare Complete.
"We've talked about it and talked about it and been to seminars and been to seminars," Ann Skwartz said. "We've done a lot of homework on this. One day we came home from a seminar and we spent most of the day and went through the Pacificare book and the United book to see what the differences were."
The couple spent about $4,000 on prescription drugs in the first nine months of this year, and they feel they can save more money with United. It won't pay for their "Silver Sneakers" gym memberships, but they feel they will save enough money on medications to buy their own memberships.
Those who are still uncertain can take comfort in the fact that if the coverage they choose starting Jan. 1 turns out to be a disappointment, they can change plans once again before May 15. Then they're locked in until Jan. 1, 2007.
But will there be as many plans to choose from then? "It's too early to tell," said Medicare's Ashkenaz.
