Posted At San Luis Obispo Tribune

BY : Nathan Welton

Paso Roblan Valerie Hambey, like many local seniors, noticed more and more advertisements filling her mailbox in the months leading up to the unveiling of the new Medicare drug program.

The circulars came from a myriad of different insurers, all trying to persuade Hambey to sign up with their prescription plan. In January, Medicare essentially outsourced its drug coverage to private companies.

So like many local seniors, Hambey turned not to Medicare officials but to a private insurance agent who helped her pick a plan.

"We were getting so much information from the insurance companies and from Medicare -- I was thoroughly confused," Hambey said. "And the more info we read, the worse it got. It was overwhelming."

More and more around the county, experts say, bewildered seniors are seeking help from private health insurance agents who have unexpectedly become Medicare counselors.

Agents say the influx of Medicare clients has bogged down their businesses.

There's little money to be made dealing with Medicare drug plans -- commissions are sometimes as low as a few dollars a month, agents say.

At least some, though, are happy to help, because they consider their work a community service.

"It's a mess, it's a huge mess," said local agent Susan Polk. "I don't know if it's a poor idea or if it's been poorly executed, but I want to do the best we can with what we have."

Medicare changes

On Jan. 1, the federal government instituted some of the biggest changes in the 40-year history of its Medicare health insurance program.

Prescription drug coverage, a highlight of the plan, became privatized to encourage competition and lower costs.

Under legislation passed by Congress in 2003, coverage is organized by dozens of companies.

They receive government subsidies, and the program will cost taxpayers about $720 billion in the next decade.

Now, the hundreds of available plans cover an array of drugs, and most seniors have to pay an average monthly premium of about $37 -- along with a yearly deductible of $250.

But it's proven confusing for patients to pick a plan that covers all their medications.

Each plan covers some drugs, but not all. Each plan's formulary -- the list of covered medications -- is different, and some are better than others. A few cover all of the 100 drugs that seniors most commonly take, while others cover 80 to 90.

The result

If it sounds baffling, that's because it is.

"I'm sure there are some out there who are so confused that they're afraid of (the drug plan), and they're not even using it," Hambey said.

Hundreds of thousands of seniors are ringing Medicare for help each day, and stories of long waits on hold abound.

And not everyone is comfortable with anonymous phone operators.

Hambey first met Susan Polk, her new de facto Medicare counselor, at a meeting at a local senior center. She decided to ask for help picking the right drug program out of the nearly 50 available to Californians.

Should she sign up with the YOURx PLAN from HealthCo Health Solutions, for $29.16 per month and a $250 deductible? Or should she pick the WellCare Signature plan for $18.02 per month and no deductible, but with fewer covered drugs?

Or how about the Humana PDP Complete S5884-060 for $50.91 a month and no deductible?

Even the plans' names aren't that clear, so figuring out which ones could cover her bone, eye and other medication seemed daunting.

The choice was a crucial one for her. One of Hambey's pills, which she takes once a week, costs $30, in addition to the other medications.

"The different insurance companies were saying if you go with our program we can offer you this or that," she said, "but you really have to get online -- and good luck with that. Some of us don't have computers."

Making the right choice adds up to a lot for a senior on a fixed income, especially one who's already gutted her savings to pay for her medications.

"So what do you do, end up selling up your home and winding up in the poor house?" she asked.

Ambitions

"Will it work eventually?" asked Melinda Monteen, another local insurance agent helping seniors pick the plan that fits them best. "I believe it will help the majority of people."

And while it may help, she said there are drawbacks.

One problem is that the government may have been a little ambitious.

"There are 19 million people eligible for Medicare Part D, and to think they could somehow move all those people in six weeks is crazy," said Polk.

Enrollment for the program began in mid-November, and it started up Jan. 1. The earlier seniors enroll, the sooner they can take advantage of their annual deductible.

"Pharmacists' systems are failing and insurance companies' systems are failing because they can't handle the load," Monteen said. "Even a day of being down puts the whole thing behind, and some carriers are a month behind getting out an identification card."

Identification cards are required to get drugs at the discounted rates.

Impacts on businesses

The local agents who are offering assistance are making little money signing patients up for Medicare drug coverage.

"In an ideal world, if any government program is going to be self-sufficient, the consumer needs to be able to understand it," Monteen said. "But how many government programs are like that?"

Polk, for instance, has signed up hundreds of seniors in new plans. She'll earn $40 for up to 1.5 hours of work, which makes covering overhead difficult.

"And if their drugs change, you have to do it all over again," she said. "Most brokers feel like it's paralyzing their business, but they have to do it."

Her office has hired a temp worker to help input drugs and streamline the process.

"We're trying to help everyone that we can, but it's doubled our workload easily," Monteen said. "I need to help them look up their prescriptions -- seems like they take seven on average -- and see which ones are covered and at what percentage, and that's time-consuming."

After Polk had spent an appointment analyzing Hambey's medications, she came to an ironic and perhaps frustrating conclusion: the government, totally at random, had signed her client up with a plan that was probably her best option.