New Medicare Rx causes numerous headaches
BY TERRY SAVAGE SUN-TIMES COLUMNIST Jul 14, 2006
Updated: May 3, 2013 12:14PM
Jan. 1 was D Day for 43 million Americans -- senior citizens who qualified for Medicare Part D prescription drug benefits. But by year-end 2005, only about 6 million to 7 million did in fact enroll, with most of them joining through the auto-enrollment program that took care of seniors who are also on Medicaid, the low-income medical plan.
Medicare officials held a press conference call late last week to insist that enrollment was on target, and new figures will be released later this week. But they faced a barrage of aggressive questioning by reporters from across the country, each telling horror stories of seniors who could not get their medicines, and of pharmacists who waited on telephone lines for hours trying to confirm customers' eligibility.
Larry Kocot, senior policy adviser for the Centers for Medicare & Medicaid Services, promised that "glitches" would be straightened out in a matter of days.
The entire process has been a difficult one, especially for seniors who are understandably anxious about the changes. Seniors who enrolled in a plan received a letter of authorization from their plan, which they must present to the pharmacist, who uses that information to bill the correct plan.
But many low-income seniors who were automatically enrolled in one of the plans for their state didn't understand the process or never received the letter of authorization.
In Illinois, seniors who were on Senior Care or Circuit Breaker, and did not choose a plan, were automatically enrolled in either United Healthcare or Pacificare.
Pharmacists had problems, too. The government maintains a computerized database of those who have signed up. If the senior doesn't present a card or an acknowledgement letter, pharmacists must cross-check the database to see which plan the senior is enrolled in, before dispensing prescriptions. Those support lines are now available 24 hours a day, 7 days a week, with additional staffing dedicated to resolving pharmacists' issues.
With at least 7 million new enrollments, many at the very end of the year, there was bound to be confusion. Many seniors didn't receive the letters; others didn't understand them. That's small consolation to those who were turned away because of lack of coverage, and couldn't afford to pay for their drugs.
And suddenly the reputation of insurers became an issue.
"Everyone was competing on price, but here's where service really does make a difference," says Peter Rodes, vice president at BlueCross BlueShield of Illinois. Rodes notes his company has gone out of its way to make sure those enrolling in Part D could get immediate access to their prescriptions when the program went into effect Jan 1. Blue Cross even sent second copies of acknowledgement letters by FedEx to those who enrolled late in December. Within the first three days of January, Blue Cross of Illinois had processed more than 27,000 prescription claims.
But Rodes acknowledges there were bound to be glitches. Rose Marie Clark was one of them for a few hours until the Blue Cross customer service department went into action. She and her husband joined at the same time, but while he received his acknowledgement letter, hers was missing. She contacted Blue Cross customer service, and the problem was quickly resolved.
Clark went to her pharmacy last week, and gave me a delighted report: "I normally spend $538 for a three-month supply of my drugs. But this time it cost only $278. And these weren't even generic drugs.
Previously she had no drug coverage. And even with her $27.77 per month premium, she figures she'll come out far ahead, saving at least $700 this year on the drugs she takes.
It's important to double check your medicines and the prices you are charged when you start buying under the new Part D plan. Some dual-eligible seniors (on Medicaid) found the government hadn't updated their low-income status to the database. They were asked to pay more than expected for their prescriptions. If this happens to you, keep your receipts, and when it's sorted out your plan will reimburse you.
By now, most of the immediate issues at the pharmacists' counter have been resolved. But if you are a senior, or know a senior, who is still confused, or unable to get his or her prescriptions at the promised prices, you should call 800-MEDICARE. They promise to resolve your issues quickly -- and we'll see if that's The Savage Truth.
Terry Savage is a registered investment adviser. Distributed by Creators Syndicate.