WASHINGTON—With less than a week to go before the signup begins, Medicare's new drug benefit is proving to be a prescription for confusion.
With a multitude of plans to pick from, delays in rolling out Medicare's computer tool to help compare them and the general complexity of the benefit, many of those eligible are wondering if it's worth the trouble.
Most of the 43 million elderly people and those with disabilities who qualify must select from about 40 plans, making sense of an array of premiums, formularies, co-payments, coverage gaps, deductibles and pharmacy networks.
Barbara Potter, who's disabled and now gets Medicare benefits, said she'd had trouble getting information about the 46 Medicare drug plans available in her area.
"I've been a government contractor for years, so I'm used to bureaucracy, but this is just ridiculous," said Potter, a retired freelance health writer in Hornell, N.Y. "I am finding this the most labyrinthine experience I've ever had with government."
Medicare officials recognize that getting people to enroll depends largely on the ability of their staff and volunteer counselors to steer fragile, elderly and sick clients through the confusion.
"It's going to take time for seniors to become comfortable with the choices they have," Health and Human Services Secretary Michael Leavitt said Thursday. "Enrollment may start out slowly. But we're confident that over time seniors are going to like the benefit."
Medicare officials hope to sign up 28 million to 30 million people during a general enrollment period that runs from Nov. 15 to May 15. Coverage begins Jan. 1.
However, Potter's assessment is hardly unique.
According to a survey released Thursday by the Kaiser Family Foundation and the Harvard School of Public Health, 61 percent of seniors said they understood the new benefit "not too well" or "not well at all." Only 35 percent thought they knew it "very well" or "somewhat well."
Nearly 3 out of 4 of the respondents thought that the myriad of choices "makes it confusing and difficult to pick the best plan," the survey found.
In the Los Angeles area, Medicare recipients have nearly 80 plans to choose from, said David Lipschutz, a staff attorney at California Health Advocates, a nonprofit Medicare education and advocacy group.
"There's such a thing as too much choice," Lipschutz said. "If you give seniors a bunch of choices as opposed to a few, their typical reaction is to throw up their hands and take no choices."
Among seniors with no drug coverage—who need the benefit most—23 percent of those surveyed said they wouldn't enroll in a Medicare plan and 49 percent weren't sure.
Leavitt was undeterred. "By the time we get to May, people will have experience with this and they'll have a much deeper understanding and those polls will have changed."
Earlier this week, Medicare administrator Mark McClellan defended the galaxy of offerings, saying they stimulated competition that lowers costs. He added that a "one-size-fits-all plan" couldn't provide the flexibility or cover all the drugs that Medicare's clients need.
"The advantage of having this range of choices is that you can focus on the kind of coverage that you want," McClellan said.
"The alternative is having one drug plan that does not reflect what you want ...," he said. "I'm not sure that's a good option for beneficiaries at all."
To make the process easier, Medicare offers an online plan finder, at www.medicare.gov, that tells people which Medicare drug plans cover the medications they take, how much those plans charge and what pharmacies are in their networks.
But 64 percent of the Kaiser survey respondents had never heard of the Web site. Seventy-six percent had never been online.
In addition, the software for the site just became operable this week, nearly a month later than previously announced.
Earlier this week, Potter said she couldn't access the Web tool because it was malfunctioning.
"It has made it impossible for us to make decisions because that's the only source for formulary information that's out there," Potter said.
The delay was caused by the failure of firms that offer the plans to provide pricing information, McClellan said.
The wait left thousands of volunteer Medicare counselors across the country unable to assist callers in selecting plans.
"It takes our credibility away," said Lisa Trumbell of Detroit, the assistant director of the Michigan Medicare and Medicaid Assistance Program, which helps callers pick Medicare plans. "If a beneficiary gets to us and we say, `Gee, the Web site's not up and running yet,' what does that tell them? It tells them we don't know what we're talking about."
McClellan said seniors also could call 1-800-MEDICARE, which has trained staff to help select plans. More than 800,000 calls were made to the line last week and waiting time was less than two minutes, he said. But only half of survey respondents had heard of the Medicare toll-free number and only 8 percent had called.
The survey said seniors were more likely to ask their doctors or pharmacists for help in choosing plans. But doctors, pharmacists, nursing home administrators and hospital managers can give only the names of plans in which they participate.
"This whole thing is like an onion," said Lipschutz, the attorney from California. "The more you peel, the more you cry."
For an online list of state counselors who can help select a Medicare drug plan, go to www.healthassistancepartnership.org and click on "Medicare" in the left-hand column. Then click on "State Health Insurance Programs."
(c) 2005, Knight Ridder/Tribune Information Services.
GRAPHIC (from KRT Graphics, 202-383-6064): 20051110 MEDICARE
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