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Plan to pay prescription drug costs for elderly poor to roll out

WASHINGTON—One year after foul-ups spoiled the launch of the Medicare prescription drug discount card, the government is hoping for a smoother rollout of a new benefit that will essentially provide free prescription drugs for millions of the poorest Americans.

On May 27, the government will begin mailing letters to nearly 20 million elderly citizens asking them to fill out a five-page application for the new Medicare benefit. On May 31, more letters will alert another 10 million people that they will automatically qualify for the coverage, which will pay between 85 and 98 percent of their drug costs beginning in 2006.

The enhanced coverage is one of the most generous public health offerings in U.S. history. It will provide immediate relief and life-prolonging treatments for millions of impoverished people struggling with high prescription drug costs.

Yet getting the benefit requires an extensive application as well as an income and savings test to ensure that the poorest Americans qualify.

Medicare officials estimate that 1 in 3 of their 43 million beneficiaries will be eligible—roughly 14.4 million people. But the actual number could be far higher—as the mailing of 20 million application letters suggests.

While the early application period should help Medicare sign up more people, some experts say it may not be enough to avoid the confusion that greeted the launch of the Medicare-approved discount drug card program.

Of particular concern is the five-month gap between applying for the drug benefit in June and selecting a drug plan in November. That lag could cause many people to forget the November enrollment requirement.

In addition, the five-page application, which requires information about bank accounts, insurance policies, stocks and other personal assets, could prove daunting for many. Twenty-three percent of Medicare beneficiaries have cognitive impairments, 29 percent live alone and 29 percent are in fair or poor health.

"This is a new, important and lengthy piece of paperwork that they're going to need some help with," said Jane Fumich, the director of the Cleveland Department of Aging.

Similar problems forced Medicare to hire hundreds of new phone operators last year to handle millions of calls from people confused and frustrated by the application forms and enrollment process for the discount cards.

The card program, which will be replaced by the discount drug benefit in 2006, was slow to recover and hasn't met original enrollment expectations. Only 25 percent of eligible low-income Medicare patients have signed up for cards even though the cards pay $600 a year toward their drug costs.

If the application drive for the low-income benefit is successful, it will portend a smooth transition into the full Medicare drug benefit. But if needy seniors stay true to history and don't sign up in high numbers, the valuable coverage could miss many of the people who need it most.

Getting Medicare's neediest to sign up for the coverage "is going to be a real challenge," said Medicare administrator Mark McClellan. "But we're going to do significantly better than past programs that have tried to reach the same population."

The Social Security Administration, which determines eligibility for Medicare benefits, is providing a big assist. In addition to the mailings, the agency has hired 2,200 people to work in its 1,300 local offices to help answer questions about the Medicare application process. In all, the agency will spend $500 million to help with the effort, said Social Security spokesman Mark Lassiter.

Medicare is also working with pharmacies, community groups, social service organizations and churches to provide applications and to help find people whose incomes and assets qualify them for the coverage.

Local outreach efforts are being organized through the Access to Benefits Coalition, an umbrella group of local and national organizations that work in 37 states to sign up Medicare recipients for the drug card program. The group will soon begin efforts to sign up 7 million people for the low-income benefit, said James Firman, CEO of the National Council on Aging and chair of the coalition.

The group will count on thousands of outreach workers like Leigh Sindelar of Belleville, Ill.

Sindelar, who works with the Area Agency on Aging of Southwestern Illinois, recently discussed the program with seniors at a fair in Columbia, Ill. She said the average annual value of the drug benefit—about $2,100 a year for low-income people—should make recruiting easier.

"That alone is going to cause a lot more people to participate because it's what they really need. They need help paying for their medication," she said.

Medicare officials expect 11 million people to sign up for the low-income benefit by the end of 2006. The Congressional Budget Office projects 8.7 million. The CBO, in a May 2004 report, said enrollment would be "somewhat greater than that for other welfare-related programs because individuals are allowed to enroll at offices of the Social Security Administration, which is easier for enrollees and carries less (of a social) stigma."

But there are obstacles. Processing the coverage applications in June will cause some applicants to mistakenly think the entire plan enrollment process is over.

"Inevitably, some people are going to think they've already done it and not recognize they have to fill out two sets of forms. In today's world it ought to be possible to make it easier for people," said Sherry Glied, who chairs the Department of Health Policy and Management at Columbia University and has studied obstacles to health program enrollment.

To address that problem, 6.3 million of Medicare's sickest people, who also receive full Medicaid benefits, will be automatically enrolled in a plan when coverage begins Jan. 1.

And even though the application form has been simplified and features enlarged type for easier viewing, many seniors could be thrown by questions such as whether they "own life insurance policies with a total face value of $1,500 or more?" Or whether "your savings, investments and real estate (other than your home)" are worth more than $11,500?

"My fear is that people who should get (the application), won't get it. That many who do get it won't open it. That many who do open it won't read it. And that many who do read it won't understand it," said Bob Hayes, director of the Medicare Rights Center, a seniors advocacy group in New York City.

McClellan said the application is the simplest around for federal programs that base eligibility on income and assets. It doesn't require additional documents to be attached and it's much shorter than applications for most federal assistance programs, McClellan said.

Phone counselors at the nation's 54 State Health Insurance Assistance Programs will also provide one-on-one assistance to help seniors through the application process. Staff members from across the nation will meet with Medicare officials in Annapolis, Md., starting Sunday to receive training.

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(c) 2005, Knight Ridder/Tribune Information Services.

PHOTOS (from KRT Photo Service, 202-383-6099): MEDICARE

GRAPHIC (from KRT Graphics, 202-383-6064): 20050520 MEDICARE DRUGS

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