Confusion Reigns as Medicare Drug Benefit Begins

With enrollment starting Nov. 15, survey finds seniors misinformed about program

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By E.J. Mundell
HealthDay Reporter

FRIDAY, Nov. 11, 2005 (HealthDay News) -- Created to ease the financial burden of soaring drug costs for America's seniors, Medicare's long-awaited "Part D" prescription drug benefit is set to start enrolling new members on Tuesday.

But, according to a new survey conducted in late October, nearly two-thirds (61 percent) of seniors said they still don't understand how the new benefit works, and only one in five said they intend to enroll at all.

Part D, which works with private plans to supplement drug costs beginning Jan. 1, is especially designed to help low-income elderly get the medications they need.

However, the new Kaiser Family Foundation/Harvard School of Public Health survey of more than 800 seniors "found that those people who were most likely to benefit from the low-income subsidy component of this law don't know it," according to the foundation's vice president, Mollyann Brodie.

"Half of the people who make less than $15,000 a year, and are therefore likely to be eligible, don't know [about it] or don't think that they are eligible," she noted.

Compounding the problem is the fact that the Internet is the most highly touted source of information on the new plan -- even though 76 percent of seniors polled admitted they had never surfed the Web.

The bottom line: The majority of the drug plan's 43 million potential beneficiaries are confused about what it is and how to access it.

"The overwhelming bewilderment begins with the scores of competing plans that are being offered," said Robert Hayes, president of the nonprofit Medicare Rights Center, in Washington, DC.

In most locales, he said, seniors will be faced with between 40 and 80 competing plans from various private companies, all pitched to consumers with "promotional advertising that obviously focuses on the most appealing elements of the plan," while leaving less-attractive elements buried in the fine print.

According to the Kaiser survey, two-thirds of elderly Americans don't even realize that they must go through one of these private-industry plans to take advantage of Part D. And almost half don't know that Medicare imposes a penalty if seniors enroll after the May 15, 2006, close of the official enrollment period.

Among other key findings from the survey:

  • More than one-third (37 percent) of those polled said they had no intention of enrolling in Part D for 2006, while another 47 percent said they weren't sure. Only 20 percent of seniors said they would definitely sign up for the coming year.
  • Just 5 percent of seniors correctly understood that at least 20 plans (and probably more) would be offered to them; most of those polled guessed they'd only have to choose from a handful of plans.
  • Just 31 percent of those polled said they had a "favorable" view of the new benefit, although that number rose as seniors became more informed.
  • One in 10 seniors erroneously believed they would be automatically signed up for Part D, while another 25 percent said they weren't sure.

Seniors do have resources available to them, experts said, especially the "Prescription Drug Plan Finder" tool at, or numerous toll-free phone hotlines, either at Medicare (1-800-MEDICARE) or through their local State Health Insurance Program (SHIP).

Still, "if you're a senior and you figure out that there are some 60-odd plans to choose from in your area, that can be overwhelming," said George Keleman, manager of AARP's Medicare Rx Outreach Campaign.

He urged seniors to "narrow the field to a much more manageable number" by concentrating on what AARP calls the "3 Cs."

First, he said, seniors need to compare the expected cost under various plans of the drugs they're taking, then focus on coverage -- "investigating whether the plans actually cover those prescriptions."

Finally, enrollees need to focus on convenience, he said.

Convenience can often be more important than cost, added Bill Vaughan, senior policy analyst at Washington, D.C.-based Consumers Union, which publishes Consumer Reports.

He cited the example of two plans, both of which might cover 97 percent of needed medications at roughly the same price and with the same deductible. However, one of the plans may require a doctor's "prior authorization" before a particular drug is covered.

"That could mean a major difference in access to medications by the beneficiary," Vaughan pointed out. So, even though the two plans may seem identical, "one of them is a pain in the neck," he said.

Then there's the much talked-about Part D "doughnut hole."

Under the standard benefit design, enrollees pay a monthly premium, a $250 annual deductible and varying coinsurance amounts. Medicare pays 75 percent of a beneficiary's drug costs up to $2,500, while beneficiaries pick up 25 percent of the tab through coinsurance.

But here's the catch: Many beneficiaries will encounter a gap in insurance coverage sometimes called the "doughnut hole," once their drug purchases for the year reach $2,500. At that point, seniors pay 100 percent of the cost of their drugs. Once a person's total drug costs hit $5,100, and he or she has reached an out-of-pocket maximum of $3,600, Medicare starts picking up 95 percent of the cost.

"So, if a beneficiary is concerned about going into that coverage gap, and not wanting to face 100 percent out-of-pocket costs, it would behoove them to research the plans in their area that do provide coverage in the coverage gap," Keleman said.

With Tuesday's enrollment kick-off looming, seniors may be worried they have to make all of these decisions quickly. But all of the experts stressed that there's no rush -- and it might even be prudent to hold off picking a plan for now.

First of all, Vaughan said, it'll take a while for competition to shape the marketplace. He pointed to the 2004 introduction of discount drug card programs. At the time, drug companies "either didn't get their data up right, or when they saw what their competitors were doing, they changed their prices," he said.

"It took about five or six weeks before the process settled down," Vaughan said, adding that he believes a similar shake-up will happen over the next month or so and could work to the consumer's advantage.

And the Kaiser Family Foundation's Brodie believes the information available to seniors should improve over the next few weeks, as well.

She noted that, right now, many Americans contacting Medicare or state agencies for help with Part D are facing busy signals, long periods "on hold," or malfunctioning Web sites.

"The [Medicare] Web site is still new, the 1-800 operators are still getting trained," Brodie pointed out. "I'd advise people to keep their powder dry and to wait until December. Remember, [if they sign up then], they can still get their drug coverage starting Jan. 1."

And she reminded seniors that an enrollee's choice of plan isn't necessarily carved in stone.

"They can switch [plans] anytime before Jan. 1, and then after Jan. 1 they can switch one more time before May 15," Brodie said. "Then, after May 15, they are locked into their plan for one year."

"Remember, this process is only beginning Nov. 15," the AARP's Keleman said. "Its a long process and it's time for beneficiaries to get up to speed and get familiar with things, take their time -- and make the selection that's best for them."

More information

To find out of the new drug plan will save you money, head to the Kaiser Family Foundation.

SOURCES: Mollyann Brodie, vice president, Kaiser Family Foundation, Menlo Park, Calif.; Robert Hayes, president, Medicare Rights Center, Washington, D.C.; George Keleman, manager, Medicare Rx Outreach Campaign, AARP, Washington, D.C.; Bill Vaughan, senior policy analyst and health lobbyist, Consumers Union, Washington, D.C.; Nov. 10, 2005, telephone press briefing, The Medicare Drug Benefit: Beneficiary Perspectives Just Before Implementation, Kaiser Family Foundation and Harvard School of Public Health

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