Medicare Drug Plan Still Fuels Dissatisfaction

And more work is needed to reach seniors who haven't signed up yet, researchers say

TUESDAY, Aug. 1, 2006 (HealthDay News) -- Despite high enrollment in the Medicare prescription drug plan, many who signed up now feel dissatisfied with Medicare because of their experiences with the cumbersome process of choosing coverage plans.

That's one of the conclusions from a new government study that also reported the fear that many seniors would not enroll has turned out to be unfounded. The study was funded by the National Institute on Aging (NIA), and appears in the Aug. 1 issue of Health Affairs.

Meanwhile, seniors are starting to feel the pain of having to pay the full cost of their medications and premiums as they begin to fall into the Medicare drug coverage gap that has come to be known as the "doughnut hole," the Washington Post reported Sunday.

In the NIA study, led by Daniel L. McFadden, a Nobel laureate from the University of California, Berkeley, researchers interviewed people aged 65 or older in November 2005, the week before enrollment began. They surveyed the same group again between May 16 and June 2, 2006, right after open enrollment in the program ended. At that point, 90 percent of eligible seniors had enrolled, meeting the government goal set before the program was launched.

"Generally, the program has been pretty successful in getting coverage for people," McFadden said. "There is a small core of people who should have signed up who haven't. These are people that are hard to reach and get to think about their own interest."

McFadden said he believes this group is made up mostly of people with low levels of education. "They are people who don't have automatic coverage," he said.

Part of the problem has been the complexity of the enrollment procedure, and the many plans from which to choose.

Many of those surveyed said they were less satisfied with Medicare and the government overall as a result of their experience with the drug benefit program.

"It really is in Medicare's interest to try to simplify and streamline the information about the process, so for new enrollees it is easier for them to make these decisions," McFadden said. Medicare should also keep trying to contact people who are not enrolled to make them aware of their options, he added.

In the future, McFadden fears increasing premiums will make it difficult for many seniors to afford the program. "The premiums keep going up because the people who buy it are the ones that use it heavily," he said. "That's a problem with medical insurance in general."

One health industry expert thinks the program is already a success.

"There was a lot of good news in the report," said Mary R. Grealy, chairwoman of Medicare Today and president of the Healthcare Leadership Council. "Despite the fears at the beginning of the program, people who are enrolled are finding that they are having good experiences," she added.

The good thing about having so many choices is that people can sign up for plans with different benefits at different costs, Grealy said. However, she does expect that some plans will close down. "There will be some shakeout," she said. "We will know soon which plans will drop out."

Another expert is interested in whether the drug program will have an impact on health. "It's a bit to early to answer," said Richard Suzman, director of the Behavioral and Social Research Program at the NIA. "But we are interested to see how this will improve health."

There is one aspect of the Medicare drug plan that is already causing seniors pain. That's the "doughnut hole," a gap in coverage that occurs when one reaches $2,250 in annual drug costs. At that point, the drug benefit doesn't start again until one reaches $5,100. Seniors are responsible for the full cost of drugs, as well as their monthly premium, until they reach that level. After that, prescriptions are almost completely covered. In addition, the very poor can get special subsidies to bridge the gap.

"Although the Medicare handbook clearly describes the coverage break, critics say most Medicare recipients, bombarded with advertising from private prescription plans, focused on deductibles and premiums and the drugs included," the Post. reported.

Democrats in Congress have called for change. In one proposal, Medicare, not the drug plans, would negotiate directly with the drug companies, which could save money that could help eliminate the gap. Another plan, introduced by Sen. Barbara A. Mikulski (D-Md.) and three colleagues, would waive the premium in any month when a participant lacks coverage, according to the Post.

More information

Medicare can tell you more about drug coverage.

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