Monday, November 14, 2005

More than 40 million Medicare beneficiaries today start signing up for the government’s new drug-benefit program, known as Part D.

But the maze of options, with states typically offering an average 45 plans, already is confusing consumers, physicians and health care experts.

“There is just a lot of different options — and options within options — that make it complicated for the average beneficiary,” said Jack Hoadley, research professor at Georgetown University’s health policy institute.

“It’s a complicated process for those of us in research who spend our days studying this program,” he said.

The government-subsidized coverage for prescription drugs starts Jan. 1. Patients on Medicare, the federal health insurance program for senior citizens and the disabled, are eligible for coverage that day if they enroll by Dec. 31.

“It’s perfectly understandable to me that an individual, who has never had to do a lot of shopping for health insurance, would find this daunting,” said Sara Rosenbaum, a health law and policy professor at George Washington University.

Most senior citizens already have a hard time understanding how the new Medicare drug plan works, according to a poll released last week by the Kaiser Family Foundation, a Menlo Park, Calif., health policy research group.

The study, which surveyed 802 senior citizens in October, found 61 percent said they knew little about the upcoming Medicare program. About 43 percent said they were unsure whether they would enroll in 2006.

The Centers for Medicare and Medicaid Services, the federal agency in charge of the benefit, said the options allow senior citizens to customize their drug coverage and get the most value out of their plan.

“It’s going to take a little more energy, but we are hearing people are excited about the coverage,” said spokeswoman Barbara Cebuhar.

The agency hired more than 8,000 counselors to handle the expected high volume of calls to its help line, 800-MEDICARE (800/633-4227), Ms. Cebuhar said.

Maryland has about 25 counselors ready to handle calls, said Cassaundra Brown, health insurance specialist at Maryland’s Department of Aging.

The state, with 673,000 Medicare beneficiaries, will offer 66 Medicare plans and 14 Medicare Advantage plans, which generally provide drug coverage with health insurance, she said.

Virginia will provide 41 prescription drug plans and an unspecified number of Medicare Advantage plans, said Janet Riddick, spokeswoman with the state’s Department for the Aging.

The state had 1.04 million Medicare beneficiaries as of March 15, she said.

Ms. Rosenbaum said she expected the number of Medicare drug plans to drop in the next few years “as the market settles.”

AARP, the senior citizens advocacy group, advised eligible consumers to take their time picking a certain drug plan.

“We don’t want anyone to feel anxious or that they need to enroll on the first day,” said Cheryl Matheis, director for AARP’s health strategies. She advised Medicare recipients to talk with family, friends and physicians about their options.

Eligible participants have until May 15 to enroll for 2006 coverage. After the deadline, a penalty fee of about 1 percent of the plan’s monthly rate will be imposed and coverage won’t be available until January 2007.

But Washington general internist Dr. Alan Pocinki said he is offering his patients only basic information.

“There are so many variables that come into play that I would shy away from saying a certain plan works for a patient,” he said, adding he will refer specific questions to Medicare counselors.

Timothy Trysta, a former CMS senior policy adviser, said it will take months before the public fully understands the available options.

“There is going to be a big learning curve. It’s impossible for CMS to anticipate all the different questions that people will have,” said Mr. Trysta, counsel in the health care group at the D.C. office of national law firm Alston & Bird LLP.

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