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What benefit?

New Medicare drug plan confusing everyone

Despite months of training and chances to learn, health care providers and patients are having a terrible time figuring out the federal government’s Medicare Part D prescription drug plan, which has been up, and apparently limping, for two months.


Dafna Gutfreund, right, helps Joy Amsel of Teaneck fill out her Medicare forms.

Health care workers and family members are being corralled into helping seniors find and understand online information about Part D, as it is known. Seniors are also being inundated with mail from companies vying for their Part D business. And, somewhere in all that mail, seniors who already have a drug benefit plan should be finding a letter from that provider, letting them know whether they should even bother enrolling in the Medicare plan or if they are covered better or just as well by what they already have.

Jeff Lampl, executive director of the Jewish Family Service of Bergen County, said his most important advice for seniors is, "Please look for that letter from your existing insurance company and hang onto that letter the way you hang onto your birth certificate, marriage license, deed for your house."

If a person’s situation changes and he or she decides to enroll in Part D, that letter needs to be produced to avoid stiff penalties.

Lampl, one of about a dozen people reached by The Jewish Standard, said JFS staff members had been trained by the county for well over a year in the plan’s "labyrinth of rules and regulations." Although the situation is "a nightmare," he said history shows such plans can improve with time, despite initial problems. He cited Medicare’s own beginnings in 1964 and the first Social Security Act in 1935. Establishing a Medicare drug benefit plan at all has at least established a budget line for it.

The Bergen County Division of Senior Services made staff available to speak about Part D, and the JCC on the Palisades in Tenafly and the UJA Federation of Northern New Jersey were among the groups that took advantage of this over the last several months.

A program on Superbowl Sunday drew about 30 seniors to Cong. Beth Israel in Bergenfield, said Miriam Allenson, UJA-NNJ director of media relations. It was offered by UJA-NNJ through its Synagogue Leadership Initiative and the federal non-sectarian Naturally Occurring Retiring Communities program.

Not only are the workings of Part D "very confusing," said Amy Winn Dworkin, the special projects director for SLI, but there’s also the problem of the "great big donut hole." Standard Part D coverage ends when a senior’s drug expenses reach $’,500 and does not kick in again until a person’s drug costs exceed $5,100, at which point "you gotta be pretty sick."

"Anyone who’s over 65 has to face this," said Winn Dworkin, "and it doesn’t matter whether you have money to pay for your prescriptions right now or not."

Mona and David Mozur of Cresskill are seniors who are so computer savvy that they volunteer as computer teachers for other seniors at the Tenafly JCC. But they’re taking a pass on Part D for the moment, partly because the online information is confusing — even for them — and partly because of costs.

The Mozurs fall into the "donut area," said 78-year-old Dave. They have found it difficult to figure out which of their medications are covered by which options. "There’s a lot of analysis involved," and he’s also heard that what the government says online about payment is not necessarily "what they are prepared to guarantee in writing."

Seventy-four-year-old Mona said she’ll continue to use a Canadian pharmacy for some of her more expensive medications. "The [American] pharmaceuticals are really cheating us. Why can’t the government argue? [And] the insurance companies are going to make a fortune."

Part D got off to a rocky start. Huge numbers of seniors in transition between plans were told by pharmacies that their medications were not covered, so many states, including New Jersey, had to step in to pay the bills. But New Jersey and other states want to be reimbursed.

In late January, Sen. Frank Lautenberg (D-N.J.) and Sen. Olympia Snowe (R-Me.) introduced a bill calling for that federal reimbursement.

Gloria Montealegre, Gov. Jon Corzine’s deputy press secretary, said 140,000 New Jersey seniors were left without drug benefits when they moved from Medicaid coverage to Part D. The state has already spent $130 million — which was not provided for in the budget — on these and many other transition reimbursements. At a hearing on Monday in Washington during the National Governors Association annual meeting, Corzine and several other governors heard from Dr. Mark B. McClellan, administrator of the Centers for Medicare and Medicaid Services at the U.S. Department of Health and Human Service. McClellan indicated that New Jersey will be reimbursed, according to Montealegre.

But Lautenberg, through communications director Alex Formuzis, seemed skeptical about McClellan’s "verbal reassurance" of reimbursement since, two months into the program, no payments have yet been made.

"The Bush Administration Medicare drug plan has been a confusing disaster since it started," said Lautenberg. "Tens of thousands of seniors have been turned away when trying to fill their prescriptions, leaving New Jersey to bear the huge costs of these failures by the federal government. Congress must correct these mistakes for the sake of our senior citizens."

The federal government could not possibly have made this benefit any more confusing, said Lautenberg. In New Jersey there are close to 80 plans — 44 stand-alone drug plans and 33 HMO plans — from which seniors can choose, each with its own structure of co-payments, deductibles and formularies.

"It’s just mind-boggling, the options that are out there," said Susan Lilly, director of social services at the Jewish Home at Rockleigh.

Rabbi Richard Address, director of the department of Jewish family concerns at the Union for Reform Judaism in New York, said he knows firsthand about the confusion, having spent a couple of hours at the computer with his mother trying to help her.

Although the URJ has no formal program to educate congregants about Part D, Address said, he’s been urging congregations to make sure they help their older congregants figure it out.

The director of public relations for the Orthodox Union in New York, Stephen Steiner, said the O.U. has no national program to help seniors with Part D. Neither does The United Synagogue of Conservative Judaism, said Rabbi Lisa Vernon, N.J. regional director for Hazak, the USCJ’s seniors program. However, said Vernon, many Hazak chapters have organized informational meetings on their own.

Pharmacists will have to bear the brunt of Part D’s problems, including dealing with people who find that their plans are denying them a medication, said both Frank DaSilva, chief operating officer at the Daughters of Miriam Center in Clinton, and Charles Berkowitz, Rockleigh’s executive vice president.

Part D is "a difficult, difficult thing," said Sandy Kessler, a pharmacist at Alvins Discount Pharmacy in Teaneck. Kessler said that, if asked, he’ll tell patients that the AARP and Horizon Blue Cross Medicare drug plans are the "most fair" of those available in New Jersey — although they are not problem-free. He bases his assessment on how they handle their other insurance plans, how long they’ve been in business, and that they do come back with answers to questions.

Still, for seniors, "it’s almost like what happened in New Orleans," he said. "It’s such an onslaught and they’re just not prepared for it."

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