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MEDICARE DRUG PLAN IN S.C.
Many seniors trapped in maze
The new Plan D has often been a prescription for confusion, frustration
By LINDA H. LAMB
Staff Writer
For millions of Medicare recipients, it’s been a challenge to deal with the new prescription-drug coverage, called Medicare Part D.
But for Mary Alice Wood of Columbia, it’s been an absolute panic.
While trying to use the new coverage to get a refill of her anti-anxiety medication — one of more than a dozen drugs she takes for a variety of ailments — Wood suffered a full-blown panic attack in the Walgreens on Forest Drive.
“And,” the 61-year-old Wood added, “every time another one of my medications runs out, I relive the anxiety all over again.”
Not everyone’s experience has been so dramatic, and officials say the situation is improving.
As of mid-January, about 57 percent of South Carolina’s 654,600 eligible Medicare recipients were signed up for prescription drug coverage. That compares to about 52 percent in Georgia, 60 percent in North Carolina and 55 percent nationally.
But, for many seniors as well as the agencies and pharmacies that serve them, Medicare Part D has been a prescription for pandemonium. They tell stories about perplexing drug-plan options, late enrollment cards, contradictory information and long hours spent on hold.
“We’ve had people calling us, wheezing, saying they were at the pharmacy and having problems,” said Sharon Seago, director of the Central Midlands Area Agency on Aging.
“We’re trying to make it as smooth as possible ... but there’s a huge communication problem,” said technician Nicole Martin at Hawthorne Pharmacy on Taylor Street in Columbia.
“It could be best described as a nightmare,” said pharmacist Dan Bushardt of The Medicine Cabinet in Lake City. “There just was not enough planning to get ready for this thing.”
“I’m so confused, and I don’t consider myself an idiot,” said John Ryan, a retired printer in Irmo who is trying to decide on a plan. “I called a customer service number, and they couldn’t even tell me about the deductible in their plan. It’s hard to understand.”
‘SO MANY CHOICES’
The Bush administration rolled out Medicare Part D last summer, touting it as a much-needed way for 40 million Medicare recipients to enroll in privately offered, prescription drug coverage. South Carolinians have 45 drug plans and 11 comprehensive Medicare plans to choose from, with varying benefits, drug lists and deductibles.
Enrollment for the new benefit started in November, with plans taking effect Jan. 1. People who are eligible to enroll — and who do not already have drug coverage that’s at least as good as the Medicare plans — must enroll by May 15 or face a penalty if they want to sign up later.
Lt. Gov. Andre Bauer, who oversees the state Agency on Aging, said he’s pleased that so many of the state’s elderly and disabled Medicare recipients now have prescription drug coverage. But he’s concerned about those who don’t.
“The federal government created part of the problem in that (the plans) gave people so many choices,” Bauer said. “We’ve been inundated with calls.”
One reason all the phones are ringing at state and regional agencies on aging is that national Medicare phones have been swamped.
Ryan, 65, said he’s been trying to get through to the national number every day for weeks. Pharmacists tell of being stuck on hold for as long as three hours as they try to confirm whether customers are enrolled. (It takes about 10 days to get a letter of confirmation, and about four weeks to get a membership card.)
People like Ryan should keep calling, said Chris Downing, the Atlanta-based regional director for the federal Department of Health and Human Services.
“We got caught ... with our pants down,” Downing said. “(But) I’m happy to report that things are getting better.”
Early critics were worried there would not be enough drug-plan options; now they say there are too many, he noted. He said the feds have added operators and phone lines, including a special toll-free number just for pharmacists. Also, he said, “data transfer problems” are being dealt with through computerized backup programs.
“Fifty thousand people a day are signing up,” Downing said. “We know it’s a good program.”
COMPLEX NEEDS
A major source of early trouble has been the group of low-income seniors who were transferred automatically to one of the drug plans, Seago said. Some find themselves with a plan that doesn’t suit their needs.
That situation is especially difficult for people such as Wood who have many physical problems.
A disabled former saleswoman, Wood has a heart-rhythm ailment, hypertension, diabetes, scoliosis, arthritis and high cholesterol. She also is a breast cancer survivor and copes with colon spasms and anxiety-related problems.
Her assigned plan covered her blood pressure medication promptly but not her diabetes medication. Perhaps the difficulties were just computer glitches, she said, but that doesn’t lessen her worries.
Diana Terceiro, who lives in senior housing in Columbia, also had problems with the plan she was automatically enrolled in. Terceiro, 66, has had brain surgery, ulcers and two heart attacks, among other ailments.
At the drugstore, “they filled two prescriptions but wouldn’t fill another one,” she said. “They had my name spelled wrong. Then they were saying the drug I needed was something they didn’t cover.”
Terceiro said she has switched prescription plans and just hopes she made the right choice. At one point, her church gave her money for her heart medication.
“I’m trying to hang on as best I can,” she said. “I don’t want another surgery ... or another heart attack.”
People whose medical needs are less complicated seem to have better luck finding the right plans.
Mary Simms of Lexington used the Internet with the help of a friend. She found a Humana Standard plan that covered the Fosamax and Coumadin prescriptions she needs, and she enrolled online. She ordered her medications by mail, and that went smoothly as well.
“I’ve been real happy with what I got,” said Simms, 68, who still works as a nursing assistant.
When Simms meets her deductible, she said, her new plan will cost her just $15 a month, compared with the $80 she was spending before.
Sara Ouzts, 71, in the Upstate town of Woodruff, also plans to enroll online and buy medications by mail for herself and her husband, Perry, 75.
Ouzts said the array of choices initially struck her as “quite a mess.” She said she was grateful for help she got by calling the state’s toll-free number.
“I’ve done a lot of work on the computer,” she said, adding she’s close to making a decision.
Being computer savvy is not the strong suit of every senior, however.
Medicare dramas also are playing out in drugstores as patients seek help (see accompanying story). Last week, Health and Human Services Secretary Mike Leavitt praised pharmacists’ “heroic efforts” to make sure people get their medicines.
Mary Alice Wood has only gratitude for her pharmacists at Walgreens, who she said have been patient and compassionate throughout her ordeal. Frequently, she says, she stops by or calls the pharmacy with questions.
“I have some problems with my memory,” she said, “but that’s one number I know by heart.”
Reach Lamb at (803) 771-8454 or llamb@thestate.com
