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Medicare Part D Baffles Brooklyn Senior Citizens

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If it sounds like gibberish, it probably is. This is the assessment many Brooklyn seniors have made about the prescription drug coverage program Medicare Part D. The program, which took effect January 1, has left many senior citizens – and even some doctors – scratching their heads as to which plan is best, and whether signing up is worth it. And scratching one’s head has never been so expensive. Those who decline to sign up by May 15 will be penalized should they decide to later. For every month that elapses between June 2006 and the month they join, their monthly premiums, which are an average of $32.50, grow by one percent for the life of their coverage, although there are exceptions for those with coverage of equal quality during that time. Among the program’s detractors is a southern Brooklyn senior who asked to remain anonymous when she called Medicare D “a terrible arrangement” that is frustrating to decipher. “Everybody is really quite up in arms. I would love very much if they just did not do this,” she said, adding that she has declined to join the program because it requires a $250 deductible sign-up fee, even though a family member offered to cover the cost. “No one really understands it, and these are intelligent, college-educated people who all speak English,” echoed Edith Cohen, a senior who lives in the Coney Island area. By the May deadline, she hopes that “maybe they’ll make it a little easier to understand.” The program, which is intended in part to cut costs for seniors who pay out of pocket for multiple prescriptions, is most likely to benefit those in the middle income bracket who make too much money to receive Medicaid and too little to afford medical expenses themselves. It will be costly for the federal government, but will also save the government money by pushing the use of generic drugs, and by creating a “doughnut hole,” or coverage gap, already widely despised. The doughnut hole is a period in which Medicare pays nothing towards seniors’ medical expenses from the time they run up a $2,250 total drug bill, between what they and the agency have paid, to when their needs become “catastroph­ic,” or they expend an additional $2,850 of their own money, at which point coverage resumes. Some of the major beneficiaries are pharmaceutical companies, as seniors are required to choose a plan offered by one of the companies. Their prescription coverage is then limited to drugs produced by that company, and they are unable to switch plans at any time during the year other than from November 15th to December 31st, although there will be exceptions for new arrivals to the city, and those with similar coverage that expires. The decision of whether to sign up forces seniors in good health to speculate about the worst case scenarios of their futures to determine whether to invest now. On the official website www.medicare.gov, seniors are encouraged to sign up with statements like, “Even if you don’t use a lot of prescription drugs now, you should still consider joining…For most people, joining now means protecting yourself from unexpected prescription drug bills in the future.” In a September 23 Medicare press release, Mark McClellan, administrator for the Center for Medicare & Medicaid Services, said, “As a result of the strong competition in New York, Medicare coverage will include options that cost less and also that provide coverage that goes beyond Medicare’s standard benefit.” In a September 30 press release, Health and Human Services Secretary Mike Leavitt advertised the program by saying, “Seniors will be able to get Medicare-approved prescription drug coverage that will help protect their health as well as their savings….Medicare drug coverage is coming with lower costs and better coverage options than many people expected.” But Dennis Campbell, a senior who lives in Clinton Hill, has his doubts. He called the program “a total fraud” and said he is sickened by the power it gives to pharmaceutical companies. Nevertheless, he is considering signing up if he finds a plan that suits his needs. “The concept is good,” he said, and “the other part of Medicare works like a charm.” Part D, for some reason that Campbell speculates may be political, is bewildering, and much like a chess game. “It takes a lot of noodling around to figure it out,” Campbell said, and he has better things to do. Despite the initial outcry, the program has some supporters who say it will pay off in the long run after the dust surrounding the complicated changeover settles. A Brooklyn pharmacist who declined to give his name said he was favorable toward the program’s theory even though he criticized some of its practices. “In general it’s a good concept,” he said, not only for Brooklyn but for the nation, and it is best for the middle class because “the poor are taken care of” and “the rich have enough.” However, he finds it distressing that the program prohibits him from recommending a particular plan to his customers, “even though I know one plan is better,” and he is unhappy that those with Medicaid – who are automatically enrolled in Medicare D without their input – must now put out $1-5 for each of their medications, which were previously free. Pharmacists are permitted to wave the fee when they believe customers cannot afford it, but are also permitted to withhold drugs for lack of payment. Another pharmacist at a Myrtle Avenue drug store who asked not to be named said a significant portion of his days since January 1 have been spent discussing the changes with confused customers. “I have to spend a lot of time explaining,” he said, which takes him away from filling prescriptions. He is especially concerned that many seniors are unable to continue taking the popular blood pressure medication Nurvasc, which he called “the most important medication in the United States,” because their plans do not cover that brand. “This is blood pressure. We can’t play around with this,” he said. For the transitional first month of the program, Medicare was required by law to cover patients’ desired medications, but that reprieve expires in February and recipients will now be limited to specific drugs covered by their plans. The results have yet to be seen. Medicare, the federal health care program for those 65 and older that began under the Kennedy Administration in response to the poor quality of life that many seniors across the nation faced – notably recalled as a time when seniors ate cat food because it was all they could afford – contains four parts. All Medicare recipients have part A, which covers hospital insurance, including nursing home care for up to 100 days, some help at home, and hospice services, yet only some have part B, which covers physician and outpatient care, lab tests, durable medical equipment and ambulance services. Part C, known as managed care, was created in the 1990s as an alternative to the first three, and covers all medical needs, and D was created solely to cover prescription drugs.

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