RespiteMatch.com Health Blog

By Sarah Skidmore
UNION-TRIBUNE STAFF WRITER
October 1, 2005

Beginning today, Medicare enrollees can expect an onslaught of television, mail and telephone advertising from insurers that want to sign them up for the new Medicare prescription drug program.

“They are going to be deluged,” said Deane Beebe, spokeswoman for the Medicare Rights Center, an independent organization that helps seniors with Medicare.

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Medicare beneficiaries can begin signing up for the program Nov. 15, but today is the first day insurers can advertise their plans directly to consumers. The prescription drug benefit is the biggest change to the program since its creation in 1965.

It’s a potential windfall for insurers, according to analysts. But consumer advocates say seniors will have a difficult time cutting through the marketing to make an important decision about the voluntary program.

Anyone on Medicare is eligible for the prescription drug benefits. That’s roughly 4.3 million people in California.

The federal government selected which companies would offer the plans, which vary state by state. In California, 18 companies will offer stand-alone prescription drug plans, and 19 companies will offer drug coverage through a Medicare managed care plan, which provides additional benefits.

New Medicare
drug benefits
The program benefits begin Jan. 1, 2006. Initial enrollment runs from Nov. 15 to May 15. If a beneficiary does not sign up during this time, their costs will go up. For more information:

The Medicare Web site: www.medicare.gov

Medicare hotline: 1-800-MEDICARE

California Health Insurance Counseling and Advocacy Program, a nonprofit organization, at www.calmedicare.org or (800) 434-0222

The Centers for Medicare and Medicaid Services said the competition helps control costs and increase choices for seniors. Competition from insurers wanting to offer plans in California dropped the state’s average premium to one of the lowest in the nation: $25 a month for a stand-alone plan versus the $32 national average.

But some consumer and Medicare rights groups said that because each company can offer multiple plan choices, people will be overwhelmed by the options.

“It is confusing,” said Vicki Gottlich, senior policy attorney for the Center for Medicare Advocacy in Washington. “Especially when you are thinking of all of the variables: what are the copayments, do they cover my drugs, does it include my pharmacy, will I save money?”

The first decision seniors need to make is if they want drug benefits.

Seniors who have prescription drug benefits currently, either from a former employer or a Medicare managed care plan, will receive information comparing their current plan with new options.

For those wanting to add or change drug coverage, the toughest step is next: evaluating the various benefits and costs, consumer groups said.

The government is mailing an informational handbook to enrollees about the program. And by mid-October, the Centers for Medicare and Medicaid Services will add an online tool to compare plan benefits side by side, allowing individuals to look at personalized needs such as coverage of specific medication.

The federal government has agreed to work with numerous state and local groups to aid seniors with hotlines, one-on-one counseling and informational meetings.

“It’s going to be difficult to handle the sheer volume of information and the slick materials and giveaway incentives,” Beebe said.

Insurers are spending millions to market the plans, more than $80 million at Humana alone.

According to Goldman Sachs & Co., the prescription drug program could generate as much as $10 billion in revenue and $250 million in earnings next year for nine large insurance companies.

Pacificare, a California company, is using a recreation of Fred and Ethel from the “I Love Lucy” television show to promote its product.

Consumers can sign up for plans directly with a company or through Medicare. However, the government has numerous advertising and enrollment rules in place to limit fraud.

Companies can advertising by phone, mail or television. But a company cannot visit a consumer at home unless requested by the individual.

Insurers can sign someone up by the phone but not on a call placed by the company, to avoid high-pressure sales. The consumer must call the company back.

Additionally, a company can sign members up online but payments cannot be made over the Internet. This also is to avoid misleading sites, CMS said.

Federal, state and local officials urge seniors to be wary of anyone requesting personal information such as Medicare, bank account or social security numbers. Officials also urge seniors to report any suspicious or fraudulent behaviors to Medicare or local law officials.