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Frustration leads to demands to clarify Medicare drug plan Complexity of benefit perplexes many elderly

Designed to boost the health of millions of seniors when it takes effect Jan. 1, the new Medicare prescription drug benefit appears to have an unintended side effect: paralysis.

No, not the literal kind, but the kind anyone would face when having to choose between dozens of competing health plans, all presented in complex detail on the Internet.

"The benefit is basic but real," said William Daniels, an Erie County Senior Services health insurance expert. "The problem is trying to choose one of the 46 plans. People are almost paralyzed by all the choices."

For that reason, three weeks into the enrollment period for the new program, experts in Western New York and Washington said it has been slow going so far.

Help hotlines and congressional offices are overwhelmed with calls from seniors.

Enrollment among the low-income elderly has been surprisingly low.

And lawmakers are beginning to talk about extending the May 15 enrollment deadline for the plan.

"At this point, people are just thirsting for information," said Cheryl Matheis, director of health strategies integration at the American Association of Retired Persons. "We don't get a lot of complaints. The uptick is in people asking for information."

And what an uptick it is!

"I'm several weeks behind in my phone calls," said Daniels, who has spent the last few months presenting as many as five Medicare educational sessions a day to thousands of residents.

"We're receiving a lot of calls," said Julie Kruger, a senior caseworker for Rep. Brian M. Higgins, D-Buffalo. "And obviously, people who are calling their congressmen are a bit confused or frustrated."

And angry seniors are traumatizing caseworkers for the New York-based Medicare Rights Center, according to its president, Robert Hayes.

"They're getting so many people yelling at them," he said.

All that yelling is about a program designed to give seniors prescriptions they can afford.

>Each policy differs

Starting Jan. 1, Medicare, the federal health program for the elderly and disabled, will begin to offer voluntary coverage for prescription drugs. Under a new part of Medicare called Part D, private companies will provide the coverage, while the government subsidizes the cost.

The nearly 280,000 Medicare beneficiaries in Western New York can choose one of 46 stand-alone prescription policies, which would be combined with traditional Medicare Part A and Part B. Or they can join one of 17 private Medicare HMO or preferred provider organization (PPO) plans that include prescription coverage.

Every policy is different, with monthly premiums in the stand-alone plans ranging from $4.10 to $85.02. Some cover nearly all of the 100 most-prescribed drugs, while others cover a smaller number.

Seniors who depend on Medicaid, the state-federal health program for the poor, will see Medicare pick up the drug coverage as of Jan. 1. But they must choose from 15 private Medicare health plans in New York State or they will be automatically assigned a health plan.

Joan Slattery is trying to work through the issues that the new drug benefit presents. The 71-year-old Buffalo resident receives drug coverage from her former employer, but her husband relies on Medicaid.

"I have to make sure the plan for him covers the drugs he takes and uses the pharmacy he uses," she said.

In trying to reach her decision, she's been bombarded with information. She has a stack of paperwork to read. Last week, she ventured out on a frigid day to attend an educational seminar at the Valley Community Center.

"I know what my options are," said Slattery, whose husband is in a nursing home. "I'm getting through this. But it has been hard."

>Many avoid Internet

For many seniors, the difficulty stems from the fact that much of the information on the plans is available primarily on the Internet, a tool that many of them don't use.

What's more, Medicare's Web site (www.medicare.gov), where people can enroll, has been overwhelmed during peak hours, as has the program's 800 number. That fact recently prompted Rep. Louise M. Slaughter, D-Fairport, and Higgins to write an angry letter to the agency that administers Medicare.

Sophie Szafranek, 85, of Buffalo, said she wishes she could get help with the program the old-fashioned way: by talking to people.

"The frustrating thing about this Medicare benefit is that you can't get to them as an individual person," she said.

Perhaps that's why enrollment numbers are disappointing for the one piece of the program that has released such data: the part covering poor seniors.

>Under 10 percent enroll

Out of an estimated 7 million people who are eligible for a subsidy that dramatically cuts the cost of the drug benefit for low-income seniors, the Social Security Administration has approved 661,000 applications.

"It's low, less than 10 percent of the number eligible," said James Firman, chairman of the Access to Benefits Coalition, which is encouraging people to enroll in a private Medicare drug plan. "It concerns me, because it's a no-brainer that people eligible for the subsidy should take it."

Firman said he's far less concerned about overall enrollment in the plan.

"It's too soon to tell how it's going, because most people don't need to make a decision right away," he said. "What we're learning is that most people are still learning."

Nevertheless, Democrats in Congress have started sniping at the program. Sen. Charles E. Schumer, D-N.Y., has suggested that it be scrapped and replaced with something more understandable. And Slaughter suggests that the May 15 enrollment deadline might have to be extended.

"The penalty is awful," Slaughter said of people who don't sign up by then. She noted that late enrollees will see their premiums go up by 1 percent for each month they delay.

"This is just a terrible piece of legislation," Slaughter added, arguing that it was meant to benefit private companies rather than individual Medicare recipients.

>Reynolds urges patience

But Rep. Thomas M. Reynolds, R-Clarence, urged seniors to give the program a chance.

"This is the first time in 40 years that we've seen a major change in Medicare," said Reynolds, who has been holding meetings across his district on the drug plan. "And it's not a one-size-fits-all program. But the education process is coming along."

If the confusion persists, Reynolds said, he would be willing to consider changes in the program.

But Leslie Norwalk, deputy administrator of the agency that runs the program, stressed that it provides seniors with something they've been clamoring for for years: a cheaper way to fill their prescriptions.

"Once people enroll in the program," she said, "they aren't complaining."

The federal government provides information and enrollment forms on the Internet at www.medicare.gov or by calling (800) 633-4227.

e-mail: hdavis@buffnews.com and jzremski@buffnews.com

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