For Some, Medicare Drug Plan Pays Off

Published June 1, 2006

When Lacey P. Green went to his neighborhood pharmacy to pick up five prescriptions, he thought he heard the pharmacist say he owed $250, but he was wrong. The cost, with his new Medicare prescription drug card, was just $50.

“I was flabbergasted,” said the Rialto resident, whose kitchen counter looks like a medicine chest, full of pills for high blood pressure, heart failure, arthritis, and nerve pain.

Green, 79, had been buying medicines from a mail order pharmacy in Winnipeg, Manitoba but now uses Medicare instead. “I was amazed at the amount of money it saved,” Green said. “It was hard to believe.”

Hearing Horror Stories

Green, who is African-American, says he was reluctant to sign up for Medicare Part D after hearing horror stories from the media and members of his church. He is one of Medicare’s satisfied customers. They are not vocal, they are not organized, but they say it was worth wading through the hassles, confusion, and complexity of the new program to enroll.

Treasury Department figures show Medicare spent a total of $5.1 billion on prescription drug benefits in January and February, the first months of the new program, which is expected to cost more than $675 billion over 10 years. Medicare officials say the program is paying for more than a million prescriptions a day.

Saving Real Money

One way to assess the program is to talk to people in places such as the Inland Empire, a heavily populated region in Riverside County between Los Angeles and Palm Springs. People here are far removed from the raucous debate in Washington, where Republicans describe the drug benefit as a boon to older Americans and many Democrats call it a disaster.

In December 2005, Fontana couple Lee and Carla Myles paid $586 for their monthly prescriptions. He takes six drugs; she takes 18. They enrolled in different Medicare Part D plans, and their combined drug costs dropped from more than $25,000 a year to $4,900 or less.

Satisfied beneficiaries such as Leon Washington say they could never have analyzed the options or made a choice without the help of friends and relatives, pharmacists, or counselors from groups like Life Support Senior Services, a private nonprofit organization that offers advice at seminars and enrollment clinics.

Relying on Samples

Bill Terrell, 73, had been relying on free samples from doctors for some expensive medications, but he found it demeaning to ask for them.

“I’m a proud man. I worked hard, raised a family, and then found myself begging for samples. You get the feeling you’re a beggar,” Terrell said.

The satisfaction of some beneficiaries stands in contrast to the frustration of many others, who were overcharged or unable to get essential medicines in the first chaotic weeks of the program.

“People who are satisfied are quieter voices,” said Terrell, a retired mechanic who is losing drug benefits from a former employer. He said he did not expect to see any savings under Medicare. For a medicine that previously cost him $120, he now pays $20. “At first, you don’t believe it. It’s almost like it’s too good to be true.”

Getting Expert Help

The experience of those who have enrolled is particularly significant because millions of Medicare beneficiaries faced a May 15 deadline for signing up. Current beneficiaries who decide to join after that date will generally have to wait until November 15, and will then pay higher premiums as a penalty for late enrollment.

People satisfied with the new drug benefit appear to share some characteristics:

They did not sign up for one plan and then switch to another. They did not rely on advertising or their own instincts, but got help from Medicare experts, insurance counselors, or friends and relatives. They are not on Medicaid, the federal-state program for the poor.

People eligible for both Medicaid and Medicare had comprehensive drug coverage under Medicaid, but lost it on January 1 and were reassigned randomly to private Medicare drug plans. Many of those plans charge higher co-payments and often cover fewer drugs than the new Part D programs.

Signing up for Benefits

“This is a tremendous help to my mother and me,” said Leslie Sykes, whose mother receives Medicaid. Ward had been chipping in to cover the $476 a month cost for her mother’s Alzheimer’s medications. Under Medicare Part D, the cost for all her drugs is less than $100 a month.

Poor people often get hung up on fear of the unknown. They worry about racism, and mistrust of government and health care. Justifiably so; however, eliminating race and cultural-based health disparities is a two-way street.

“How can poor seniors expect to reap the benefits of a national drug plan if they sit back, complain, and don’t enroll?” Sykes said.

Chris Levister is a reporter with The Black Voice News in Riverside, California. This article originally appeared in the April 20 issue of the paper and is reprinted with permission.