Prognosis perplexing

Lack of drug pricing info in new Medicare prescription program makes it difficult for seniors to choose plan

The government's roll-out of its $40-billion-a-year Medicare prescription drug plan has hit another snag.

People trained to help seniors figure out which plan to choose under the new program said they don't have the pricing information they need and seniors are scratching their heads in confusion.

Earlier this week, Dr. Mark McClellan, head of the federal Centers for Medicare & Medicaid Services, launched a prescription drug plan finder designed to help those on Medicare plug in specific financial information and prescription needs so they can determine which plans are best for them. The tool is available on www.medicare.gov and is also used by those trained to counsel seniors.

But a crucial piece of data -- pricing information on the drugs -- is still not available, making it difficult for 42 million Medicare participants nationwide to figure out the best coverage at the lowest cost. Enrollment for the new Medicare prescription drug program starts Nov. 15. Forty-six drug plans are being offered in New York State alone.

"People are asking questions and we don't know the answers," said Jim, who is one of 9,000 customer service representatives hired to answer questions at 1-800-Medicare. Jim, who asked that his last name not be used, said he and his colleagues joke that "it's kind of the same way FEMA is run; I guess we're using the same playbook."

Deane Beebe of the Medicare Rights Center in Manhattan said its 183 volunteers who are trained to answer questions for the 2.5 million seniors in the state are frustrated. "The tool is useless," Beebe said. "The phones are ringing and we can't help anybody."

"It's definitely a slow start for CMS," said Holly Rhodes-Teague, head of Suffolk's Office for the Aging. She said her office's phones "have been ringing off the hook." A mistake in the "Medicare & You 2006" handbook, which outlines the different plans being offered, "didn't help," she said. The handbook tells low-income beneficiaries eligible for extra help that all drug plans are available with no monthly premium. However, 60 percent of the plans require premiums.

Medicare spokesman Peter Ashkenaz said drug pricing information is not available because some of the health plans did not provide the information in a usable format. To keep the "playing field level," Medicare officials decided to withhold the pricing information until it was all available, he said. But it is unclear when that will be.

Danielle Liss, a regional Medicare spokesman, pointed out that seniors have until Dec. 31 to sign up if they want coverage to begin Jan. 1; otherwise they can sign up by May 15. "It's important for people to get ready, but they don't have to make a decision on Nov. 15," she said.

Seniors who were interviewed said they had received the new Medicare booklet but found it tough reading, and only one said he called 1-800-Medicare; none reported going online for more information.

"You have to sit down and have a whole day to read it," Susan Tasker, of Greenport, said of the booklet. At this point, the 78-year-old who is on four medications said she plans to stay with her current drug plan. "That's just too much book," she said.

Betty Jean Thomas of Freeport, who is trying to parse the plans for her mother, who is on both Medicaid and Medicare, agreed. "It's really bad. You have to think on it. You have to go through it and spend a whole day on it," she said. She plans to visit her pharmacist for advice on what plan is best for her mother.

Murray Chernow, who lives in Rego Park and Deerfield Beach, Fla., who called the booklet "a tome," said he is meeting with a private health insurance representative to discuss his options. He said he called 1-800-Medicare and spoke with a man "who was very nice and very helpful -- to the extent that he could be helpful. "