Prescription for failure? The system may have trouble enrolling enough relatively healthy people
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As a tax attorney, Bill Vogel was not easily stumped by complex calculations. Wife Donna, a retired nurse recruiter, navigated the health care world with ease.
But the two Salt Lake City residents admit that selecting a Medicare prescription drug plan has left them confused - and angry.
"There is one good aspect to this. We will have national health insurance sooner than later," Bill Vogel predicts. "Seniors will be sick of this, the complications, the paperwork."
The new coverage, which seniors can sign up for beginning next Tuesday, is the biggest change in the 40-year-history of the Medicare program, adopted in 1965 to provide health insurance for people ages 65 and older and those with certain disabilities. Currently, about 42 million Americans are eligible for Medicare, though about a fourth of those have adequate coverage through current jobs or retiree benefits.
When he signed the new prescription benefit into law in 2003, President Bush hailed it as something that would "save our seniors from a lot of worry."
Perhaps that will prove true in the long run. At the moment, it is instead causing many of them angst, even as experts call for patience.
In part, that is because seniors here, as in many other states, are overwhelmed by options. In Utah, there are 18 companies offering more than 50 plans, each requiring seniors to work a complex calculus involving need, existing coverage, premiums, deductibles, co-pays and drugs covered.
"There is confusion, there is uncertainty and they are worried about making mistakes," Carol Einhorn, executive director of the Jewish Community Center in Salt Lake City, says of the seniors attending seminars her agency has sponsored.
This week, the Medicare Web site is expected to offer an evaluation tool to help seniors identify the three best plans for their needs. The tool, initially promised by Oct. 13, is being criticized as a high-tech solution for a decidedly low-tech group.
"How many elderly people are computer savvy?" asked Bill Vogel, who also must help his wife select a program for her 94-year-old mother who lives in another state.
Advocates for senior citizens say the new insurance program clearly will benefit seniors who are low-income, or have no drug coverage, or are on Medigap plans or use expensive medications - something that happens routinely in the last months of life.
It is predicted that people in those categories will save hundreds of dollars annually.
For others, the program is being touted as a hedge against age-related health disasters, similar to home insurance.
And that leaves some seniors in a quandary. What about those like Muriel Abrams, 83, who takes nothing more than a Tums a day to stay healthy? After attending one seminar on the program, she left more convinced than ever that she should do nothing.
"Why would I pay for something?" she said. "If I get to the point where I need it, certainly I'm going to do it, but I live on a fixed income. I can't afford [it]."
The new program carries a penalty provision aimed at scaring people like Abrams out of such do-nothing decisions. Advocates are working to steer them into plans, too.
"People need to approach this like they would any insurance decision," said Rob Ence, state director of AARP Utah. "This is protection against risk that you may not currently have but you have to anticipate some things in the future."
The fact is, Uncle Sam needs people like Abrams.
The program's cost effectiveness - and profitability for the dozens of companies offering coverage - depends on getting healthy, higher-income seniors to sign up.
If they don't, premium costs could increase significantly in the future, according to an analysis done for the Kaiser Family Foundation.
The same study predicted that if plans were seen as too expensive or overly complicated, many people would balk. Muriel Abrams illustrates the point.
So do Kathryn and Varon Howell of Murray. The retired educators - he was a principal, she was an elementary school teacher - have read about the program and talked to friends and a pharmacist, but remain confused on whether there will be any benefit to them. Next step: Meet with their supplemental insurance plan agent.
"We are undecided and, honestly, I don't understand fully why it is such a good thing if you have to pay," Kathryn Howell said.
Most of the information she has received so far seems vague and confusing, she said. And her friends all seem confused, too.
"There is a lot of fear that you may pick the wrong plan or will be locked into a plan or, worst of all, won't sign up and will be penalized financially for life," said Deane Beebe, communications director for the Medicare Rights Center.
The national, not-for-profit organization in New York focuses on ensuring access to high-quality, affordable health care for older adults and people with disabilities.
Like with most health insurance benefits, premium costs are likely to rise - especially if buy-in from healthy, wealthy seniors is low. Drug costs also are likely to fluctuate. Health status may change, too. And there is a chance that the plan you select today won't be around in the future.
"There is nothing stable about this plan," Beebe said. "There is nothing guaranteed about it. Even the savviest consumer can shop for the drug plan that he or she thinks meets their needs but find that the plan they picked today is of no use tomorrow."
The center sees the new program as the first step toward privatizing Medicare and says it likely will be seen someday as the trigger for a "battle over the soul of the Medicare program."
Despite that, it is encouraging seniors to take a look at what is being offered.
"For low income people, we encourage them to enroll and get the subsidy to pay for the benefit," Beebe said.
"For people with high drug expenses, we encourage them to try and pick a plan that works for them, to the best of their ability and given that drug needs change, plans change and formularies change. For everybody else, it is a matter of how much discretionary income you have, how averse you are to risk and how much of a gamble you want to take."
Contact Brooke Adams at email@example.com or 801-257-8724Â. To comment on this story or pose questions you would like us to explore about Medicare drug plans, write firstname.lastname@example.org.
Take your time. You do not have to make a decision until May 15.
If you need assistance, find someone you trust to help decipher the differences between plans.
Know what drugs you use so you can compare what's covered in plans.