Royal Oak Daily Tribune: Levin Meets with Seniors on Prescription Drugs

Feb 26, 2006

Seniors clear air on Rx plan confusion

By Catherine Kavanaugh
Daily Tribune Staff Writer

MADISON HEIGHTS Melva Karliss, a retired accountant, read about her 40-plus prescription plan options being offered in Michigan and crunched the numbers to find the one that made financial sense.

She and her husband, George, enrolled in Medicare Prescription Blue/Option 2 through Blue Cross/Blue Shield of Michigan. Their doctor gave them 90-day prescriptions to save even more money on co-pays and the Huntington Woods couple filled them at CVS.

On Feb. 1, however, the Karlisses got a letter from Blue Cross notifying them that CVS isn't in their plan. Melva hoped the matter could be resolved by switching pharmacies.

"So I called Blue Cross for the 14,000th time and I was told there is a pharmacy list but it's not ready," Karliss told U.S. Rep. Sander Levin, D-12th District, at a town hall meeting Friday at the Madison/Solberg Tower.

"I was told maybe try Walgreens then I was told Meijer, which is six miles from my home," Karliss said.
The Karlisses are among thousands of senior citizens encountering problems with the prescription coverage offered to Medicare beneficiaries this year. Many seniors contend they are being overcharged and even denied coverage while others complain the enrollment process is intimidating.

Of the estimated 21 million Medicare beneficiaries who did not have drug coverage prior to Jan. 1, only 3.6 million have signed up for a plan. That's about 17 percent of the target population.

Levin said he conducted his own phone survey recently and got a response from more than 4,300 people in his district. Almost 60 percent said they need prescription drug coverage but don't feel they have the information to pick one, 30 percent said they signed up for a plan and filled their prescription with no problem, and 11 percent said they are having problems getting their prescriptions filled or have been charged the wrong amount.

The deadline to enroll without a penalty is May 15. After that, beneficiaries will pay a premium penalty of 1 percent per month, which means the longer someone waits the higher the penalty.

Levin told the crowd of 40 in Madison Heights that he has co-sponsored legislation to give seniors more time to choose a plan and enroll, and to give people an opportunity to change plans if necessary.

"We don't want seniors to lose out because of the complexity of the process," he said.

Levin also said the process could have been simplified by having Medicare cover prescription drugs like it does doctor visits and hospital stays. Instead, he said a separate private insurance program was set up by the Republican-held Congress.
"After 15 minutes of voting, that plan was losing and they held the vote open for the longest in the history of Congress," Levin said. "I believe it was three hours.

Some deals were made, and after three hours there was a difference of one vote. Then someone switched from 'no' to 'yes' to get it passed."

In addition to the enrollment deadlines, Levin sees other "structural difficulties" with the program, including:
n Beneficiaries and their doctors have to appeal denials of prescriptions to the private insurer and not Medicare.
n Insurance companies can change which drugs are covered and the co-pays anytime during the year but beneficiaries can't change plans until the end of the year.
n At the end of the first year, plans can drop out of the program or change benefits, premiums and covered drugs, forcing beneficiaries to search out another plan that meets their needs.
n Most plans have coverage gaps.

The Karlisses added another gripe to the list. After their frustrating letter from Blue Cross, they got one from the Social Security Administration telling them $70 would be taken out of each their next checks.

"That's because Blue Cross insists on being paid in advance," Mrs. Karliss said. "My husband and I will still eat with that $140 out of our checks next month, but surely there must be people around who will find that a problem."