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Sunday, May 7, 2006 - Page updated at 12:00 AM

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Medicare drug plan is scoring

Los Angeles Times

WASHINGTON — With the first enrollment deadline a week away, the Medicare prescription benefit apparently is achieving its primary objective: helping millions of Americans obtain protection they did not have previously against one of the most draining problems of growing older.

By the May 15 deadline, federal officials expect to have more than 20 million seniors or disabled Americans enrolled in plans under Medicare Part D, as the benefit program is called. That would include an estimated 7 million or more who previously lacked insurance for outpatient prescriptions. Of the millions who have signed up, many are enjoying significant savings, sometimes $1,000 a year.

That's a considerable achievement for a government that has not tried to roll out such an ambitious entitlement program since the days of President Lyndon B. Johnson. It's especially notable for President Bush, no fan of big government. Even some of the program's critics have given up trying to repeal it, while vowing to make it better.

Under the program, 43 million Medicare beneficiaries can enroll in a private plan that will subsidize the cost of their medicine. The savings vary depending upon one's prescription-drug needs, income and the plan chosen. Medicare officials claim the average enrollee will save about $1,100 a year.

The plan is a test of Bush's idea that, instead of creating federal bureaucracies, Washington, D.C., can use businesses, informed consumers and market competition to solve knotty social problems such as access to health care for potentially all Americans.

"This is the first full test of competition in Medicare," said Joseph Antos, a health-policy expert at the business-oriented American Enterprise Institute. "It's also a test of consumerism in health care."

On Saturday, Bush urged elderly and disabled Americans to review their options and sign up for the benefit. "By enrolling before the deadline, you can ensure the lowest possible premiums and start saving on your prescription-drug bills," Bush said in his regular weekly radio address.

To get help


For advice on signing up for Medicare Part D, contact:

The Statewide Health Insurance Benefits Advisors: 800-562-6900.

The Medicare administration: 800-MEDICAR (800-633-4227).

The Senior Rights Assistance Program: 206-448-5720 or 888-435-3377 (ask for Senior Rights Assistance).

Online help:

The Medicare Web site: www.medicare.gov

Other help: MedicareRxConnect, a coalition of nonprofit health organizations, has a comprehensive Web site to walk people through the process: www.maprx.info

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"Competition in the prescription-drug market has been stronger than expected, and costs for seniors are lower than expected," Bush said, noting that the average monthly premium is $25 a month instead of $37 a month, as previously projected.

So if Medicare Part D is meeting its goals and helping millions of older Americans, why isn't it being hailed as an unqualified success?

For one thing, the system remains so complex and hard for seniors to navigate that many have yet to enroll, including about 2 million who live near the poverty line and would benefit from its subsidies.

More important, Part D might not be working so well for a substantial minority of patients: seniors with complex illnesses and those requiring relatively expensive medicines.

These patients often face high costs under the new program that threaten to put needed treatment beyond their reach. A recent poll for the Kaiser Family Foundation found that 19 percent of enrolled seniors said they expect their medications to cost them more under Part D, compared with the 55 percent who said they would save.

That's because the private insurance companies quietly put these medicines into special coverage tiers that carry higher costs for patients. Doing this helps the companies meet the twin goals of saving taxpayers money while earning a profit.

Officials of organizations representing patients with multiple sclerosis, mental illnesses, arthritis and cancer have expressed particular concern about the coverage policies of the plans.

Another problem is that many pharmacists say they continue to experience difficulties with basics such as timely payment. Pam Grisnik of Grove City, Pa., told Congress recently that more than one-third of her fellow pharmacists around the country fear Part D will put them out of business.

The program still faces challenges:

• Simplifying the plans and the choices so that seniors who have remained outside the program will be induced to join.

• Finding ways to make Part D work as well for the patients with special needs as it has for the majority.

• Dealing with the issues raised by pharmacists and others whose continued cooperation is vital to the program's success.

Farther down the road, financial problems lurk. Part D does not have its own dedicated revenue stream or tax base.

It's financed with general tax revenues and premiums paid by beneficiaries. Currently, costs are running below initial projections, but the program's long-term financial shortfall is estimated to be greater than that of Social Security.

For now, however, the insurance companies and the government vow to fix problems and make the Bush approach work. And, overall, they say it's working well.

Material from The Associated Press is included in this report.

Copyright © 2006 The Seattle Times Company

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