The Dallas Morning News

DALLAS – If you’re one of 5.7 million older Americans still lacking prescription drug coverage, government officials have a message for you: Time’s running out.

You have until midnight Monday to enroll in a Medicare plan. After that, you won’t be able to sign up again until Nov. 15. And you’ll pay 1 percent more in premiums for each month you’ve delayed.

Health and Human Services Secretary Mike Leavitt says Monday’s deadline won’t be extended, despite some lawmakers’ calls for it to be pushed back to the end of the year.

“The deadline has worked – it’s helped seniors focus on this issue and act,” he said. “An extension would only allow people to put off what they could do today.”

Medicare’s actuaries have figured that 2 million fewer older adults would sign up for prescription coverage now if they were given another 7½ months to do it.

The holdouts fall into several groups, Leavitt said.

Besides the habitual procrastinators, there are healthy seniors who don’t believe they need the insurance and people who think the benefit is for only low-income seniors.

Medicare officials say both notions are wrong.

“Even the healthy should sign up in case they get sick or injured,” said Medicare administrator Mark McClellan. “Buying a low-cost plan now will avoid paying a penalty later.”

Nor is the drug coverage for just poor people. Any Medicare beneficiary is entitled to it regardless of income, McClellan said.

The only seniors who shouldn’t feel any deadline pressure are those with drug coverage from elsewhere that’s as good as Medicare’s, such as from an employer. They won’t be penalized and forced to pay a higher premium if they lose or drop their insurance later and enroll in a Medicare plan.

For everyone else, the eleventh hour is here.

To accommodate an expected rush in the next three days, Medicare will have 6,000 telephone operators available at 1-800-633-4227. The agency has also quadrupled its computer capacity at www.medicare.gov.

“It’s all hands on deck for us,” McClellan said.

The agency is also participating in hundreds of community enrollment events.

One of Medicare’s local partners, the Dallas Area Agency on Aging, opened its offices from 9 a.m. to 3 p.m. Saturday to sign up seniors.

“Bring your medications and your Medicare card, and we’ll help you do the rest,” said Carolyn Toliver, the Area Agency on Aging’s benefits counseling coordinator.

She says the enrollment process takes 30 to 45 minutes.

Toliver said her counseling staff would also help seniors on limited incomes apply to Social Security for extra assistance with their out-of-pocket prescription costs.

Those who qualify for the extra help will pay no premiums or deductible for their coverage, and their co-payments will be only a few dollars for each prescription.

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By midnight Monday, the Bush administration projects it will have enrolled 31.4 million older adults and exceeded its goal of 28 million to 30 million this first year.

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Medicare’s drug coverage has been controversial since it was first proposed, so it’s not surprising that the initial six-month enrollment has gotten mixed reviews.

It’s faced criticism from older adults confused by the dozens of drug plans and from poor or disabled seniors who weren’t automatically enrolled as required.

Yet most seniors who have joined a drug plan report that they’re satisfied with their new coverage and having no difficulty filling their prescriptions.

The Kaiser Family Foundation, an independent research group in Washington, surveyed Medicare drug beneficiaries last month and discovered eight in 10 were content.

“People are saving an average of $1,100 a year on their drugs,” said Paul Zobisch, a Medicare volunteer who’s spoken to Dallas seniors about the new benefit.

Many older adults have apparently found their way through the maze of drug plans by relying on two long-standing consumer guides: brand recognition and price.

Although dozens of companies have scrambled to sell drug coverage, two have captured almost half of the business, according to Bush administration officials.

As of last month, UnitedHealth Group had 27 percent of the seniors who signed up for a drug plan, followed by Humana, with 18 percent of the market.

UnitedHealth is offering the only drug coverage endorsed by AARP, while Humana has sold low-cost plans with premiums as low as $2 a month in some states.

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The cheapest Humana plan in Texas has a $10.31 monthly premium.

Seniors who have carefully compared the dozens of plans have uncovered significant differences.

The Kaiser Family Foundation checked a sample of 152 generic and brand-name prescriptions that included both common medications and specialty drugs.

“We discovered big differences from plan to plan in the drugs covered and the out-of-pocket expenses,” said foundation president Drew Altman.

The plans covered an average of 81 percent of the medications in the sample. The most restrictive plan included only 64 percent, while the least restrictive covered 97 percent.

Kaiser also turned up big variations in out-of-pocket costs – from $15 to $62 for Norvasc, a drug for high blood pressure, and from $15 to $66 for Fosamax, which is used to treat osteoporosis.

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Kaiser Family Foundation President Drew Altman said his foundation’s study underscored how important it is for seniors to do their homework when shopping for the plan that best suits them.

“The drug plan you choose really does matter,” he said.

McClellan said most seniors have been savvy shoppers, selecting enhanced drug plans with special features such as no deductibles, low premiums or additional coverage.

“Only one in 10 older adults has opted for the minimum drug benefit set by law,” he said. “Everyone else has tailored his plan to his individual needs.”

Girding themselves for an expected onslaught of seniors over the next three days, drug-plan counselors have dubbed Monday “D-Day,” for deadline day.

Seniors who sign up by midnight Monday will have their prescriptions covered beginning June 1.

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AT A GLANCE

-Medicare started offering prescription drug coverage Jan. 1.

-Seniors aren’t required to sign up. But if they want coverage, they have until midnight Monday to choose one of the private drug plans Medicare has approved. Texans may select from 47 plans.

-Monthly premiums average about $25.

-Under the standard benefit, seniors pay a $250 annual deductible, then 25 percent of the next $2,000 of drug costs. After that, seniors pay 100 percent of the next $2,850. Once beneficiaries have paid $3,600, they’re responsible for only 5 percent of any other drug bills.

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(c) 2006, The Dallas Morning News.

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AP-NY-05-13-06 1437EDT

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