February 22, 2006

By CYDNEY GILLIS
Staff Reporter

Some retirees might be saving money under the private insurance plans that Medicare rolled out Jan. 1 to pay for drugs. But Darline Hoggatt and Regina Owens aren’t among them.

The two women, who are disabled and live on Social Security, have been hit with new co-pays for prescriptions they used to get for free. That’s because the two are on both Medicare and Medicaid, the program that covers individuals living at or below the federal poverty line of $9,570 a year.

Hoggatt, 61, lives on about $600 a month and $100 in food stamps. Owens, 48, gets slightly more. Each takes more than eight prescriptions and says she has no extra money for co-pays, which total $21 a month for Hoggatt and more than $40 for Owens.

“ Sometimes it’s going to be ‘Do I want to live or do I want to eat?’” Hoggatt says of the drugs she takes for high blood pressure, leg cramps, and pain. “When you take even $20 away from our budget, it’s very hard.”

Charging the poor is an odd twist of the Medicare Prescription Drug Improvement and Modernization Act. In Washington, the change affects 96,000 people who, like Hoggatt and Owens, receive Medicare and Medicaid and must now come up with co-pays — if they’ve been able to get their drugs at all.

On Jan. 1, the federal government switched the “dual eligibles,” as they’re called, to one of the private drug plans that now contract with Medicare. Some, such as Hoggatt and Owens, studied up last year and chose a plan. Those who didn’t were randomly switched to one.

Either way, says Will Parry, president of the Puget Sound Alliance for Retired Americans, computer snafus and insurance company backlogs have created chaos since Jan. 1. Many people have never heard from any insurance company, received a plan that doesn’t cover their particular drugs, or weren’t added to the database that pharmacists check to verify benefits.

The problems have left Hoggatt and Owens in the lurch. Hoggatt’s pharmacy decided not to take her plan (AARP), so it sold her only a two-week supply of her prescriptions. Owens takes medication for arthritis, pain, and incontinence. She signed up for Advantage Freedom, but says she hasn’t gotten an insurance card yet.

During the transition, the law stipulates the insurance plans were to provide dual eligibles with a 30-day supply of their drugs. For those who had no plan, Medicare created a fallback called Wellpoint — a catch-all drug plan the pharmacist could use to sign up a person at the counter.

But, according to a Jan. 17 memo from the federal Centers for Medicare and Medicaid Services (CMS), many drug plans have refused to authorize the 30-day supply. And most pharmacists have no idea what WellPoint is or how to use it.

Between the two problems, Michael Marchand, a spokesman for the Seattle office of CMS, acknowledges that some Medicaid recipients have been turned away at pharmacies or told, in error, that they had to pay Medicare’s $250 deductible.

In the meantime, phone lines run by Medicare and other senior services have been jammed, topping out Jan. 9 with 285 phone calls to Medicare. Though Marchand says service times have improved, the Seattle CMS office answers with a message that its priority is emergency calls. And: “By emergency, we mean that you or the person you are assisting is without drugs or has less than a five-day supply,” the message states.

“ It’s been kind of a nightmare,” says Mary Lou Percival, financial program manager for the state’s Aging and Disability Services Administration. “It doesn’t make sense — we’re dealing with the poorest of the poor.”

On Jan. 13, Gov. Christine Gregoire wrote a letter to Health and Human Services Secretary Mike Leavitt demanding action on the problems. So far, neither she nor any legislators have proposed state funding to cover the co-pays. Twenty-six other states are already filling the gap — something the Fremont Public Association, Washington Citizen Action, and other groups are lobbying for in Washington.

“ There’s so many states that have stepped forward and taken care of the situation. I don’t understand why Washington hasn’t,” Hoggatt says. “It’s a shame.” 

[Resources]

Can’t get your prescriptions under Medicare or Medicaid? Try Senior Information and Assistance at 206-448-3110, Senior Health Insurance Benefits Advisors at 800-562-6900, or Medicare at 800-633-4227 or www.medicare.gov.