Medicare drug plan confusing to most

Robert Bazell Chief Science & Health Correspondent • Profile • E-mail

NEW YORK - The new Medicare drug benefit called “Medicare Part D” begins on Jan. 1. But last week’s NBC-Wall Street Journal poll shows that of those polled age 65 and over, 73 percent say they agree the plan is “complicated and confusing,” with only 14 percent believing the plan will help them personally.

At the senior center of the Educational Alliance in New York, Gail Siegel helps people like Sadie Feinman chose the right Medicare drug plan.

Depending on the state seniors live in, there are 40 to 60 different plans all run by private insurance companies.

“I wish they would make it more clear,” Feinman says, “so more people could understand just what is going on.”

Ready to be confused?  Here’s just a sample:

• For the first $250 a year of drug cost, there is no reimbursement.
• For $250 to $2,250, it is 75 percent.
• For $2,250 to $5,100 — that's called “the doughnut hole” — there is no reimbursement.
• Above $5,100, it is 100 percent.

And if that weren't confusing enough, people must study the lists of drugs — called formularies — for each plan. They have to find if the drugs they need are offered and at what price.

The man who runs Medicare, Dr. Mark McClellan, says the myriad of options are necessary, and good for the consumer.

“If we had only one plan available,” McClellan says, “with one formulary, there will be a lot of people who would have to switch the medicines that they're taking now in order to take advantage of the coverage.”

The confusion about medications is especially intense in nursing homes, where many residents had been covered by Medicaid but now have to enroll in the new Medicare Part D.

Nursing home residents must decide by Jan. 1 or be assigned a plan.

Dr. Robert Zorowitz runs the Hebrew Home for the Aged.  “We are hearing a lot of feedback from our residents that this is extremely complicated,” Zorowitz says, “and many of them are having difficulty making decisions.”

The government has set up a hotline — 1-800-MEDICARE — and a Web site, http://www.medicare.gov/.  But many seniors say the phone service is often not helpful and the Web site is simply overwhelming.

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