Medicare switch is coming

Beneficiaries must examine their status and call to choose a new plan before Dec. 31

ABOUT 26,000 Hawaii Medicare beneficiaries who get free prescription drugs through Medicaid must enroll in a Medicare prescription drug plan by Dec. 31 or they may start the new year with no drug coverage.

Medicare is taking over the prescription drug benefit for the so-called "dual eligibles" -- seniors and disabled people with both Medicare and Medicaid, said Tracy Okubo, legislative assistant to state Human Services Director Lillian Koller.

The new drug program has caused massive confusion because of the array of plans offering different premiums, co-payments and benefits.

The Centers for Medicare and Medicaid Services (CMS) sent letters to those affected this week informing them of the change. Many are impaired, in nursing homes or in long-term care.

People in this group may select a drug plan starting Tuesday. But if they don't choose one by Dec. 31, Medicare will automatically assign one of seven stand-alone plans, Okubo said.

Because the plans will be assigned randomly, they may not cover the drugs or pharmacy used by the recipient, she said.

Pamela Cunningham, coordinator of the Sage PLUS counseling program, advises those assigned plans by Medicare to write down their prescriptions and pharmacy and call the plan's 1-800 number.

They should ask if the plan covers their list of prescriptions and includes their pharmacy, she said. If the answers are yes, she said, "Then they're set; they don't have to do anything more."

If they want to change plans, however, they can. Those in the Medicaid/Medicare group are the only ones allowed to change plans every month.

Other Medicare beneficiaries have until May 15 to choose a Medicare Part D prescription drug plan and can't change until November of next year.

THE STATE administration and the Legislature took steps in the last session to ensure that Medicare/Medicaid recipients who haven't had to pay anything for drugs won't have to pay co-payments under the new drug plans.

"They're not used to that," Okubo said. "We didn't want them to have to pay something they didn't have to pay before."

A State Pharmacy Assistance Program special fund was established to help defray costs of prescriptions for "certain elderly and disabled individuals."

Okubo, manager of the program, met with prescription drug and Medicare Advantage providers last week and asked them to sign a contract to provide benefits without co-payments to "dual eligibles" enrolled in their plans.

Otherwise, she said the state will pay the costs of the co-payments, estimated between $1.5 million and $2.5 million.

SAGE PLUS, the health information arm of the Executive Office on Aging, has a contract with CMS to help the dual-eligible population select drug plans, Okubo said.

But it has been swamped with calls -- about 1,000 last month.

CHOOSING A PLAN Where to call for help: » Sage PLUS, 586-7299 or toll-free from the neighbor islands, (888) 875-9229. » Medicare toll-free hotline (800) MEDICARE (633-4227) or TTY (887) 486-2408. » AARP (888) OUR-AARP or (888) 687-2277 or TTY (877) 434-7598. On the Net: » www.medicare.gov

Sage PLUS has two phone lines and its voice mail won't accept more than 30 calls, said Pat Sasaki, Executive Office on Aging director.

She said there are efforts to try to expand Sage PLUS's voice mail capacity and other EOA staff are being assigned to help process the voice mail. If people still can't get through on voice mail, Sasaki said they can call her at 586-0100.

"At least I can take some preliminary information and Sage PLUS staff and volunteers can get back to them. People should keep trying," she said, emphasizing that they leave their name and phone number. "We definitely want to return everyone's call."

Standard response time is within two business days, she said.

Medicare approved 12 companies to offer stand-alone prescription drug plans in Hawaii and five Medicare Advantage organizations that offer drug coverage with additional benefits.

Sage PLUS volunteers can provide information to help people understand the plans being offered but they must make the decisions, Sasaki said.

"We're trying to help them get past the confusion," she said. "The complexities of the drug plan choices are daunting to even the hardiest of health/social services professionals."

The easiest way to work through the plans is to use the Medicare Web site, www.medicare.gov, Cunningham said.

The site appears to be running well after some problems but Sage PLUS gets a lot of calls from people who don't understand the "Medicare language," she said.

CUNNINGHAM advises people who don't have a computer or aren't comfortable with it to recruit a child or other relative to help them. "If no one is available, they can fill out a form from Sage PLUS and we'll help them."

Okubo said she is helping her grandmother and taking her computer with her to Thanksgiving dinner to help other relatives.

Many of Hawaii's 186,000 Medicare beneficiaries are retirees with drug benefits from former or present employers. They should receive a letter by Tuesday from the employer saying whether the benefits are as good or better than the standard Medicare benefits. If so, they needn't do anything.