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By SARA FRITZ, Times Staff WriterProposed premiums and deductibles would make the program more expensive and therefore less attractive.
WASHINGTON - As Congress moves to enact a long-promised Medicare prescription drug bill, many seniors are questioning whether they want to pay a $35-a-month premium for a benefit they see as inadequate.
In many cases, Medicare beneficiaries fear the new program will raise their total spending on prescription drugs. Their fears are borne out by a new study published last week estimating that more than 13-million seniors - perhaps as many as 964,000 in Florida - could find themselves paying more for their medicines after Congress acts.
"A $35 premium for that insignificant benefit is ridiculous," says William Bauers, 75, of Pinellas Park, whose HMO plan requires him to pay no premium and no deductible. "It's incredible that these people (in Congress) would come up with such a thing."
"There is bound to be some disappointment," says Beatrice Braun of Spring Hill, who is one of more than 10-million Americans over 65 who currently have no prescription drug coverage. "People's expectations are very high. Just wait until they learn this is not all the politicians have been promising them."
The yet-to-be-finalized Medicare drug benefit package is expected to be enacted by Congress early next month. While most low-income seniors who do not qualify for Medicaid will get more assistance to pay for their drugs, the program taking shape in Congress is less helpful to moderate- and upper-income seniors, particularly those whose current medicine costs are low.
In the proposed plan, a monthly premium would demand an outlay of $420 a year, and seniors would pay their first $275 in drug costs. They would pay 25 percent of every dollar after that up to $2,200, 100 percent of all expenditures after that up to $3,600, and 5 percent of everything thereafter.
This plan, to be run by private insurers using government funds, is far more expensive than the drug insurance coverage available from private companies to most people under age 65.
"That's still more than I'm paying now," adds Lois Hanna, 76, of Brooksville. "Phooey on them!"
Like many of their peers, both Hanna and Braun now get their U.S.-made drugs by mail order from Canada for a much lower price than they would pay in the United States. Unless the new program would allow seniors to submit Canadian receipts, which is not likely, the new benefit cost would exceed their current expenditures.
According to a study by the liberal USAction Education Fund, there are at least four other reasons why some of the nation's 40-million current Medicare recipients may pay more for their prescription drugs under the new program:
As many as 4.5-million seniors, or about a third of all retirees who have prescription drug coverage from their former employers, could find their coverage canceled because of the government's decision to provide a competing benefit.
As many as 5.8-million low-income seniors who would be moved from Medicaid to Medicare for drug coverage could find themselves paying higher out-of-pocket costs. The group estimated that under the House-passed bill, a low-income person with $3,000 in annual prescription drug costs would end up paying an additional $1,114 a year.
* About 1.7-million persons who receive home health care would be asked for a copayment for the first time since the program was created.
* All Medicare beneficiaries would pay more for general health services because the legislation is expected to include an increase in the deductible for doctor visits and copays for laboratory services.
David Hunt, spokesman for the USAction Education Fund, said his group was unable to calculate how many seniors are now getting their drugs from Canada at a lower price than they would pay under the new program.
A survey by the Kaiser Family Foundation and Harvard School of Public Health this summer found that 76 percent of seniors are worried, including 52 percent who are"very worried," that they will still pay too large a share of their drug bills if Congress adds a prescription drug benefit to Medicare. Nearly 60 percent are worried that the prescription benefit relies too much on private health plans.
Some Medicare beneficiaries with low drug costs have no intention of signing up for the new government program, which is voluntary, because they do not use enough prescription drugs to benefit.
Harvey Bernstein, 73, of South Pasadena, said he would not join the program when it starts in 2006, even if it means he may pay higher fees to join it later.
"I'm totally against that," Bernstein said.
Bernstein says he spent about $1,000 total "over the last few years," mostly for over-the-counter drugs.
The Congressional Budget Office estimates one-third of the 12-million retirees who currently enjoy employer-provided drug coverage would lose those benefits. That is because catastrophic drug coverage will not be available until a senior has spent $3,700 out of pocket, and employer contributions would not count toward reaching that level.
Many employers are expected to revamp their retiree health insurance to supplement the new Medicare drug benefit with something known as "a wraparound" drug benefit.
Dan Connors, 66, of Dunnellon, a retired senior field engineer for General Electric, says the unions are too strong at GE to allow the company to simply cancel his current drug benefit.
"We can always remind them how much they gave to Jack," Conners said, referring to former GE CEO Jack Welsh, whose retirement package included a $9-million annual pension, round-the-clock access to a Boeing 737 and memberships in several golf clubs.
Members of a House-Senate conference committee that is writing the new legislation have not yet decided whether to legalize reimportation of U.S.-made drugs from Canada and other countries where the prices are lower.
But many seniors already order from Canada, and the new legislation is not expected to reimburse them for those prescriptions.
Braun, 82, says she currently orders a brand-name blood pressure drug, Adalat XL, from Canada at a price much lower than her local drug store charges for the generic equivalent. The AARP activist, who also buys medicines here in the United States, said she would actually end up paying slightly less with the new benefit. She plans to sign up when it becomes available in 2006.
"I just hope I'll still be around by then," she said.