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Offering a personal touch to Medicare questions

Seniors are scrambling for answers about Medicare's new drug plan. A Clearwater man, 89, is ready to help.

By STEPHEN NOHLGREN
Published October 7, 2005

ST. PETERSBURG - At 89, Harold Densmore is blessed with good health, a sharp mind and a hankering for meaningful work.

Medicare's complex new drug benefit is just what the doctor ordered.

About 30 hours a week, Densmore heads for the Area Agency on Aging, plops behind a desk and yaks on the telephone with dozens of people a day.

He's a volunteer for a state program that helps older citizens navigate insurance matters - and the hot topic these days is Medicare's new drug rules, which have a half-million Tampa Bay area residents scrambling for answers.

Take Clearwater retiree George Ortiz, who called this week. Recent hospitalizations and chronic respiratory ailments have left his wife Michelina with huge drug bills - not to mention the money the couple now owes doctors and hospitals.

"I'm sending the doctors $50 a month," Ortiz said.

Densmore: "At least you're an honest man, I'll say that for you."

Ortiz: "I can't do it any other way. It's killing me. I got tons of bills."

The couple's combined income is too high to qualify for state help, but Densmore urged Ortiz to sign up for one of Medicare's new drug plans, which will cover more than half the costs of prescription drugs for many people.

Ortiz: "I'll do that right now."

Densmore: "You can't do it right now. You can't do it until Nov. 15."

Ortiz: "But I saw it on TV and called somebody. But I never heard back from them."

Ortiz then asks about a flyer he received that seemed like a godsend. It supposedly offered insurance that would cover drugs for the whole family, doctor bills, hospitalizations, even chiropractors for 70 cents a day.

Densmore rolled his eyes.

"George, be very suspicious of these things that promise you the moon. You are going to be able to take on a (Medicare) plan for only $11 a month, and your drugs will be greatly reduced. I don't know by how much, but it will be an honest deal."

Ortiz and his wife are new to Medicare this year. Densmore asks if they would consider joining a Medicare HMO, which usually offers good drug coverage with no premium and minimal copayments as long as patients get their care within an HMO network.

Ortiz: "I never heard about that."

Densmore: "George, George, there are ads all the time. You have to start looking."

Such are the conversations conducted all around Florida by volunteers for the SHINE program (Serving the Health Insurance Needs of the Elderly). Callers can get information on various topics, including Medicaid, Medicare supplement policies, VA coverage, low-income programs that help with costs, HMOs and PPOs.

The new Medicare drug benefit promises to rearrange the insurance landscape. For example, people now getting drugs for free from manufacturers may well find that those programs will shut down in a few months.

As of Jan. 1, Medicaid will stop providing drugs to people who also qualify for Medicare. The state will automatically enroll them in a Medicare drug plan, which could cause them to switch pharmacies or prescriptions.

Mary Leavitt wanted to know if Medicare would cover Gleevec, a $4,000-a-month leukemia drug that keeps her 44-year-old son, Joseph, alive. He gets it now through Medicaid. Densmore said he didn't know, because the government hadn't yet released details on which drugs various plans would cover. If she encounters trouble, he advised Leavitt, ask Joseph's doctor to intervene. Medicare will have appeal rules for people denied coverage of specific drugs.

SHINE volunteers don't have all the answers, said area coordinator Bob Archer. But callers are usually grateful for the personal touch.

"I can't tell you how many people have said, "I can't believe I'm talking to a real person and don't have to select from a menu.' Sometimes people just want to talk and we let them talk."

When Densmore suggested that a St. Petersburg woman consider one of the HMO plans, she seemed leery.

"What do you take?" she asked.

"I'm a vet, so I go to the VA," he responded. "But I'll tell you, if I didn't, I would go with an HMO."

Her father was a Navy Seabee, the woman said. Where did Densmore serve? He was in the Army in Europe and then in Japan with MacArthur during the occupation.

Personal interchanges enrich his day, Densmore said. In an earlier life, he built up and sold a food brokerage business in western New York. After retirement, he volunteered to teach AARP's safe driving course and, before he was done, ended up running the program nationwide. He volunteered as a nursing home ombudsman, but was never quite sure who he was helping.

SHINE gives him immediate, one-on-one problems to solve - and a complimentary deli sandwich for lunch, which he eats at his desk.

"I've always had a feeling I was put on this earth to be productive and contribute something, and not play around," he said. "I can go to bed at night and say, "It's been a pretty good day.' "

Some calls are softballs.

"I'm on Tricare (health plan for career military retirees). Should I get a Medicare plan?" No. Tricare is better than Medicare. Stick with it.

"Do you have a notary there? A friend helped me make up a will but I don't know a notary." Try a bank or lawyer's office.

"Some calls turn downright lively."

Jessie Burke, a Tarpon Springs resident, was upset because she had just received Medicare & You 2006, the government's handbook to coverage. It's more than 100 pages thick and had plenty of information about all-inclusive HMOs, she said. But it lacked the information she wanted about stand-alone drug plans that could accompany traditional Medicare Parts A and B.

"I think this is done deliberately to push people into HMOs," she said.

She had called Medicare's hotline to complain, and they just referred her to a Florida number, which then referred her to SHINE.

Could Densmore tell her if AARP will have a drug plan? She trusts AARP.

Yes, Densmore assured her. AARP will have a drug plan, but he didn't have details yet on what it will cost or cover.

When he suggested that Burke's income probably qualified her for a Medicaid program that would pay her Medicare Part B premiums, she bristled.

"Absolutely not. I own my home free and clear. All I have is a two-room cracker cabin, but by golly it's mine. I shut the hot water off in the winter. I take sponge baths in the kitchen sink. I make my own dog food, believe it or not."

In an interview later, Burke explained that she fears Medicaid because the state could put a lien on her paid-off house, which was built in 1889 and has been willed to the City of Tarpon Springs.

"I won't touch food stamps or public housing or Medicaid," she said. "I would go to my death before I allowed that deed to be encumbered."

Burke said her call to Densmore was frustrating because he hadn't read the Medicare & You handbook and couldn't answer her questions completely. After the call, though, she discovered that the handbook contained drug plan details after all. They were hidden in the back, she said, with little guidance as to how to find them.

Told that Densmore had not yet received his copy of Medicare & You when she called, Burke hesitated.

"Oh, poor Harold. They aren't giving him what he needs."

[Last modified October 7, 2005, 19:38:53]