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Special coverage: Medicare

A lot of info, if you can get to it

A Web site and phone line to help you pick from the new Medicare drug plans are still working out the kinks.

By STEPHEN NOHLGREN
Published November 13, 2005

TARPON SPRINGS -- Robert Loos, 83, can Google with the best of them.

He searches travel deals on the Internet, pays bills online and stores crucial phone numbers in a digital address book.

So with enrollment in Medicare's new Part D drug benefit to begin on Tuesday, Loos powered up his Compaq 7550 last week and headed for the government's Web page.

In Florida, 19 companies are marketing 43 Medicare drug plans, and that doesn't count the various HMOs and PPOs that people can join.

Medicare has never been so complicated, so full of choices. It's a classic chance for computer-savvy people to bypass commercial advertising and free-lunch seminars by searching www.medicare.gov on their own.

Medicare literature advises people to do just that.

But Loos fiddled at it for an hour Thursday with only mixed success. The Web site was often ponderous. It answered some questions, but rarely quickly.

Things got worse when Loos called Medicare's toll-free hotline, 1-800-633-4227. He meandered around in an irritating phone-tree loop for about five minutes until he finally hung up and called back. The second time, he found his way to one of Medicare's 8,000 new "customer service representatives," a polite, patient man who turned out to be a fount of misinformation.

Medicare beneficiaries need not panic. They have six more weeks to choose their 2006 coverage before it begins on Jan. 1. That also gives Medicare's designers time to tweak the Web site and hotline employees time to learn their jobs.

Still, Loos worries about his fellow retirees, especially those who don't use computers.

"I can't see how older people are ever going to determine what the best plans are," he says. "They are going to be very confused."

Loos, who owned a trucking equipment business before retirement, does not want to join a Medicare HMO, which usually carries drug coverage. He and his wife, Eileen, don't want to change doctors if an HMO shuffles its provider network.

The seven drugs Loos takes would cost more than $8,000 a year if he bought them at his local Publix pharmacy. Instead, he buys one from Canada, one from New Zealand and gets two free from Merck's patient assistance program. That winnows his bill to about $2,700 a year.

He would like to join a new Medicare Part D drug plan because he thinks the government is going to crack down on foreign drug importation.

When he checked www.medicare.gov his high-speed Internet connection moved him quickly through preliminary questions until he was asked to enter his seven medications. Then it slowed to a crawl by forcing him to register his medications one at a time instead of all at once.

At one point, he tried to register Flomax and the computer said "service unavailable." He back-tracked, tried again, and it worked the second time.

"It's very, very time-consuming," he muttered.

After about 15 minutes, the computer finally listed how much each plan would cost, from cheapest to most expensive, ranging from about $3,600 to more than $8,000. When he clicked on other buttons, Medicare's Web site showed him how he could knock about $500 off the cheapest plan - Humana Complete - by using its mail-order pharmacy. He could knock off $770 more by swapping his drugs for similar ones preferred by Humana.

That brought the cost to about $2,400 - less than he pays now.

"Boy, there's a lot of stuff here," he said. "So far, it's working pretty good."

After an hour, Loos was ready to quit, even though he still lacked price-reduction information that might make other plans more attractive. The Web site would only let him work through one drug plan at a time, which slowed him down.

He also wanted to check which plans restrict how his doctor can prescribe his drugs. The Humana Complete plan, for example, required either prior-authorization, quantity limitations or "step therapy" on every one of his seven drugs.

Maybe cheapest wasn't best.

Medicare's Web site can provide details about these restrictions. But Loos had previously played around with that section of the Web site and found it confusing and time-consuming.

Perhaps Medicare's toll-free hotline could help. Medicare literature urges people to call, particularly if they don't have access to a computer.

Medicare has 43-million beneficiaries, so it was no surprise that Loos was greeted by a recorded female voice guiding him through a phone tree.

When she asked if he wanted "information," that seemed like a good choice, but it sent him into a loop of various messages and didn't seem to tell him how to reach a live person.

After five minutes, he hung up and tried again. This time, he tried other options and a customer service representative came on the line. Loos asked what various drug plans would cost.

Would Loos like to keep his premiums and deductibles low, the man asked. Deductibles range from zero to $250 a year.

"I'd like to pay nothing if I can," Loos responded. As for premiums, maybe something like $25 to $30 a month.

It was a mistake on both their parts. Given Loos' seven medications, the cheapest plan is Humana Complete, with a $61-a-month premium. Its total cost is less because it offers broader coverage that more than makes up for the higher premium.

The Medicare worker was following a script, as trained. But when he limited Loos' premiums to $30 or less, the computer spit out a different Humana plan, an AARP plan and a United HealthCare plan as the three cheapest.

Then the worker inaccurately said each of the three plans carried co-payments of 25 percent. That's the amount for a hypothetical boilerplate plan that Medicare uses as a guideline in its literature. But it bears no relationship to actual co-payments.

"Who determines the cost of prescriptions?" Loos asked.

"I guess the pharmacist," said the worker, when in fact the companies that offer the plans determine the cost of prescriptions.

Medicare spokesman Peter Ashkenaz said hotline workers are trained for at least a week before answering calls and receive at least two more hours a week of ongoing training. Supervisors monitor about four calls a month for each worker. The part of Medicare's computer program that lists the cheapest plan was installed last week, so the worker who helped Loos had only a few days of experience with it, at best.

Medicare hopes hotline calls will average about 10 minutes, Ashkenaz said.

Loos' call took 30 minutes.

The St. Petersburg Times needs your help to monitor how the Part D drug plan is working.

Are you taking the drug coverage or not? And why?

If you picked a drug plan, which one and why?

Was the toll-free hotline (1-800-633-4227) helpful?

Was the www.medicare.gov Web site useful?

Please contact us by letter or e-mail by Dec. 31 and briefly relate your Medicare experience in 100 words or less. You must include your name, city of residence and telephone number.

Write to My Medicare Experience, St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731 or e-mail at medicare@sptimes.com

[Last modified November 13, 2005, 07:27:07]