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By STEPHEN NOHLGREN, Times Staff WriterA look at eight people who shared their experiences with The Times.
Eight people have shared their experiences with the new Medicare - what drugs they take, what choices they have made and how they feel about it. Their stories appear throughout the section.
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Name: JOHN BOWLES
Home: Palm Harbor
Age: 70
Occupation: Retired investment banker and author
Drugs prescribed: Atenolol, Warfarin, Diltiazem, Lovastatin
Current coverage: None
Current yearly cost for drugs: $945
Decision for 2006: Will join WellCare Signature Part D drug plan
Rationale: Spent considerable time analyzing Medicare & You 2006, October St. Petersburg Times Seniority issue, then narrowed list to seven companies and called all seven for best price and assurances that they would cover all four drugs. Purposely avoided www.medicare.gov Web site because had tried using it for Medicare drug discount card with bad result though plugging his four drugs into Medicare's Drug Plan Finder indeed yields WellCare Signature as the cheapest plan.
Thinks Medicare's drug benefit is fiscally imprudent for the country and a burden on future generations. "The only reason I am doing it is because it is there and you are crazy not to take advantage of it. I am going to take half my savings and put it in a mutual fund I set up for my granddaughter, because she is the one who is going to have to pay for this."
Estimated cost for 2006: $224
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Name: ROBERT DIAMOND
Home: St. Petersburg
Age: 75
Occupation: Retired university professor and administrator, semi-retired educational consultant
Drugs prescribed: Advicor, Minocycline, Azelastine HCL, Lisinopril, Metoprolol, Indapamide, Cilostazol, Nifedical, Levothoxine
Current coverage: None
Current yearly cost for drugs: About $6,000
Decision for 2006: Humana Complete Part D plan
Rationale: One of few plans that covers both generic and brand name drugs in the "coverage gap" also known as "doughnut" hole that begins when total drug costs reach $2,250 and ends when they reach about $5,100. Called different plans and got good advice from CVS pharmacist who was able to help estimate costs. Also worked Drug Plan Finder on www.medicare.gov which gave a higher figure.
"I don't know if I am going into that gap, but it is not worth the gamble not to have it. Just my Advicor was $900 for three months."
Would not consider Medicare HMO or PPO. Wants freedom to pick doctors.
Estimated cost for 2006: He estimates $1,900, but www.medicare.gov indicates about $3,600. Says Medicare's Web site would not accept some of his generic drugs and forced him to substitute brand names, which threw off its estimate. "Tune in a year from now and I'll let you know how much."
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Name: RUTH EDGERLY
Home: Zephyrhills
Age: 83
Occupation: Retired potato farmer and travel planner
Drugs prescribed: Atenolol, Norvasc, Synthroid
Current coverage: WellCare HMO
Current yearly cost for drugs: Almost nothing
Decision for 2006: Stay with WellCare
Rationale: Has been with company since it began. "It's just a small premium and I have zero things to pay for with WellCare." Had major arm and leg infections recently, with extensive hospitalization and rehabilitation. HMO covered everything.
"I would not in any way ever do what the Bush administration keeps telling people. They are going to keep upping the price. Your prescriptions' cost and premiums will increase every so often and you will have to pay after a time out of your own pocket."
Estimated cost for 2006: Almost nothing
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Names: ESTHER FREEMAN and OLIVIA LAWSON
Home: Tampa
Ages: 68 and 57
Occupation: Retired hotel worker and her disabled sister
Drugs prescribed: Hydrochlorot, Prevacid, Pentoxifylli, Nifedipine, Etodolac, Diovan, Labetalol, Albuterol inhaler, Vytorin and (for Freeman), Albuterol inhaler, Advair inhaler, Nexium, Singulair and Duoneb
Current coverage: Both on Medicaid, which covers their drugs
Current yearly cost for drugs: $0
Decision for 2006: Not sure if they can afford coverage
Rationale: Since Medicaid drug coverage is ending, the state will assign them to a Medicare Part D drug plan if they do not sign up for one by the end of December. They will receive a low-income subsidy, which the government calls "special help," but still will have to pay a $1 to $3 copayment for each of their prescriptions, which will cost between $13 and $39 a month, "which we don't have," Freeman says.
Their two Social Security checks total about $1,200 a month. Sometimes, at the end of the month, says Freeman, "she and I don't even have one dollar left to pay the bills and get something to eat. We already rob Peter to pay Paul. There is nothing I can give up. I would give up my medicine to get hers. That's the one thing I would give up. I can survive, I think, but she wouldn't survive without that asthma medication."
Estimated cost for 2006: $156 to $468
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Name: SANDY GRIDLEY
Home: Dunedin
Age: 68
Occupation: Semi-retired real estate agent
Drugs prescribed: Fosamax, Vytorin, Tretinoin, Lunesta
Current coverage: None
Current yearly cost for drugs: $2,000 to $2,500, sometimes buying drugs from Mexico and India.
Decision for 2006: Will join AARP MedicareRx Part D plan.
Rationale: The yearly cost is $2,814, which she can probably lower by using the 90-day mail order pharmacy option. That's about the same as she pays now.
"I've been getting drugs from Mexico and India, I might as well get some from here." Also, the plan will give broader coverage if she gets sick and needs more drugs.
The AARP plan was slightly more expensive than a few others, "but I already use AARP for my part B supplement and they have not raised the rates very much since I began. I believe they will not raise the monthly premium for part D either, at least not much. Also they do not have a deductible."
Estimated cost for 2006: $2,814 or less
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Name: DOROTHY HARRIS
Home: St. Petersburg
Age: 76
Occupation: Retired administrative assistant in a New York hospital
Drugs prescribed: Coumadin
Current coverage: None
Current yearly cost for drugs: About $500
Decision for 2006: Will stay on traditional Medicare but not join a drug plan.
Rationale: Takes few medications and doesn't think drug plan would save money. Worries that if she does join, costs will be raised down the road. "They are just helping the pharmaceuticals get rich." Had bad experiences with HMOs. "They send you to whatever doctor they want you to go to. I want to be able to go to the doctor I want to go to."
Estimated cost for 2006: about $500.
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Name: WALLACE WITHAM
Home: Belleair Bluffs
Age: 66
Occupation: Retired public school teacher, part-time university professor
Drugs prescribed: Lantus, Humilin, Cozaar, Coumadin, Niaspan, Flomax, Rhinocort Aqua
Current drug coverage: Aetna HMO offered by Pinellas County Schools
Current yearly cost for drugs: HMO premium is roughly $3,500, which includes drug and nondrug coverage, plus $1,080 in drug copayments.
Decision for 2006: Will stay with Aetna HMO
Rationale: Estimates that a Part D plan would cost up to $4,500 a year (though the Medicare drug plan finder lists the cheapest plan for those medications at about $2,500 a year).
Would like to know how quickly he will reach the "doughnut hole" in Medicare coverage, but can't find out because insurance companies do not reveal the prices they pay the pharmacies. (The "doughnut hole" begins when total drug costs reach $2,250, which is what the insurance company pays the pharmacies, not what a beneficiary pays out-of-pocket. In many plans, beneficiaries then pay everything until total costs reach about $5,100.)
"Seniors have no way to calculate when during each calendar year they will have to begin paying for the full cost of their prescription drugs," he says.
"June? August? November? - until they arrive at the magical $5,100 amount when catastrophic coverage kicks in. Therefore, since I am neither poor or in perfect health, I have to pass on this poorly constructed plan."
Estimated cost for 2006: Same as now