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Special coverage: Medicare

Calming callers' Part D fears

By Times Staff
Published April 25, 2006

"The problem is, I have cancer,'' the man explains, his voice tight and controlled. "I have to take this medication once a day, and it's $503 a month.''

Harold Densmore leans toward the phone, listening intently. As a volunteer for SHINE, he has helped hundreds of people sift through the 100-plus private drug insurance plans offered to Floridians under Medicare Part D.

He steers them away from those with hidden costs, and he warns them that certain plans don't cover the drugs they need.

Densmore also helps people like this man, who is on his speaker phone. The man has signed up for a plan but still can't get the drugs he needs.

"My sales rep ... he said if I didn't get my insurance card by Monday, I should call him and he would give me the numbers I need,'' the caller continues. "So I called him several times on Monday, on Tuesday, on Wednesday, on Thursday. Now it's Friday, and I need my drugs.

"I could always get through to him when I was in the market to buy, but now he won't return my calls.''

Densmore gives the man the number of Medicare's regional office in Atlanta. "They'll help you,'' he says, reassuringly.

Densmore is busy these days as the May 15 deadline for signing up for Medicare's Part D approaches. He deals with about 20 people a day, mostly by phone, but occasionally in person. He expects his load to get even bigger as the deadline gets closer.

Many of the callers sound distraught.

"I was so shocked I couldn't sleep last night,'' says one woman who tried to apply for a drug plan under Part D, only to be told by the insurance company that she is not in the Medicare system. "I've had my Medicare card for so long - since 1993 - and now she tells me it won't work.''

Densmore reassures this caller that if Medicare is paying her medical bills, she is definitely in the system. Then, after asking her income, he tells her she also qualifies for Medicaid. He gives her the phone number to call to apply for that benefit.

Densmore, 89, has volunteered for one organization or another since he retired in 1977. For 15 of those years he offered his services to AARP, promoting a driver safety course for people 50 and older.

""They tried to give me a staff position, but I told them I didn't want a full-time job,'' says Densmore, who retired after 40 years as a self-employed food broker. "That way, they couldn't tell me what to do.''

For the past few years he has been a volunteer for SHINE, a free service supported by a grant from the Centers for Medicare and Medicaid Services and the Florida Department of Elder Affairs. He says he works about 5 hours a day, Monday through Friday, simply because he likes to help people.

Densmore looks at his phone and notices he has received an urgent message, so he returns the call.

"I received a form yesterday stating they they're going to take $88.50 out of my disability payment every month for Medicare Part D,'' a woman tells him.

She says that at age 52, she gets a disability payment of $799 a month, plus another $233 from a retirement account.

"Is there any way I can get assistance?'' she asks.

"That $88.50 that is going to be taken out of your disability - the state of Florida will take care of that,'' Densmore explains. "I can get the state of Florida to give that back to you. I'll just send you the application form.''

Then, after she names 11 prescription drugs she takes, Densmore steers her toward a drug insurance plan under Medicare Part D that will charge her $2 for each generic drug prescription she fills and $5 for every brand-name prescription.

"Thank you,'' the woman says. "I've been a wreck. Now I'm more relaxed.''

Next, a woman Densmore spoke with earlier in the day calls back, her voice shaking.

"I've been in tears since I talked to you,'' she begins. "I've been told that I'm eligible for Medicare, but I'm not eligible until May of 2007! That means I'll have to go without insurance for seven months.''

Densmore considers her options: She has been on Cobra, a costly extension of insurance from a former employer, but that will run out. She could apply for private insurance, but at her age, even if she could afford that costly premium, she probably would be rejected for one reason or another. And if she were rejected, there is no state agency or insurer of last resort that would provide her with an affordable policy.

Densmore asks her a few more questions. Finally, he says the words he always tries so hard to avoid:

"I'm afraid there's nothing I can do to help you.''

[Last modified April 25, 2006, 15:38:32]