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Answers to Questions About the New Medicare Maze

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Estimated read time: 6-7 minutes

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Ruth Johnson, 81, figures it'll take at least three years to decipher the esoterica in the new 1,100-page Medicare bill and laughs she may never enjoy its benefits, "if that's what they are."

"I don't know if I'll be around long enough," says Johnson, a Snellville resident and veteran of the Women's Army Corps in World War II. "And even if I am, I don't understand the benefits. Most seniors need some kind of expert to help them with these things."

And she's afraid she'll be forced to go to doctors picked by some giant health maintenance organization.

Gerna Davis, 69, of Atlanta fears "it's going to harm more than help many, many seniors, from what I understand."

Mack Abbott, 81, of Gainesville is worried, too.

"I'm in good health today. My medical bills are covered by Medicare, but my drug bills are not. And drug bills are the problem," says Abbott, president of the Atlanta chapter of the Pearl Harbor Survivors Association, who's trying to read the entire bill to be able to explain it to members. "And some of the politicians say this is great, and others say it's awful, and they've read it. So what are senior citizens supposed to think?"

That's how most seniors feel, says William Custer, a professor of business at Georgia State University and an expert on health care issues.

It's possible, he says, that confusion among seniors explains why so many have mixed feelings about the bill. Two public opinion polls conducted by AARP, the nation's largest seniors organization, indicated that many of the 40 million elderly and disabled people don't know whether to cheer or boo.

Here are some questions seniors are asking: Q: When do prescription drug benefits go into effect? A: The drug benefit kicks in fully in 2006. But a discount card will be available before June 2004. Q: How will the discount card provision work? A: In the coming two years, beneficiaries will have a chance to buy a discount card saving them 10 percent to 25 percent on all prescriptions. The cost of the cards has not been set, but they aren't expected to be more than $30 a year. Q: How about lower income seniors? A: People on Medicare with incomes up to 135 percent of the federal poverty line ($12,123 for an individual) will get a free discount card along with a $600 subsidy toward drug purchases in 2004 and 2005. Q: How does the benefit change in 2006? A: Recipients will pay about $35 a month for prescription drug coverage, though premiums will vary slightly around the country. They'll pay for the first $250 of their drugs, and after that will get 75 percent of the cost of the drugs up to $2,250. Then they get no coverage until paying out $3,600 of their own money. After that, Medicare will pick up 95 percent of drug costs. Q: The Kaiser Family Foundation says the average senior in 2006, the year the Medicare provisions take full effect, would have $3,160 in annual drug bills. How would the bill affect that? A: Seniors who have met the average would end up spending $2,080 out of their own pocket for drugs --- $420 for the monthly premiums, $250 for the deductible and $500 for the next $2,000 worth of prescriptions (covered 75 percent under the new bill). And then $910 for the remaining prescriptions, which receive no coverage until the senior hits the $3,600 cap. Q: How much does the average senior household spend now per year on prescription drugs? A: $955 in an average senior household of 1.7 people (1.4 seniors and 0.3 non-seniors), says Dr. Devon Herrick, senior fellow at the National Center for Policy Analysis. Q: Are people really going to save money? A: That depends. Most seniors will spend more for drugs in 2007 than in 2003, according to the Consumers Union, which publishes Consumers Report. Custer says seniors need to do some comparison shopping of supplemental plans. Q: If a senior is now getting prescription-drug coverage under Medicare from an HMO or a former employer's health plan, what happens under the new bill? A: The HMO coverage would continue provided your plan or a successor continues offering coverage in your area through Medicare. The bill contains major payment reforms and incentives to encourage more preferred provider networks, HMOs and other health plans to serve Medicare patients in all parts of the country with coverage that would include prescription drugs. Employers have several options. They could decide to drop retiree coverage and leave it entirely to Medicare. Or they could redesign their retiree drug benefits to work with the new Medicare benefit, just as they do now with medical benefits. Or, they could continue their own coverage and claim a subsidy for drug costs. Q: Why doesn't the bill promote cost-cutting by letting seniors go to Canada to buy cheaper drugs there? A: It does allow seniors to buy drugs from other countries if the Department of Health and Human Services declares those imports to be safe and reliable, Custer says. "Basically though, Canada would not have enough drug volume to be able to sell to all seniors in the United States. Some will be able to buy some drugs after certification by the Department of Health and Human Services." Q: How does the bill affect people of limited resources? A: Low-income beneficiaries (up to 100 percent of federal poverty level) will have no premiums, deductibles or gaps in coverage. They'll face co-pays of $1 for generics and $3 for brand name prescription drugs. Q: Does every senior have to have a baseline physical to get into the program? A: No. The bill gives newly enrolled Medicare beneficiaries access to a free physical and health screen. New screening tests for diabetes and heart disease are covered, along with improved payments for mammograms. A disease-management program for patients with chronic illnesses is also covered for the first time. Q: Is there a financial assets test? A: Private HMO programs may have different requirements. In 2009, seniors with incomes of $80,000 or more will pay a higher premium, yet to be decided, for all Medicare coverage, including the drug benefit. Q: Will the bill ultimately end up letting private companies "cherry-pick" their customers, choosing to insure the best risks? A: Not necessarily. There will be an experimental competition between private insurers and traditional Medicare in six metropolitan areas in 2010 . It is aimed at lowering Medicare costs, but it will not apply universally around the country. Q: Is it true that in this bill Democrats ended up demanding that big businesses that provide health insurance get subsidies and Republicans fought them? A: Both conservatives and liberals were concerned that employers would drop their current coverage after the bill's passage. So the bill has incentives for employers to maintain their current employee health coverage. The subsidy is 25 percent of the cost of the coverage. Most retirees have supplemental health coverage in addition to Medicare. Q: As a senior, where can I go for help? A: On the Internet, visit, which has a lot of info on the Medicare program. Also, visit and

Sources: William Custer, Georgia State University; Devon M. Herrick, National Center for Policy Analysis; Brad Plebani, deputy director of the Center for Medicare Advocacy in Washington; Dr. Jacque Sokolov, chairman of Sokolov, Sokolov and Rurgess, a national health care management firm in Scottsdale, Ariz.

Scripps Howard News Service contributed to this article. On > Skip the extra pounds this holiday season. Find out how at

Copyright 2003 The Atlanta Journal-Constitution

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