A coalition of 18 local groups will work to ensure Rhode Island's Medicare beneficiaries understand their options before they enroll in the federal program's prescription drug coverage.

09:08 AM EDT on Wednesday, September 28, 2005

BY FELICE J. FREYER
Journal Medical Writer

PAWTUCKET -- It's not often, said federal health official Brian M. Cresta, that Medicare beneficiaries face a choice. Seldom have the words "Medicare" and "choice" even appeared in the same sentence, said Cresta, the New England regional director of the U.S. Department of Health and Human Services.

But now, elderly and disabled people covered by Medicare are facing a huge choice: which of 18 different plans to pick when they enroll in Medicare's prescription drug coverage. Enrollment starts Nov. 15 and the benefit takes effect Jan. 1.

Cresta went to the Leon Mathieu Senior Center yesterday to announce that help is on the way. The Medicare Rx Access Network of Rhode Island, a coalition of 18 local groups, will be working to make sure all 177,000 Medicare beneficiaries in Rhode Island and their caregivers understand the options and make a decision.

"We are on the cusp of the most dramatic change in our health-care system since 1965," Cresta told a gathering at the senior center. "It's a great day to be a Medicare beneficiary."

Truth be told, the last time Medicare beneficiaries had to cope with choices, the results were less than stellar. The Medicare drug discount card offered last year had such uncertain benefits and befuddling choices that most elderly people decided not to bother.

But Cresta said the drug benefit will be different. There has been time to marshal a multifaceted educational effort. Unlike the discount card, the drug benefit is permanent, and clearly offers savings: Medicare drug plans will cover at least 75 percent of drug costs, after a $250 deductible, up to $2,250 in total drug spending. After a beneficiary has spent $3,600 out of pocket, the plan must cover 95 percent of drug costs. Low-income people will get extra help with costs, and may pay little or nothing out of pocket.

Medicare beneficiaries are strongly advised to enroll in a drug plan by May 15, even if they don't spend a lot on drugs now. Those who sign up after May 15 will face higher premiums for the rest of their lives.

In Rhode Island, 18 companies are offering Medicare drug plans. Additionally, two companies are offering managed-care plans that include a drug benefit. These options differ in their out-of-pocket costs, the drugs covered, and the pharmacies participating. Starting Saturday, the plans will begin providing the details to elderly and disabled people.

The Medicare Rx Access Network will coordinate efforts to make sense of it all. One of 50 state-based programs under contract with the federal government, the network includes such groups as the AARP of Rhode Island, the American Lung Association of Rhode Island, Easter Seals of Connecticut & Rhode Island, the Rhode Island Pharmacists Association and the Rhode Island State Nurses Association.

The network intends to:

Hold rallies, meetings and events to disseminate information and encourage enrollment.

Train people who work with the elderly -- including the doctors, nurses, and pharmacists to whom they are expected to turn for advice.

Work to ensure that all groups working with the elderly have accurate information and provide correct, consistent answers.

John Quinn, president of Easter Seals of Connecticut & Rhode Island, advised Medicare recipients to start now by making a checklist of the drugs they take and dosages, the pharmacies they prefer, and what prescription drug coverage they now have.

The annual Medicare & You handbook, coming out early next month, will detail the plans in each region and provide advice on choosing.

Starting in mid-October Medicare will offer a service, both online (www.medicare.gov) and on the phone, at (800) 633-4227 (or 800-MEDICARE), in which beneficiaries can describe what they want in a plan, what drugs they use, and where they live, and a get quick answer on which plans meet their criteria.

Additionally, one-on-one counseling is offered through the state's Senior Health Insurance Program (462-3000).