Tuesday, February 28, 2006


Who cares if Medicare's new drug plan is a bit confusing, Dixie and Frank Gulyas of Citrus Heights concluded. For the first time in their retirement, they'll have coverage to help pay for prescription drugs. "It's going to save us a lot of money," said Dixie Gulyas. "I feel good about it." Overshadowed by the troubles that have plagued the Medicare Part D drug plan since its Jan. 1 start is the fact that many Medicare beneficiaries who have been paying out of pocket for expensive prescription drugs can get help. Even consumer advocates who complain that the implementation has been disastrous don't want seniors and disabled persons who can benefit to be deterred from signing up.

New enrollment figures released Wednesday by Mike Leavitt, the U.S. Health and Human Services secretary, show 1.3 million more people have enrolled since Jan. 13, bringing the number of Medicare beneficiaries with some type of drug coverage now to 25 million nationally. Among the 4.3 million Californians on Medicare, the number who signed up for stand-alone drug plans increased from about 155,000 to 235,000. The number in managed-care plans with drug benefits remained about the same. "Enrollment is up, the price is down, the system is working better every day," said Leavitt at a press conference in Pensacola, Fla., to encourage Medicare beneficiaries to sign up.

About 1 million Californians were required to switch from Medi-Cal to Medicare for their prescriptions on Jan. 1. Declaring the problems that ensued an emergency, California said Medi-Cal will continue to pay for drugs until problems can be worked out with Medicare. From now until May 15, all other Medicare beneficiaries will have to decide if they want to buy the coverage. Some may choose to remain with other drug coverage if they have a similar plan through their former employer.

Sacramento's Health Insurance Counseling and Advocacy Program, HICAP, is still busy trying to help those making the switch from Medi-Cal who ran into lots of trouble getting their prescriptions filled, said assistant director Margaret Reilly. But those problems don't mean that all Medicare beneficiaries should stay away from the new benefit, she said. "If you have a limited income and limited assets, you could benefit," she said. "If you don't have prescription drug coverage now and haven't had it in the past, you could benefit."

For example, she recently enrolled an 84-year-old woman who uses only two prescriptions whose income wasn't low enough to qualify her for free or reduced-cost coverage. Reilly explained her reason for signing up. "You look at it as a traditional health or insurance plan," she said. While the woman doesn't need much help in paying for her prescriptions or use many drugs now, she probably will in the future. "You're looking at the future, not so much what your needs are today," said Reilly, who pointed out that beneficiaries who sign up late will face lifelong penalties for their delay in enrolling. "That's going to become important."

That's exactly why Leslie Farrell of Sacramento signed up her 85-year-old mother on Medicare's Web site even though the older woman is in good health and uses few prescriptions. Her mother, who had no drug coverage, will save about $200 a year on her current prescriptions through her drug plan, she said. But Farrell was more concerned about making sure the drugs her mother might need as she ages are covered.

Leavitt said seniors need to consider their future drug needs and remember that like any insurance plan, it will cost more if they wait until after the May 15 deadline to enroll. He also urged those wanting to change plans not to wait until the last of the month to avoid delays in getting their coverage.

While Medicare's 24-hour telephone help line now has a wait time of one minute or less, the new drug plans need to make more improvements in their customer service.

The Gulyases decided to sign up for the Secure Horizons Medicare Advantage plan, which will provide both managed-care health coverage for their medical care and prescription drug coverage. Instead of paying $300 a month for health insurance alone with no drug coverage, they'll now pay $37 per person per month for medical care that also provides drug coverage. Dixie Gulyas, 73, is healthy and still works part time, but she said her 69-year-old husband takes eight prescriptions and suffers from circulatory problems, high blood pressure and other chronic problems. The drug coverage has relieved her worries about how to pay for future prescription drug costs. "It's one less thing I have to worry about. With my husband's condition, you never know," she said. "Something is going to get all of us one of these days."


Australian health insurance price rises not as bad this year: "Private health fund premiums will climb an average of 5.7 per cent from April 1, adding $3 a week on a typical family policy. But the increases - which will fall to an average weekly slug of $2 after the federal Government's 30 per cent rebate - are the lowest annual price hikes for five years. Health funds say increased payouts to members, which rose 8.1 per cent to almost $5.9billion for hospital benefits alone in 2004-05, are one factor behind the rises. Other drivers were said to be a 20 per cent rise in payouts for prostheses and the popularity and spread of "gap cover" products that in some cases paid the doctor's entire fee. Private health fund membership is increasing. There are now about 8.8 million Australians with hospital cover - 43.1 per cent of the population - and 8.6 million with ancillary cover. Almost all the increase is among people aged more than 60, who place the greatest pressure on health funds."


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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