Understanding the Medicare Prescription Drug Coverage Program

Problem or Situation:
Forty-two insurance plans became available to Iowa seniors through the new Medicare drug coverage program as it opened for enrollment in late fall of 2005. Sorting through all that information and trying to make a good decision on choice of plan proved to be a major challenge for many elderly citizens. They had to decide if plans would reduce their costs and which plan would provide the best coverage. Each person’s situation differed, depending on the prescription drugs and dosages they were using and the formulary (list of drugs covered) and coverage features of each plan. The cheapest premium cost plan is not always the best for a given situation. Tools to help with these comparisons and decision making are available over the internet, but many elderly do not have access to computers or the skills needed to use these tools effectively.

Response:
As the enrollment period drew closer, the CEED was receiving requests from various people in the community for information, and in fact, was going through the same decision process himself for his mother who was in nursing home care. At about the same time, Joyce Lash, family resource field specialist, was contacting her counties to determine interest in educational sessions or conferences to help seniors better understand the program and sift through and compare the myriad of choices. The field specialist and CEED scheduled two days for counseling sessions with individuals and couples in Decatur County. The sessions were advertised through local media, flyers and health care providers.

Impact:
The seven, one-hour sessions for each day were reserved within a week or two of advertising. Twenty-two people, represented by couples and individuals, attended the confidential sessions with the field specialist in the Extension office conference room. In addition, the CEED helped several other seniors in the community, who could not attend these sessions, examine their plan choices. Calculations for many of the clients showed an out-of-pocket savings of 50% or more of their prescription drug costs if they selected a policy. On one day of the sessions, some company plan information was off-line and Mrs. Lash had to hand-calculate the comparison information as well as call some companies for clarification on formularies, deductibles, or other coverage features. In some cases, clients had existing plans through supplemental coverage and the Medicare plan offered no advantage. More often, however, participants were relieved and pleasantly surprised to learn how much enrollment in a plan would save them in annual drug costs. All of the participants expressed gratitude for the sessions. Several stated that they had attended informational meetings conducted by other groups or insurance companies about the Medicare drug program, but found the information to be complicated or confusing and quite often a biased sales-pitch. They indicated that our counseling sessions helped them understand the program much better and provided them with much clearer information for comparison and decision-making. Since the sessions, the CEED and field specialist have followed up with a few of the clients who had additional questions or problems dealing with specific companies or plans. They were advised on how to proceed or referred to appropriate agencies or resources for help.

Another important positive outcome of this program is its connecting or re-connecting Extension with an important and growing (and perhaps underserved) segment of the county population-senior citizens-through special program efforts in a high profile financial life decision issue.

Contact:
Jack Van Laar, CEED
Decatur County ISU Extension
309 North Main, Leon IA 50144
Phone (641)446-4723; Fax (641)446-6142
Email jvanlaar@iastate.edu