CHICAGO (Reuters) - When it comes to finding the best deal on prescriptions under the Medicare health insurance program, 68-year-old Carol Paremske of Miami says she knows all the tricks.
The Internet-savvy senior knows about step therapy, which requires a patient to try a less expensive drug favored by the insurer before using the one prescribed by a doctor. She knows about the so-called doughnut hole, where coverage is limited after spending tops about $2,300. She's called the private companies that run the plans and the government help lines.
Still, a week before the Medicare agency suggests seniors decide which Medicare prescription drug plan to choose for 2007, she is perplexed.
"The thing is so complicated and convoluted. You don't really know if you are saving money or if it is just going to the drug companies," Paremske said.
Coverage for prescription drugs under Medicare began this year and was hailed by supporters as a major improvement to the decades-old federal health insurer for about 43 million elderly and disabled.
But for millions of people enrolled in the privately run plans, the choices for 2007 are dizzying, and many plans are making big price changes and dropping some covered prescriptions, senior advocates said.
"There is a real risk for seniors who take the path of least resistance. By the time they figure out that premiums have gone up or their plan might not be covering their drugs (anymore), they are locked in," said Tricia Newman, who studies Medicare at the nonprofit research ground, the Kaiser Family Foundation.
The government says the average monthly premium will be stable in 2007 at around $24, but that average is deceptive and obscures big changes to some popular plans, experts said.
The U.S. Centers for Medicare and Medicaid Services runs the prescription drug program. Open enrollment began November 16 and runs through December 30, though the government advises seniors to decide about whether to switch their plans by December 8 to avoid coverage disruptions.
MORE CHOICES, MORE CONFUSION
The Medicare agency says there are 1,920 plan choices in 2007 for seniors to choose from, 474 more than in 2006, when many seniors complained of confusion among the myriad options.
The first year roll-out of the program was fraught with problems, including hundreds of thousands of recipients left stranded without coverage due to technical glitches in the sign-up process.
The Medicare agency has largely smoothed those edges and many national polls say seniors feel largely content with the program.
"The industry understandably fought very hard for market share in 2006 because there will be a tendency of people to stay where they are," Robert Hayes, president of the consumer group, Medicare Rights Center, said. "Complacency is likely to work to their disadvantage, though."
Humana Inc., the second biggest provider of the plans with about 3.5 million members, is changing its most benefit-rich plan because too many "high utilizers," or sicker patients, signed up and the company lost money.
The company was one of few which offered brand name drugs during a coverage gap in the program, when consumers must pay out of their pocket for prescriptions after reaching $2,250 in spending. It eliminated that brand name coverage for 2007.
"The vast majority of people that bought the plan were high utilizers," said Steve Brueckner, Humana's vice president for senior products. "We were the only place to go, so we had to restructure the program in a manner more consistent with what our competitors are doing."
Mark Ford of Socorro, New Mexico, is searching for a new plan after Humana changed that plan. His 66-year-old wife Ligia takes about a dozen medications, has ovarian cancer, and he has found very few plan options for her.
"I've got four spreadsheets. I print them all out and I go through their listings as far as drugs," he said. "I know I have limited time to decide."
He is likely to pay the extra costs for brand-named drugs with his credit card.
NOT IN WRITING
Paremske, the Miami senior, chose UnitedHealth Group's plan for 2006, a plan endorsed by the seniors group, AARP. UnitedHealth is the biggest private plan provider for Medicare.
She was unhappy to learn, though, that her plan now has quantity limits and a requirement that a patient first try one drug over another, including her high blood pressure drug, Cozaar.
When she called AARP to make sure she wouldn't have to take an alternative to Cozaar that had caused her kidney problems, they said she could if her doctor recommended.
"But I wanted something in writing, and they couldn't give me that," she said.
AARP wears two hats in the Medicare prescription drug program. In addition to its business arm, which markets the UnitedHealth plan, it lobbies for about 37 million people over age 50. Its support was key to the passage of the 2003 law adding the prescription coverage to Medicare.
The group warned members its plan could be changing dramatically.
"What I am seeing is people are not as aware as they should be of the potential for change and are not inclined to seek out new information," Cheryl Matthias, a spokeswoman for AARP said
© Reuters 2006.