Wednesday June 23 2004
James Fuller Daily Herald Staff Writer
Even into her 70s, Hazel Leahy never thought of herself as a senior citizen. Then she took a tumble at work that damaged her nerves so badly she can no longer walk.
"I had to face the music," said Leahy, a West Chicago resident.
As her medical problems mounted, she felt the pain in her pocketbook, too. Without a job, Leahy, now 75, had to buy her own health insurance plan.
"Oh my God, is that expensive," she said. "It's enough to choke a horse."
Leahy quickly found it didn't pay for everything. The monthly bill for her 11 prescriptions still hit $800, even with her insurance. That's just $100 less than her total monthly income, which comes from her Social Security check.
Leahy needed help. She turned to the Medicare department at Central DuPage Hospital and quickly learned what many other Illinois seniors are finding: Benefits from a new federal Medicare discount drug card program begin this month, but experts say Leahy and many other seniors in Illinois are better off sticking with programs the state already offers.
It's not so easy to figure that out, though.
The world of discount drug cards is a confusing game of mix-and-match. No one card covers all drugs for all conditions.
"That would just be too easy," said Sue Davison, Medicare advocate for Central DuPage Health, based in Winfield. "A lot of people don't want this new card. What they have to realize is if they have their own insurance coverage, they probably don't need it."
Determining who can benefit from the new Medicare prescription discount card is a multi-step process of comparisons.
'Extremely confusing'
Medicare's will be one of more than 50 drug discount cards offered in Illinois, which debuted its own discount card this year called the Illinois Rx Buying Club. Determining which card offers the deepest discount for a particular drug is key. For seniors with multiple prescriptions, the choice can come down to picking the card with the largest discount on their most costly prescription, then paying full price for all the others.
"This gets extremely confusing," said Mary Bean, manager of DuPage County's Senior Services Department. "It's something that everyone is still trying to sort their way through."
Bean admitted even she hasn't mastered all the aspects of the card.
Bill Anderson, co-owner of Oswald's Pharmacy in Naperville, hasn't noticed a groundswell of seniors using the card. He likewise said the number of options has made it difficult for elderly customers to choose which is best for them.
"It's so new, and I think most people are so confused that they hang back," he said.
One thing seems clear so far to local experts: The new federal Medicare discount cards don't offer that much for Illinois residents.
For instance, the Medicare cards offer a $600 credit to people falling below the federal poverty level. Illinois' SeniorCare program offers a similar credit, but it provides $1,750.
"There may be a situation that someone may benefit more by the federal card than SeniorCare, but I don't know what that situation is," said Linda Seyler of the Northeastern Illinois Area Agency on Aging.
The Medicare card and SeniorCare program both siphon from the same pool of federal dollars. Seniors can't double-dip by enrolling in both programs. They must choose one or the other.
"If I could only have the Medicare card or SeniorCare, I'll take the latter," Seyler said.
Of Illinois' three pharmaceutical programs, SeniorCare is for the poorest senior citizens. That includes Leahy. Her monthly income is so low she easily qualifies for the SeniorCare program. Her $800 monthly drug bill will shrink to as low as $1 per prescription if she can find a generic version.
In the other two programs, Circuit Breaker and the Illinois Rx Buying Club, seniors can also carry a Medicare discount card.
'No card compares'
Circuit Breaker covers most drugs that treat 10 of the most common conditions of old age, such as Alzheimer's disease. Drugs through that program come with either a $3 co-pay or no co-pay at all.
"It's comprehensive for those who qualify," Seyler said. "No discount card from any source can compare to that."
Circuit Breaker participants are also enrolled in the Illinois Rx Buying Club, for which all seniors qualify, regardless of income. The club offers discounts up to 20 percent for drugs on the program's list. That's one instance where a Medicare discount card might be useful, Seyler said. If Illinois' programs don't offer a discount for a particular drug, a Medicare card might.
The other benefit will be to procrastinators, said Polly Maschinski, coordinator of advocacy and support for senior services at Kenneth Young Center in Elk Grove Village. Illinois seniors who forgot to enroll or re-enroll in state programs earlier this year will lose benefits July 1. The Medicare card could serve as a small bridge until those seniors can re-apply, Maschinski said. Only about 66,000 Illinois seniors re-enrolled in the circuit breaker program this year.
"We know there's more seniors than that," she said. "So where are the rest of them?"
Drug vendors offer their own Medicare-approved cards. Those work for all drugs the particular vendor provides. But those companies also set the discounts, so they often change from week to week. That's when a senior may get stuck with a useless card.
A senior could sort through all the information, find a card with the best discount for him or her, then end up with a useless card if the discount evaporates. Once seniors pick a Medicare drug card, they can't change cards for one year, except in several unusual circumstances such as a move out of state. Only one Medicare-approved card can be had at any time.
A piece of the action
Then there's the option of drug discount cards that don't carry the Medicare-approval stamp. Dozens of those cards exist, and there's no limit to how many a person can have. The Medicare-approved card can cost no more than $30 per year by law. Cards without the Medicare stamp don't have membership fee limits. Aside from not carrying the Medicare label, the cards work the same.
"Individual companies, drug houses, pharmacies, insurance companies, anybody under the sun can just jump their butt right in here and do this," Maschinski said. "Everybody wants a piece of the action."
The process of weeding out which card, if any, is a good buy is so tough that Lake County's Warren Township is offering counseling with a social worker for the confused.
"People can't just pick a card and go with it," said Joanne Adams, director of the township's senior services. "They need to research it. Most of the people who come in find, if they already have a discount of any kind, the discount the cards offer isn't any cheaper."
Illinois' Rx Buying Club card costs $25. Seyler used to be a big advocate of it and promoted it - until reports of the actual benefits trickled back to her. That's when she decided all the discount cards, Illinois' included, only provide the illusion of relief.
"The market works in way where a 10- to 20-percent discount is just not that much," Seyler said. "When you have a senior living on limited income and they are paying $500 a month for medications, the savings just doesn't get them there. They're still choosing between medicine and food."
So how many Illinois seniors will see any benefit from the new Medicare drug cards?
"Not many," Maschinski said. "It's going to be few and far between."
That's OK with Leahy. She still has diabetes and high cholesterol. She has to call the senior citizens cab service to make her doctors appointments. But now she has enough money to get by.
"Now," she said, "I can live."
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