Congressional Democrats are pushing a broader proposal to cover 80 percent of prescriptions for all Medicare recipients. Bush promised a Medicare overhaul in his campaign, but maintains that the quickest way to help the most vulnerable seniors pay for medicine is to give money to the states to fund their own drug-assistance programs.
In his State of the State address, Gov. Bob Taft proposed making a discount prescription drug plan available to seniors through the state’s Golden Buckeye Card program. Under the proposal, which was introduced in the Ohio House in February, seniors could get up to 30 percent off the price of online prescriptions by using the card’s customer base to negotiate lower prices.
Last year, 118 of the nation’s Medicare HMOs chose to drop or reduce coverage beginning Jan. 1. That affected 934,000 — or about 12 percent — of the beneficiaries. Ohio had 70,000 recipients affected, trailing only Texas, Pennsylvania and Florida, according to the U.S. Health Care Financing Administration.
Currently, 39 of Ohio’s 88 counties have no Medicare HMOs.
Although everyone dropped from a Medicare HMO can return to the basic fee-for-service Medicare, it generally does not cover prescriptions outside a hospital. Supplemental Medicare policies, so-called Medigaps, either do not cover prescriptions or charge high premiums for coverage.
The average premium for moderate Medigap coverage that includes prescriptions is $1,917 a year, according to the Commonwealth Fund, a nonprofit foundation for health. Extensive coverage carries an annual premium of $3,252. Those willing to pay have to find an insurer that will accept them.
Fred Wood, 86, of Wilmington, has been looking for insurance coverage for his wife, Kathryn, since the couple’s Medicare HMO pulled out at the start of the year.
The couple receive $900 a month in Social Security and pay $350 in rent. Wood, a retired real estate salesman, said he managed to find insurance coverage for himself but not his wife, who has Alzheimer’s disease and requires about $125 worth of prescription drugs a month.
“I just have to pay them out of my pocket,” Wood said. “That can go on for a while, but it can’t go on forever because I don’t have too big of savings.”
Sue Bloom, director of the Senior Center in Wilmington, sees many seniors in similar straits.
The center, which is funded by state, county and private money, provides transportation, meals and benefit-assistance to the elderly of Clinton County.
“It’s just been a nightmare for us,” Bloom said. “A lot of the seniors will go without their medicine. They keep hoping Medicare will come through, and the new president will pass something.”
In December, then-President Clinton signed a law that earmarks $10 billion for Medicare HMOs over the next five years. The money is to be used to either reduce premiums, increase benefits or retain doctors used by the HMOs.
Four HMOs have since returned to the Medicare program and began offering coverage March 1, a move that will result in coverage for 240,000 potential beneficiaries.
Amber Bloom, who visits the elderly in their homes for the Senior Center in Wilmington, said many are reluctant to use lifetime savings to pay for prescription drugs and some are forced to choose between food and medicine. During one visit, she said, a diabetic man complained of nausea and dizziness, but told her he just could not afford to pay for his prescriptions.
“It’s sad,” she said.
Alice Black, 73, of Wilmington, and her husband were among those who lost their HMO coverage Jan. 1. They were able to enroll in a Medigap plan for $254 a month that increases their hospital coverage from 80 percent to 100 percent. But they must pay for prescriptions themselves. Black takes pills that cost $6 apiece.
“We have a neighbor lady that pays $375 a month for her prescriptions,” Black said. “We try to look at the bright side. If it uses all of our money, we can get on Medicaid. It could happen to anybody.”
Black said she hopes the government acts soon.
“If they don’t do it before very long, we’re all going to be dead,” she said.