MEDICARE RX ROLLS OUT

Sign-ups are going slower than projected and some computer records reportedly are incomplete for the new Medicare drug program, but the program has begun. With the Jan. 1 deadline gone, questions persist as to the program costs, workability and even what it might look like in the future.

Last Friday, Gov. Baldacci released a letter he sent to the Centers for Medicare and Medicaid Services (CMS), imploring the agency to ensure it had properly signed up both those dually eligible for Medicare and Medicaid as well as enrolling those who qualify for Maine’s subsidized drug program. Kathleen Harrington of CMS says those concerns are way overstated – anyone eligible who shows up with either an acknowledgment letter from their new drug plan or Medicare and Medicaid cards and a photo ID will get the subsidized prescription drugs. Those formerly on the state pharmacy assistance program, she said, should bring their cards for that program and a photo ID.

Jean Lavigne, a member of the Maine Part D Stakeholders Committee, described the situation in a Dec. 29 op-ed on these pages. She predicted a national “mess” as people try to understand and decide whether or how to sign up. She called the situation in Maine less of a mess.

What has gone wrong with the program that President Bush hailed as “the greatest advance in health care for America’s seniors since the founding of Medicare”?

First, its costs are higher than first expected, posing a threat to an already out-of-balance national budget. Before Mr. Bush signed the legislation, the estimated cost to the federal government was $400 billion, a figure that after passage jumped to $534 billion and then to $720 billion over 10 years.

Second, unless you qualify for generous low-income discounts, it can leave you with expensive drug costs in an era of rapidly rising drug prices. Medicare says that the new plan “will pay about half of your drug costs.” The remaining half can run into a lot of money.

Third, it’s complicated. You may be able to select a plan by following a systematic program on the Internet at www.medicare.gov. If that is beyond you, state or federal authorities can help you through it.

Fourth, you may do better elsewhere. Your present insurance may be better than the new Medicare Part D. Your doctor or a nearby hospital may be able to get the drugs you need more cheaply from Canada.

In these worst-case circumstances, what should one do? One possibility is to stick with your present drug insurance if you have it. An argument for signing up before the next deadline, May 15, is to insure against the possibility of a catastrophic illness that can require expensive special drugs. For example, Cerezyme, a specific for Gaucher’s disease, costs as much as $200,000 a year. Plan D would pay 95 percent after the insured had paid $3,000 in a given year.

When Congress returns to Washington after hearing in recent weeks from constituents, it will have plenty of reasons for reviewing the system. Meanwhile, expect a few bumps in the road as the program begins and don’t forget those Medicare-Medicaid cards and your ID when you go to the pharmacy.