Grasping healthcare

The changes in Medicare, Medicaid and Medi-Cal have many confused; experts users should take their time to find the best plan. Enrollment for Medicare’s prescription drug program that began Nov. 15 has left many confused about the number of plans available and the various deadlines.

Though the program is greatly needed, some critics have said the time frame the government has set to implement it is unreasonable. Many people are concerned for Medicare beneficiaries who are also eligible for Medi-Cal, California’s version of Medicaid. Medi-Cal services are set to end Dec. 31.

Low-income seniors and people with disabilities -- the population eligible for both Medicare and Medi-Cal -- will have to choose a drug plan under Medicare Part D by Dec. 31 or they will be automatically enrolled into one that may not be the best choice for them. Granted, they can change plans at any point, but senior advocates are concerned that the termination of Medi-Cal benefits will cause a lot of problems until the kinks get worked out.

“It’s really the perfect storm for dual eligibles,” said Jeanne Finberg, directing attorney for the National Senior Citizens Law Center, a national support center for senior services. “What I worry about most is the vulnerable elderly and people with disabilities.”

Finberg said she’s concerned that many Medi-Cal and Medicaid beneficiaries will fall through the cracks and could be at risk of not receiving their medications.

Jack Cheevers, spokesman for Medicare in California, said they have taken the necessary steps to ensure that this part of the population is covered.

“This is a vulnerable population,” Cheevers said. “These people tend to be poor and sicker than the general population. That’s the reason they’re being auto-enrolled and signed up first.”

Cheevers said Medicare has a national contractor in place to pay claims for people who show up at their pharmacy after Jan. 1, not knowing what plan they’re in and whether their drugs are covered. He also said they have a first-fill policy, so if people don’t get enrolled for whatever reason or of the plan they’re in doesn’t cover their medications, they will walk out of the pharmacy with the drugs they need.

“We think the plan will work fairly smoothly, but we’re monitoring it closely to make sure that this vulnerable population will be taken care of,” Cheevers said.

The Health Insurance Counseling and Advocacy Program and the National Senior Citizens Law Center are urging people eligible under both Medicare and Medi-Cal to get a 100-day supply of prescriptions before the new year, just in case of a problem with the new plan.

“I think the biggest mistake they made is terminating Medicaid services Jan. 1,” Finberg said. “I wish they would extend the Medicaid deadline.”

Julie Schoen, legal counsel for the local Health Insurance Counseling and Advocacy Program, said her group’s number of phone calls is up 350% -- with many of the callers dually eligible and confused. But they are also working with a lot of seniors who don’t qualify for Medi-Cal, helping them find an appropriate plan or determine whether they need to sign up for a plan at all. Though Medi-Cal beneficiaries need to act more quickly in choosing a plan that suits them by Dec. 31, Medicare recipients don’t have to make a choice until May 15, the end of the open enrollment period. They can wait until the next open enrollment period but will be penalized for enrolling late.

“A lot of people are telling me they’re going to wait,” Schoen said. “I don’t necessarily think that’s such a bad idea.”

Shirley Laskin, 86, of Newport Beach, has been volunteering for the Health Insurance Counseling and Advocacy Program for seven years. In the past few weeks, she has been volunteering overtime, answering phones and leading presentations on Medicare Part D.

On Wednesday, Laskin addressed more than 100 people at the Oasis Senior Center. Though many attendees may have been hoping that the presentation would clear up all the confusion, Laskin told them there are no easy answers.

“We will do the best we can, and you as individuals will do the best you can,” Laskin told her audience. She encouraged them to do their research, to narrow down their choice in plans and call the top three or four to confirm whether it will work for them.

“The doggone system works, but we are the ones who have to make it work for ourselves,” she said. “Our job ... is to tell you you don’t have to do it; there is no rush.”

* LINDSAY SANDHAM is the news assistant. She can be reached at (714) 966-4625 or lindsay.sandham@latimes.com.

20051210ir9cnvknMARK DUSTIN / DAILY PILOT(LA)Shirley Laskin gives a presentation about Medicare Part D to the audience at the Oasis Senior Center on Wednesday.