Seniors want Medicare donut hole filled


First Posted: 7/30/2009

PILOT MOUNTAIN With much of America focused on the health-care debate in Washington, about 50 senior citizens conducted a lively debate Thursday on their likes and dislikes regarding the Medicare program.
They gathered Thursday at Armfield Civic and Recreation Center in Pilot Mountain to celebrate Medicares 44th birthday and for the most part said their experiences with the federal health-care insurance program for people 65 and older have been positive.
However, just as many younger Americans are seeking a reliable system via universal health coverage, seniors said Thursday the program geared toward them also is in need of reforms, while expressing concerns about how actions in Washington could impact Medicare overall.
Im scared to death of what theyre going to do with it, said Russell Edwards, one senior who offered comments during a roundtable discussion at the civic center, sponsored by the North Carolina Alliance for Retired Americans.
Our people who are making the laws dont even know whats in the (reform) program thats what scares me, Edwards said.
Most speakers who shared their Medicare experiences Thursday were like Judy Gilley, who said, Im thankful for Medicare I havent had any problems yet with Medicare.
The Medicares been very good to me, and Im thankful because everything Ive got is falling apart right now, added Shirley Key, senior specialist at the center, whose comment produced laughter.

Donut Hole Runs Deep
Yet Gilley and others said a definite improvement to the largely successful program would be filling the donut hole seniors are falling into with the Medicare Part D program that subsidizes the cost of prescription drugs.
The donut hole occurs when seniors exceed $2,700 in total drug expenses in a plan year, which then requires them to pay 100 percent of their prescription costs until $4,300 is spent out of pocket. The hole, which 3.4 million Americans fall into annually, can appear in a hurry when extremely expensive medications are involved, based on the discussion.
That seems to me to be a little absurd, Marsha Lowery of Ararat said of the donut hole regulation, saying it can force Medicare recipients to pick and choose their medicine and omit some in the process. It looks like theres some issues with it.
Thats something you need to take up with your elected representatives, and make your wishes known, responded Tom Bachman, head of the Mount Airy branch of the Social Security Administration, which determines Medicare eligibility. Bachman was joined at Thursdays gathering by Vernal Cooper, Social Security district manager in Winston-Salem.
Elected representatives on both the federal and state levels also were invited to the meeting, but none were there. Nor did any of the lawmakers, who are now in session in both Washington and Raleigh, send staff members to Pilot Mountain on their behalf.
Another problem with the donut hole was cited by Barbara Jessup, site director for a meals program held at the civic center. Jessup said a physicians assistant at a local clinic recently prescribed medication for her which she couldnt take. Though Medicare picked up the tab, its cost counted toward her donut hole limit, she said.
Thats 120-some dollars I could have used for some other medication later on, Jessup complained.
Edwards advised Jessup to go to one (a doctor) that dont own stock in the drug companies, which drew a supportive reaction from the audience.
Jack Marion of the North Carolina Alliance for Retired Americans, organizer of Thursdays forum, urged those in attendance to voice their support for Senate bill S.330. It would increase beneficiary choice and drive down costs by creating a Medicare-administered drug plan as an alternative to privately administered Part D plans.
Were trying to do everything we can do to keep our seniors out of the donut hole, Marion said of his organization.
Others present Thursday said they had noticed what one audience member called ridiculous charges or questionable amounts on their billing statements for medical services covered by Medicare. Some suggested that a certain degree of fraud and error is undermining the system.
When examining a Medicare statement for her husband, one woman said the program had paid an ambulance bill for him in North Wilkesboro, and weve never been in North Wilkesboro.
Im afraid Medicares going to go broke as a result of double-billing and overcharges, another elderly woman said.
Shirley Nichols, program assistant with the Retired Senior Volunteer Program in Surry County, suggested, You have to look at your statements to make sure theyre not charging you for something.
If you want to save money on Medicare, monitor your bill, program participant Jack Miller agreed.
These are ways you can help Medicare save money, said Marion.
He and Cooper, the Social Security official, said that reporting suspected abuses and billing discrepancies to a toll-free hotline at 1-800-Medicare not only will save taxpayers money but help ensure the long-term viability of the program.
You do need to report these incidents, Cooper said.

Make Viewpoints Known
Another underlying theme at Thursdays roundtable discussion was that seniors need to be more involved politically on issues such as Medicare.
Thats one of the things you can do as a senior citizen, Marion told the audience.
It was noted that toll-free numbers are listed for all lawmakers in the governmental portions of telephone directories, and that senior citizens not only should call their representatives but arrange one-on-one meetings with them. For example, Virginia Foxx, Surry Countys member in Congress, regularly devotes time to talk to constituents at her district office in Clemmons.
If you dont call, they dont know your feelings, said Nichols. If they do not hear from citizens, legislators think everythings OK with the public, she added.
Believe me, they listen, Marion told the gathering.
Judy Coggins, another Alliance for Retired Americans representative present Thursday, said seniors should strive to regularly contact lawmakers just as much as lobbyists do to influence bills affecting their industries. These drug companies and insurance companies are there all the time, Coggins said.
It was pointed out at the forum that U.S. senators, including Richard Burr of North Carolina, had voted in January to block legislation allowing Medicare to bargain for lower drug prices.
Seniors also were urged by several speakers Thursday to try to make sure politicians are elected who will disregard the pressures from pharmaceutical and other interests and work for you.
Contact Tom Joyce at [email protected] or at 719-1924.

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