Surveys Show Satisfaction With Medicare Drug Plan

Most senior citizens who signed up for Medicare's new prescription drug coverage say they are happy with their plans, but some report that they are not saving money and many say the overall program could be better designed, two new independent studies show.

The surveys -- one published today on the Web site of the journal Health Affairs, the other released last week by the Kaiser Family Foundation -- are the latest attempts to gauge the progress of the biggest expansion of Medicare since the creation of the federal health program for the elderly and disabled in 1965. The new drug benefit was passed amid furious political wrangling on Capitol Hill in 2003. In January, seniors began choosing from scores of plans offered by private insurance companies, a process that some complained was confusing and would lead to poor decisions.

"Overall so far there have definitely been bumps in the road in the implementation of the law, but it hasn't been the catastrophe that critics had predicted," said Drew Altman, president of the Kaiser foundation, which surveyed 1,585 people in June.

About 38 million Medicare beneficiaries now have drug coverage, according to the federal Centers for Medicare and Medicaid Services, which oversees the program. That includes about 25 million who enrolled directly in the program or whose employer-sponsored coverage receives a subsidy from Medicare, and millions more who have coverage through other government or private programs.

That means about 90 percent of those who are 65 and older have drug coverage, said Daniel McFadden, an economics professor at the University of California at Berkeley who conducted the scientific survey of 1,571 seniors for Health Affairs.

"Overall coverage is quite high," McFadden said. "People by and large seem to have been able to handle it and understand it."

Leslie Norwalk, deputy administrator of the Medicare agency, said, "I was heartened to know that we were largely successful."

The Kaiser survey found that more than 80 percent of people in Medicare drug plans were satisfied with their particular plan. McFadden's survey found that 58 percent of respondents thought the new coverage was a "major benefit."

Not all the findings were as positive, however.

The Kaiser survey found that nearly two in 10 enrollees had encountered a major problem in using the benefit, including having to pay unexpected costs and leaving the pharmacy without being able to fill a prescription. Low-income participants and those who take multiple prescription medications each day were more likely to say they had trouble. Also, only 46 percent of all respondents in the Kaiser survey said they were saving money, while 17 percent said they were paying more than last year.

"There definitely are problems that require real attention," Altman said.

In McFadden's survey, only 30 percent thought the Medicare drug benefit program was well designed overall. More than three in four (77 percent) said it would have been better to provide coverage automatically as part of Medicare, rather than as an optional program with scores of competing providers.

McFadden also found that about 2 million people who use one or more prescriptions a month and would benefit from the program, including half a million low-income people, have not signed up.

"Virtually anyone who is using one prescription or more should be signed up," McFadden said. "It's a no-brainer."

The "doughnut hole" in Medicare drug plans -- the coverage gap in which an individual must shoulder all his or her drug costs until the total spent reaches $5,100 -- also is unpopular, with 88 percent of those in McFadden's survey calling it a "significant drawback." Medicare officials say as many as 4 million seniors could hit that coverage gap this year.

Norwalk said Medicare officials are revamping the agency's Web site and will continue to educate consumers about their options and how the program works. "We want to be sure that beneficiaries have prescription drug coverage," she said. "It's fine no matter where they get it, as long as they have it."