By Corey Bearak
When a program picks their pockets for almost 80 percent of the first $5,100 in costs, questions abound and it demands reform. More than a decade ago, I helped organize a forum series on the “sandwiched generation” – folks approaching their senior years who care for or are concerned about caring for their parents and at the same time worry about their children and grandchildren. Dr. Arnold Honig – with whom I helped found the Northern Queens Health Coalition with Rabbi Bob Kaplan of the Jewish Community Relations Council of Greater New York – saw the need then for the forum.Last spring he suggested we not only revisit the program, but also sponsor an educational program on the new federal drug card. That program featured Liz Shollenberger, director of government benefits, Consumer & Elder Law for Queens Legal Services. The sponsors included City Councilman David I. Weprin, the Northeast Queens Jewish Community Council, Metropolitan Council on Jewish Poverty, Samuel Field/Bay Terrace YM&YWHA, Queens Region Hadassah, the borough-wide Queens Civic Congress and Services Now for Adult Persons. Schollenberger often referred to and distributed Public Advocate Betsy Gotbaum's “Senior's guide to prescription drug plans in New York City in 2005-2005.”Schollenberger discussed the current card available only to seniors not eligible for Medicaid. The card costs up to $30 for discounts ranging 10 to 25 percent and you cannot switch to another provider without paying. The program requires seniors to become rather savvy consumers. They need to research the lists of drugs a company offers at discount and check with their doctors. Where a consumer uses only one or two drugs, comparison shopping proves easy.The discount card, called the Low-Income Assistance Medicare-Approved Drug Discount Card, qualifies individuals with income up to $12,659 and married people with income up to $16,862 for a $600 credit. But many seniors already participate in the State's Elderly Pharmaceutical Insurance Coverage, Medicare Plus or Medicare Choice and the discount card option makes no sense until using the card becomes a requirement.The pharmaceutical insurance coverage enables individuals with incomes up to $26,000 and married people with incomes up to $50,000 to obtain drugs at discount. Other may use the drug benefits under their medical plans.Which plan makes sense depends on the drugs a doctor prescribes and whether a doctor will modify it to help a consumer get the best bargain. Some plans cover prescription drugs, others charge monthly premiums.If high monthly medical and drug costs leave a family only $950 ($659 if single) in monthly income remaining, the consumer may qualify for assistance under Medicaid. Medicaid excludes the value of your house and one car from its qualifying calculations. On the other hand, a couple living in an apartment with over $5,700 in cash ($3,950 if single) would not qualify for Medicaid. Families that incur home care service costs need to determine whether those and related out of pocket medical costs qualify them for Medicaid.This brings to mind the program Dr. Honig organized after I succeeded him as Northeast Queens Jewish Community Council president: advising families to plan to avoid a catastrophic illness' impact on family finances. Many families will need similar guidance to qualify for medical and prescription drug assistance available to them. Programs such as Queens Legal Services, where Liz Scholenberger works, will require funding to provide this additional service on a more frequent basis than any of us can imagine.The uncertainty only gets worse. Government must draft the regulations to implement the Medicare Drug Card when the plan kicks in in 2006. There likely needs to be companion state regulations. Each state and various health plans, including employer-provided plans, may determine whether they'll maintain existing drug benefits or “dump” seniors into the Medicare Card plan.These are the basic outlines of the program benefits: The senior consumer pays $35 per monthly ($420 per year). As with many insurance programs, the consumer faces a $250 deductible before the benefit kicks in. The consumer pays 25 percent ($500) of the next $2,000 with Medicare picking up the remaining 75 percent ($1,500). After reaching the $2,250 threshold, the senior now pays the next $2,850 out of pocket. When the cumulative $5,100 level gets passed, you reach the catastrophic level and pay only five percent. Adding back the $420 annual program costs means a senior pays $4,020 of the first $5,100.Did Congress intend this?Corey Bearak is an attorney and adviser on government, community and public affairs. He is also active in Queens civic and political circles. He can be reached via e-mail at Bearak@aol.com. Visit his web site at CoreyBearak.com.
