Understanding Medicare

New drug plan puzzling for non-English speakers

By Rebecca Vesely, STAFF WRITER Inside Bay Area



Figuring out Medicare's new prescription drug program is hard enough for seniors. What about for those who don't speak English?

In the Bay Area, community groups are racing to make sure the thousands of seniors with limited or no English skills understand the new Medicare drug benefit, called Part D, which starts Jan. 1.

This is important because most of these seniors are very low-income and will see big changes to their drug coverage in just two weeks, advocates say.

In policy speak, low-income seniors and disabled people whose health care is covered by both Medicare and Medi-Cal, the state's health insurance program for the poor, are called "dual-eligibles."

Starting Jan. 1, dual-eligibles' drug coverage will no longer be offered through Medi-Cal. Instead, dual-eligibles will switch over into one of 10 private plans approved by Medicare to cover their drugs.

In Alameda County alone, there are 7,800 dual-eligibles who speak limited English, according to county Supervisor Alice Lai-Bitker's office.

Most of these seniors are immigrants from China, Vietnam, Central America and Mexico. All are here legally, and many are citizens.

All dual-eligibles statewide -- about 1 million seniors and disabled -- received a yellow letter in the past month from the federal Centers for Medicare and Medicaid Services notifying them of the change and telling them which of the 10 plans they have been automatically enrolled in.

If these dual-eligibles don't like the drug plan they were automatically enrolled in, they can switch to one they like better. They are allowed to switch after Jan. 1, but no matter what, their prescriptions will be paid for by a new provider starting the first of the new year.

The problem is that in some cases, these seniors were automatically enrolled in plans that do not cover their specific prescription drugs. So dual-eligibles are being advised to check their medications against the plan they have been enrolled in to make sure they are getting the best deal.

For seniors with limited or no English skills, this task can be insurmountable -- especially since that yellow letter from Medicare notifying them of the change was written only in English.

"Most of our clients are very confused," said Wai Fong, social services manager of Family Bridges, a nonprofit agency that serves people with limited English who are mostly from Asia. "They don't understand that the law has changed."

Many seniors with limited English skills threw away the yellow letter because they didn't understand that it was important, Fong said.

On a recent Saturday at the Family Bridges office in Oakland's Chinatown, seniors clutching their Medicare paperwork and plastic bags full of prescription bottles lined up to get counseling on the new Medicare benefit.

Family Bridges has about 600 clients who are dual-eligible, and nearly all speak limited or no English.

Mee Hui, 76, of Oakland takes eight medications for arthritis and her heart. She points to her right leg and says in a Cantonese dialect that she has chronic and severe pain there from a recent fall.

Hui has her yellow letter from Medicare, and shows it to Yvonne So, a volunteer counselor who speaks the same dialect. The letter informs Hui that she has been enrolled in Blue Cross MedicareRx Value, one of the 10 plans that dual-eligibles are being automatically assigned to.

Using the plan finder tool on Medicare's Web site, www.medicare.gov, So picks up each of Hui's prescription bottles, reads the label, then types the drug name into the computer.

Three of Hui's drugs now covered by Medi-Cal are not covered under any of Medicare's drug plans. These are over-the-counter drugs -- Tylenol, aspirin and an iron supplement. Medi-Cal will still provide these free of charge to dual-eligibles.

In her Web research, So discovers that Blue Cross does not cover several of Hui's other medications. If she stays with Blue Cross -- the plan she's been assigned to by Medicare -- Hui will pay $146.84 a month total for five of her prescriptions.

But if she switches to one of two other plans -- AARP Medicare Rx or United Health Rx -- Hui will pay only $13 a month for her five medications in small co-pays of $1 to $3 each.

So explains all this to Hui, who looks confused, surprised, then relieved. She chooses the AARP plan.

Albert Yee, a retired pharmacist who volunteers at Family Bridges, said the process is so individual because each of the 10 plans have different lists of drugs they cover, called formularies.

"The state had a uniform formulary and seniors paid nothing," he said. "Now there are many different formularies and there's also a co-pay."

Today, under Medi-Cal, Hui gets her eight drugs for free. Starting in January, she will pay $13 a month in co-pays. That's somewhat substantial for dual-eligibles, who make less than $9,570 a year for individuals, and less than $12,830 for couples in California.

What's more, if Hui had not sought help from Family Bridges and had stuck with Blue Cross, the plan she was assigned to, then she would be paying far more -- $1,752 a year for five drugs.

"It makes a lot of difference," Yee said. "Some plans do work and some are really expensive."

The state Department of Health Services this week sent letters to all one million dual-eligibles in the state, reminding them of the change to their drug coverage. Unlike the Medicare yellow letter, the state's letter was sent out in 12 languages.

To ensure dual-eligibles have no lapse in drug coverage, Medi-Cal is allowing pharmacists to refill prescriptions up to 100 days until the end of the year.

Many dual-eligibles will luck out, and the plan they were assigned to will cover all their drugs, with nominal co-pays.

Lai-Bitker, who has dispatched her staff to senior centers to help non-English speakers with the new benefit, said dual-eligibles with limited English skills are most at risk of paying more than they need to for their drugs.

The process of just finding the information can be extremely time-consuming.

At the Fruitvale San Antonio Senior Center in Oakland Wednesday, Sarah Wilson, an assistant to Lai-Bitker, spent half an hour using Medicare's Web-based plan finder to determine whether HealthNet will cover all 12 medications taken by a Vietnamese-speaking senior.

After half an hour of trying to find the information online, Wilson finally gave up and called HealthNet directly to inquire about the 12 drugs.

HealthNet did cover all the drugs, so no changes to coverage were needed. Still, the whole process took nearly an hour.

"A lot of people have been misled to think they don't have to do anything," said Michelle Taylor Lagunas, program manager of the San Antonio Senior Center, of the dual-eligibles. "That's simply not true."