Health insurance doesn't faze experts

Wednesday, May 17, 2006

By Joe Fahy, Pittsburgh Post-Gazette

When she needed advice about Medicare's prescription drug program, Anna Gariti turned to Apprise, a state program that provides beneficiaries with free counseling about health insurance.

Ms. Gariti, of Crescent, met with the program's Allegheny County coordinator, Bob Kubit, who spent two hours helping her understand her options.

Apprise and other community groups have worked for months to educate Medicare recipients about the program, known as Part D, before the initial enrollment period ended Monday.

For people such as Mr. Kubit, that has meant long hours of explaining the intricacies of the complex program to Medicare recipients, many of them worried or confused.

"There have been some days when I didn't get off the phone," said Mr. Kubit, who also spoke at scores of community meetings to explain the basics of the program.

In general, Medicare recipients have not had to consider enrolling in private plans offering Part D if they already have coverage at least as good from a former employer, for example, or from the state's drug assistance programs, PACE and PACENET.

Still others were automatically enrolled if they were in Medicare HMOs or state Medicaid programs, though they could choose a different plan.

Many others, however, had to sign up by Monday or face a penalty consisting of higher monthly premiums if they ever decide to enroll.

That prospect prompted many people to sign up in recent weeks, Mr. Kubit said, though some seemed to regard May 15 with the same lack of enthusiasm often reserved for the tax deadline in April.

Without doubt, many people are saving money through their Part D plans, he said, yet many feel the benefit could be improved.

Some are dissatisfied, he said, with a coverage gap known as a doughnut hole and the fact that covered drugs and other details vary from plan to plan, a departure from the standardized medical benefits provided through the traditional Medicare program.

Literally dozens of plans are available in Allegheny County alone. Enrollment in the plans began in November and coverage started Jan. 1.

As interest in Part D grew, many insurers, government agencies and community groups added staff to handle questions and help consumers enroll. Mr. Kubit said his program, operated by the Lutheran Service Society, expanded its staff of trained volunteers from about 20 to more than 30.

Ms. Gariti, 57, said making a decision on coverage was not easy. "When you call the different insurance companies, of course they want to sell their product," she said.

She investigated Part D plans for herself and her son Michael, 24. Both qualify for Medicare because of disabilities.

Ms. Gariti, who suffers from depression, a thyroid problem and other health conditions, said she was interested in Part D because she was paying hundreds of dollars a month for coverage through a private plan.

Her son, who had a head injury a decade ago that left him in a coma for weeks, has weakness on his left side, migraine and other health problems. He had received his medicine through an assistance program for people with low incomes.

But drug manufacturers said he would no longer be able to get some drugs through the program because he was eligible for Part D, Ms. Gariti said. He was automatically enrolled in a Part D plan by his Medicare HMO, but that plan did not cover all of his prescriptions.

She soon settled on a different Part D plan for each of them, but wasn't comfortable with her choice.

"All decisions I have to make on my own are difficult for me," she said, noting that her husband, John, died in November 2001. "We always worked together on everything."

She turned to Apprise and said Mr. Kubit was knowledgeable and explained Part D in terms she could understand.

A longtime Lawrenceville resident, Mr. Kubit, 54, developed an expertise in health plans through a roundabout route.

After receiving bachelor's and master's degrees from Duquesne University, he intended to become a teacher or school librarian. Instead, he got involved in local politics.

He held county and state jobs before going to work as an assistant for Tom Flaherty when he served on the City Council and, later, as city Controller. Mr. Kubit then was a district justice in Lawrenceville for six years, but lost a re-election bid in 1993.

Out of a job, he began working for a temporary service, which sent him to HealthAmerica, which was developing an HMO in the Pittsburgh area. Soon, HealthAmerica hired him as a customer service representative.

He held similar positions with two other health plans, a pharmacy benefits manager and a durable medical equipment company before coming to Apprise in 2003.

Mr. Kubit said his background with the plans and in teaching prepared him well for the job. "I feel I fit here like a glove."

To contact Apprise in Allegheny County, call 412-734-9330. For information on other Apprise programs in Pennsylvania, call 1-800-783-7067.