Health Care


From NPR News, this is All Things Considered. I'm Jacki Lyden. You may have recently gone through open season where you work, you know, the once-a-year opportunity to change benefits like your health insurance. Well, the Medicare Prescription Drug Insurance Program has its own open season, and it's happening right now. The choice can be pretty complex - low premium plans, higher cost plans that carry more brand name drugs, plans that may pay costs right through that notorious doughnut hole where insurance suddenly stops paying until you spend a lot more money. Open season ends on Wednesday, December the 31st, and this year it's especially important to pay attention to the options. Some of the big insurers have changed their plans quite a bit. Robert Hayes joins us from our New York bureau. He's head of the Medicare Rights Center, a non-profit organization that, among other things, help people figure out what to sign up for. So, Mr. Hayes what exactly has changed this year?

Mr. ROBERT HAYES (Head, Medicare Rights Center): Well, this is now the fourth year we're going into the Medicare prescription drug benefit, and many of the largest plans, the ones that had drawn the most subscribers, have dramatically increased their monthly premium costs, so it really does require people to take another look and see what plan will work for them in 2009.

LYDEN: Do those plans have a name like Plan A, Plan B?

Mr. HAYES: Well, there - it's one of the problems. There in any given market place could be more than 50 different plans that people have to examine to see whether or not they're getting the best deal they can. What that means, ironically, is you really do need to go to pretty sophisticated Internet technology to fight your way through the marketplace, and the problem of course is most people with Medicare, most of them 65 and older, have never used the Internet, so it has created a bit of an unfair marketplace for the consumer.

LYDEN: I guess the basic question is, are people going to be able to get the same drugs they got last year at the same price?

Mr. HAYES: Well, probably not, because across-the-board drug pricing has gone up and the cost to consumers is going up.

LYDEN: I understand that some of these plans have added a lot more paperwork where the doctor has to certify that a patient really needs a particular drug. Is there some reason for that?

Mr. HAYES: Well, yeah and some good reasons, some bad reasons. The first thing a consumer needs to look at is to see whether or not the plan they are now in, or considering going into, covers the drug that they are currently taking. Now coverage of a drug you have to look at two things: one, is it on the list of covered drugs? That's the easy part, but the paperwork you refer to has to do with often having coverage within one of these plans only after a doctor has filled out some forms attesting to the fact that no other medication will work for the patient and sometimes it's pretty tough to get a doctor who does not get paid for this service to do that.

LYDEN: So what is the best way to go about choosing a plan? You mentioned that there's lots of competing information, sometimes 50 different plans.

Mr. HAYES: The best thing to do is find someone who can work with you if you're a person with Medicare, not comfortable with the Internet. If you're comfortable with the Internet, go to the government's website or the Medicare Rights Center website, go to and begin comparing with these Internet tools, the kinds of comparisons that the plans have. To do that though, you have to have a list of the drugs you're taking, you have to kind of be a person of faith, because no matter how smart you are in January, you don't know for sure what drugs you'll be taking in November, so you have to recognize there'll be some wiggle room, and then figure out what would be the best plan based on the two or three plans that these Internet tools can kick out.

LYDEN: OK. Well, thanks very much. Robert Hayes is the head of the Medicare Rights Center, and he joins us from New York. Thank you again.

Mr. HAYES: Thank you so much.

LYDEN: And for more information about places that can help you, or someone you know, choose the right Medicare drug plan, go to

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