MEDICARE PLANS STILL A MUDDLE FOR MANY.

Byline: JULIA M. SCOTT Staff Writer

Medicare Part D might have high satisfaction rates, but word on the street is that the prescription drug plan is still confusing for seniors.

``I'm not even sure I got the right plan,'' said Joey Goluch after he picked up two prescriptions at Rite Aid in Woodland Hills. The retired engineer spent six months sifting through medical plans before he signed up recently.

Seniors can enroll or change their plans until Dec. 31 but are asked to do so by Dec. 8 to ensure their new plans kick in Jan. 1.

About 90 percent of seniors who were eligible signed up last year and just a fraction of them are expected to switch, according to Laura Perry, spokeswoman for Health Net, a health care provider.

In Los Angeles County, there are 30 plans to choose from, Perry said, including ones that cover gaps in prescription benefits, called the doughnut gap.

This year, seniors must pay for drugs out-of-pocket after receiving $2,400 in benefits. Coverage kicks back in at $5,451.25.

Of 43 million people who signed up nationwide, about one in 13 reached the gap.

Even though the sign-up process was cumbersome for many, three out of four seniors said they were satisfied with the plan they selected and its coverage, according to a J.D. Power survey of 3,400 seniors in September.

With so many people already signed up and surveys returning high satisfaction results, Nelligan doesn't understand continuing confusion about the program.

``You have that satisfaction rate,'' he said. ``I'm not sure how so many people are confused.''

Medicare Part D has saved seniors $1,200 on average, with average monthly premiums at $24, Nelligan said.

If coverage has increased for seniors, it has also crunched the cash flow at pharmacies.

Alireza Alibanaei, who runs Basso Pharmacy on Fallbrook Avenue in Woodland Hills, says providers pay him once a month, but he has to pay drug companies every week.

That's not the worst of his problems.

Alibanaei, 42, has lost half his revenue because of the program, he said.

The reason?

Reimbursement rates for drugs through Medicare Part D are much lower than they were through Medi-Cal, he said.

Medi-Cal was known for high reimbursement rates, said Perry of Health Net.

``In the past five to seven years, Medi-Cal has historically paid the highest reimbursement,'' she said. ``People who were eligible for Medi-Cal and Medicare all got moved to Medicare, and so the reimbursement dropped.''

As a result, Alibanaei is looking for more cash clients by mixing creams for arthritis and skin ailments. Alibanaei is also filling more prescriptions for workers injured on the job even though they pay a few months later after the claim has been resolved.

In addition, Alibanaei loses $300 a month to low-income clients who can't afford their $1 and $3 co-pays.

``It's very hard to let them go without their medications,'' he said. ``I can't tell them I'm not going to provide them medicine anymore.''

Jim Scott, a retired Korean War veteran, is considering signing up for Part D, but said providers have not been able to get his address right. He is still waiting to receive all the paperwork describing coverage options.

``It's really aggravating,'' said Scott, 70.

For now he gets most of his drugs for glaucoma, high blood pressure and high cholesterol free from the Veterans Affairs Department.

[e-mail]

[phone]

To enroll or change your plan

Call 1-800-633-4227

Visit www.medicare.gov

Medicare Workshops by the Center for Health Care Rights

Nov. 29 at 9 a.m. at the Center for Healthy Communities, 1000 N. Alameda St., Los Angeles, CA 90012

Dec. 8 at 1:30 p.m. at the Santa Clarita Valley Senior Center, 22900 Market St., Santa Clarita, CA 91321

Register by calling [phone], Ext. 3019 or e-mail [e-mail].

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Medicare Workshops by the Center for Health Care Rights (see text)