As state drug plan ends, seniors scramble to cover costs
Susan Frick Carlman and Tina Akouris email@example.com, firstname.lastname@example.org September 28, 2012 5:04PM
Community Reource Worker Kathy Ellinger explains the Illinois Cares Rx choices in this photo illustration at the Will County Senior Center in Joliet, Illinois, Tuesday, August 14, 2012. | Joseph P. Meier~Sun-Times Media
Updated: November 2, 2012 6:11AM
A pretty big dent is left in Rivian Sarwer’s wallet after she covers a 30-day supply of two medicines she needs. The pair of prescriptions, which help the Wheaton resident manage her diabetes at a monthly cost of $550, are among a dozen medications she has to take daily.
Even if she weren’t in the “doughnut hole” period of the Medicare Part D program that has seniors footing the entire bill for their medications, Sarwer would be struggling to cover the costs. Partly to blame is the end of the Illinois Cares Rx prescription drug benefit.
When the Illinois Department on Aging sent out letters at the end of June notifying seniors that their coverage was being eliminated almost immediately, shock and rage were widespread. The program was set up to cover the medicines needed to treat at least 10 diseases that often come with aging — arthritis, cancer, diabetes and smoking-related illnesses, to name a few — and to pay a portion of the copayments seniors incurred if they enrolled in a corresponding Medicare Part D plan.
Without Illinois Cares Rx, not only do seniors have to pay more for their drugs, but they also must now pay a monthly premium for their Medicare Part D drug coverage. Most are less than $30, which may seem like a small sum, but for seniors on a fixed income, any extra expense can be painful.
“I was quite disappointed,” said Sarwer, 78. “It was really mind-boggling, to be honest with you — without notice, too.”
It’s not that there are no plan B programs. There are, but not everyone is eligible to receive their benefits.
Anne O’Hanlan, an intern hired in June specifically to field calls from seniors to DuPage County’s Community Services Department about the end of the plan, has discussed the alternatives with people who have called.
A prescription drug plan is one of the requirements of Medicare Part D, O’Hanlan said. A plan offered by AARP is very popular, she said, as is one provided through the First Health network. Other possibilities include Extra Help, which is available to low-income people on Medicare.
O’Hanlan said she also urged callers to switch to generic forms of their medicines.
“With a lot of the generic plans, you can get a 90-day supply for $10 at Walmart and some others,” she said.
For most of those who called the county for help, the concerns included premiums, deductibles and out-of-pocket costs.
“There’s quite a few plans, so they were interested in seeing whether there was another plan that was a lower cost for them,” O’Hanlan said.
Seniors can find other Part D plans during an open enrollment period. A new one begins Oct. 15 and will run through the end of the year. There also is the Coast2Coast Rx plan, available through township governments; more information is at www.coast2coastrx.com. Seniors can print a free card just by submitting their 10-digit phone number or any 10-digit number.
For some, including those unable to afford a prescription plan that would give them access to Medicare Part D, the options are limited. Louise Jacobs, manager at the Martin Avenue Apartments in Naperville, said many of those who live in the complex near Edward Hospital saw their costs rise sharply at the end of the state plan. Some were fortunate to qualify for government assistance.
“A lot of them are on Medicaid, so they aren’t affected by it,” Jacobs said.
For those whose income doesn’t enable them to take advantage of the benefit, sometimes a disability allows them to tap Medicaid support. The trouble is, many doctors refuse to accept Medicaid; some don’t take Medicare patients either.
“So they need to have a backup,” said Tom Marks, owner of the Martin Avenue Pharmacy in Naperville, which is not affiliated with the seniors’ apartment complex.
Some seniors resort to programs driven by medical necessity, but those commonly come with high deductibles and so are most useful for major medical expenses such as hospitalizations and surgeries. In some cases, Marks said, family members have limited ability to help.
“Their sons and daughters sometimes are out of work, so that’s a problem,” he said.
Marks also sees customers looking for ways to cut down the expense.
“They’re adjusting by cutting back their medications to something less expensive, if they can,” he said.
Sarwer is among those with few alternatives. She said she doesn’t qualify for plans that cover the cost of addressing diabetes and her other health issues. She’s also not the only senior who is struggling financially since state lawmakers killed the program.
Jean Andrysiak works four hours a week at Kohl’s in Downers Grove, driving to and from her home in Bolingbrook where she has lived since 1972. But Andrysiak, 72, has worked there about 12 years and recently had her hours cut from about 20 to 30 per week to single digits.
Besides her Kohl’s income, she receives about $1,277 monthly in Social Security payments. She has reduced her household expenses to the bare minimum, spending just enough for gas and groceries.
Andrysiak’s financial situation was tense even with help from the state plan for senior citizens. When it want away, her financial status took a dire turn.
Andrysiak has asthma and heart issues, which require her to take 13 prescriptions daily. The most expensive is Advair, an inhaler that helps control her asthma — and costs $298 a month. It was only $15 through Illinois Cares Rx; Andrysiak was paying about $200 monthly for all 13 medications when the program was still in effect.
She hopes to avoid taking the route some seniors have had to choose: moving in with their grown children and their families.
It is a safe option to move in with family, but it’s not a good fit for everyone.
“I’d rather be independent and not move in with my children,” Andrysiak said. “I would tell (Gov. Pat Quinn) to come down to our level and see how he likes it.”
Even among those who can manage the added expense, the demise of the benefit almost invariably has left a mark on household finances for those who used the state program.
“A lot of them didn’t have to pay premiums before,” O’Hanlan said. “So that was kind of shock to their system.”
Sarwer and her neighbors in the senior community where she lives are still feeling the sting.
“We are all kind of up in arms over the whole thing,” she said.