Medicare prescription drug card: Too much choice

Last month, I reviewed Barry Schwartz's provocative new book, The Paradox of Choice. The author argues that if people had fewer choices to make and attached less psychological weight to each decision, we might all feel less stressed and more satisfied. As an example of the problem Schwartz examines, I discussed the experience my daughter had when deciding on a health care plan at her new job.

This month, millions of Medicare recipients who lack prescription drug coverage face a similar problem: how to choose among the prescription discount cards available to them between June 1 of this year and January 1, 2006, when the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 takes full effect. Seniors must make this high-stakes decision in the face of complex rules and shifting information. To me, it seems the epitome of "choice overload."

Seniors covered by Medicare who lack prescription drug coverage may purchase a Medicare-approved discount card from a private pharmacy or insurance company. The cards vary in cost, up to $30 per year. Each card issuer determines which drugs will be covered and how great the discount is, ranging from 10% to 25% of retail cost. (Low-income seniors are eligible for a $600 cost subsidy in addition to the discount.)

To assist seniors in determining which card will provide the greatest savings, Medicare has posted an online calculator. The calculator is supposed to return a list of available plans, including formularies and prices, based on the individual's ZIP code and drug regimen.

I tried the online calculator, using the four prescription drugs my husband takes. I had to answer eight questions (including ZIP code) on the initial screen, list the drugs on the second screen, and continue through four additional, densely worded screens before I reached the "Savings Card: Program Comparison." There I found a list of 35 plans that covered all four drugs and were available at retail pharmacies within a half mile of our home. Each plan was valid at up to eighteen pharmacies in the area (presumably listed elsewhere on the site). Card prices ranged from zero to $30 dollars, in addition to monthly drug costs from $208 to $244.

And that's not counting the six additional plans listed under "Programs not in selected area or currently no information available." Or the fact that I could sort the results by card price OR monthly drug costs -- but I couldn't see a result that combined both factors. Or the indescribably confusing results on the following screen, where I landed after randomly selecting a plan so that the program would allow me to continue beyond the screen where I was stuck.

No wonder the seniors John Leland interviewed for his recent New York Times article , "73 Options for Medicare Plan Fuel Chaos, Not Prescriptions," were confused, scared, nervous, enraged, or all of the above.

My only reservation about John's article is that he interviewed only seniors. A younger person might cavalierly assume the interviewees' reactions were due to age or lack of computer literacy. As a computer-savvy boomer with more years of education than I care to count, let me tell you: The online calculator is guaranteed to increase confusion, not promote clarity.

If that's not bad enough, the posted drug prices fluctuate weekly, as highlighted in yesterday's Wall Street Journal. Since seniors are locked into whatever choice they make through the end of the year, Medicare officials are subtly encouraging people to wait until the dust settles.

Judging by the Journal's tips for "navigating the Medicare site," the process is daunting even for its upscale readers. Cautioning that "some Medicare beneficiaries and their families might find the government's drug-card Web site confusing" (my italics), the Journal lists five suggestions that require close attention in their own right. "Intuitive" is apparently a foreign concept to those who designed and approved the online prescription drug calculator.

People who believe that choices like this are a blessing should imagine the following scenario: You're 85 and in failing health. More than fifty per cent of your limited income goes for prescription drugs. You live alone, don't hear well, don't have a home computer, and don't relish the thought of discussing your prescriptions with a staff member at the local senior center or public library.

Now, go to the Medicare site -- pill bottles in hand, as the Journal recommends -- and decide which plan is best for you.

Let me know if you found the exercise any easier than I did.