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Where's the Benefit?

Raymond Parker of Reston has Parkinson's disease and needs a combination of about nine medications.

"A brand name costs me about $250 to $300 per month just for one medication," said Parker. "Then there's the meds for blood pressure and thyroid and who knows what else. It's very difficult to make ends met when you have a chronic illness."

Parker, who is on Social Security disability, gets some relief from the mounting medications bills through a patient's assistance program.

Even so, he is critical of the recently passed Medicare reform legislation, which created a prescription drug plan for seniors and those with disabilities.

"The program would be restrictive for me because my Parkinson's disease costs are out of sight. I don't consider the legislation any good. It may look good to politicians because the lobbyists put money into their pockets to protect them. It may help some, but not me."

LAST WEEK, Congress passed legislation that would in effect create a prescription drug benefit program, allowing seniors and those on disability to pay less for their prescriptions. Under the bill, according to the U.S. government's official Medicare Web site, Medicare will provide discount cards to people enrolled in Medicare as early as this spring. The cards will provide a 10 to 25 percent discount on prescriptions. Additionally, for individuals with an income less than $12,124 or a married couple whose income is less than $16,362, a credit of $600 is available for those who qualify.

Then beginning in 2006, Medicare recipients could voluntarily sign up for one of two benefit plans. The first, for those in the Original Medicare Plan, a prescription drug plan is available. The second, the Medicare Advantage Plan, would allow people with Medicare to enroll in a private health plan, which could be a Health Maintenance Organization or a regional Preferred Provider Organization. This plan would offer drug coverage along with other medical benefits, the Web site reports. For those receiving Medicare with prescription drug coverage through a former employer, Medicare will help the employer cover the costs.

"Millions of people who don't have prescription coverage at all will have it under this legislation," said Tony Hylton, the communications director for AARP Virginia, which supported the bill. "For the folks it helps, it's significant."

BUT HYLTON admits the bill has what he called "a doughnut hole." Under the approved legislation, when the bill is fully implemented, there will be a $250 deductible and a premium of about $420 per year, for recipients. After meeting the deductible, the insurance would pay 75 percent of the prescription costs up to $2,250.

"I think anybody who takes prescriptions, and I'm one of them, thinks [the drugs] are extremely high priced," Hylton said. "Medicare has been around for 35 years. When it first started, prescription treatment of an illness wasn't as prevalent as it is today. The argument could be made that if Medicare was started today, it would include prescription coverage."

Hylton said the bill is only a first step and that he expects AARP to continue to monitor the implementation, and when needed, lobby for more changes.

While this may be a first step, some seniors say it doesn't go far enough.

"I only take blood pressure pills, so this doesn't help me much," said Mary Money of Lake Anne. "They could do a lot better for the seniors."

Money said that after paying rent, there isn't much left in the bank to pay for anything else.

"If it wasn't for the patient assistance program I couldn't survive. My wife also has a ton of prescriptions for ailments and over-the-counter nutritional supplements. She was close to death a couple years ago," Parker said. "Between that and expenses in general — our mortgage, which is lower than in most areas around here, food, condo fees — our income is still in the negative plane."

He said he hopes this legislation does not affect other drug-assistance programs as a result.