Health Care Companies To Begin To Market Medicare Prescription Drug Plans on Saturday
Health care companies that have contracted with CMS to provide prescription drug benefits to Medicare beneficiaries can begin advertising their plans on Saturday, USA Today reports (Welch, USA Today, 9/30).
CMS officials announced last week that 10 companies have been approved to offer stand-alone prescription drug plans through Medicare on a nationwide basis, and Medicare beneficiaries in all regions of the U.S. will have their choice of several prescription drug plans. In addition, several companies have been approved to provide coverage on a regional basis.
As a result, beneficiaries in all states will be able to choose among at least 11 stand-alone drug plans, and beneficiaries in heavily populated states, such as New York and Texas, will have a choice of as many as 20 plans (California Healthline, 9/26). Beneficiaries can enroll beginning Nov. 15 (USA Today, 9/30).
Some health care experts are warning that beneficiaries will need to examine the benefits of each plan closely to find the plan that best fits their needs. "There are all kinds of opportunities for confusion here," JoAnn Volk, a legislative representative for the AFL-CIO, said.
According to the South Florida Sun-Sentinel, some have expressed concern about a rule that prohibits beneficiaries from having two prescription drug benefits simultaneously. They worry that beneficiaries who are enrolled in a Medicare Advantage plan that provides prescription drug coverage or have retiree prescription drug coverage could "inadvertently" sign up for a stand-alone plan. Those beneficiaries would be dropped from their existing plans automatically and would be enrolled in traditional, fee-for-service Medicare, resulting in loss of coverage for extra services, such as eyeglasses and hearing aids.
CMS spokesperson Peter Ashkenaz said federal officials will notify health plans when their members have been dropped for this reason, and insurers then will be able to contact those members and ask them if the switch was accidental. Seniors who switched coverage by accident will have one chance before May 15, 2006, to revert to their previous coverage, the Sun-Sentinel reports.
However, officials for Humana said the provisions of HIPAA prohibit them from contacting seniors and asking them if they purposely dropped their coverage. Company spokesperson Barbara Kerr added that Humana will not know a Medicare beneficiary has dropped Humana coverage until CMS notifies company officials, after the beneficiary already has switched coverage. "There is no safety net in place, no internal flagging mechanism," Kerr said.
UnitedHealthcare spokesperson Dominick Washington said the company believes its efforts to educate Medicare Advantage beneficiaries will help prevent such mistakes. UHC has distributed to members a guide to the new benefit and soon will send a letter to members warning them that enrolling in a stand-alone prescription plan or another Medicare Advantage plan will invalidate their UHC coverage (Lade, South Florida Sun-Sentinel, 9/30).
In related news, the House on Thursday approved a "stopgap spending measure" (H J Res 68) that would keep most government programs operating past the end of the 2005 fiscal year on Sept. 30 through Nov. 18 and would provide funding to implement the new Medicare prescription drug benefit. According to CQ HealthBeat, only two of the FY 2006 appropriations bills have been signed into law so far, including the Interior-Environment bill and the Legislative Branch spending bill.
The continuing resolution would establish spending levels at the FY 2005 level, the House-passed level for FY 2005 or the Senate-passed level, whichever is lowest. The Senate was expected to take up the resolution on Thursday unless it became "bogged down in efforts to amend the bill to include additional spending," CQ HealthBeat reports (CQ HealthBeat, 9/29).