Medicare Ends Automatic Enrollment for Dual Eligibles

About 632,000 Medicare beneficiaries who were automatically enrolled by the government in the Medicare prescription drug benefit for 2006 will not be automatically re-enrolled in 2007 and will have to sign up for Medicare drug plans on their own, the AP/San Francisco Chronicle reports.

When the drug benefit began, drug coverage for dual eligibles -- beneficiaries eligible for both Medicare and Medicaid -- was transferred from state Medicaid programs to Medicare, and the federal government automatically enrolled dual eligibles in private Medicare drug plans. Some of those beneficiaries are no longer enrolled in state Medicaid programs and therefore will not be automatically enrolled into Medicare drug plans for 2007, according to CMS.

Affected beneficiaries who wish to remain enrolled in the Medicare drug benefit must shop for a plan and enroll on their own during the upcoming open enrollment period, which begins Nov. 15.

Kathleen Harrington, CMS director of external affairs, said the agency will allow the affected beneficiaries to enroll in plans for an additional three months after the regular open enrollment period ends on Dec. 31. Harrington said CMS last month sent a letter to those beneficiaries instructing them that they also should apply for the low-income subsidy that allows access to plans with low or no premiums.

Some advocates are concerned that many of the 632,000 beneficiaries will "fall through the cracks" and not realize that their drug coverage has lapsed until they try to fill prescriptions in January, the AP/Chronicle reports.

James Firman, president and CEO of the National Council on Aging, said, "We believe many, if not most of the people, simply won't respond to a letter. Many won't read the letter, they won't understand the letter, they won't know how to fill out the application form." Firman said that NCOA has found that about 20% of low-income seniors generally respond to letters, adding, "We're talking about a population that's sick, may have low literacy. There are a lot of challenges. What they need is one-on-one assistance from trusted intermediaries."

According to the AP/Chronicle, some of the beneficiaries "who lost their Medicaid coverage may have lost eligibility because they're making more money and no longer qualify for the extra help."

However, Firman said it is "more likely that some states tightened eligibility requirements, or the individual did not complete all the paperwork needed to be recertified for Medicaid."

Harrington said CMS has informed insurers who market Medicare drug plans of which former dual eligibles will need to enroll on their own, adding, "It's very much in the interest of the plans to keep them in coverage" (Freking, AP/San Francisco Chronicle, 10/19).