New York Times Examines Application for Medicare Prescription Drug Benefit Assistance
The Bush administration has sent out the first of about 20 million applications to people who might qualify for additional federal assistance under the Medicare prescription drug benefit, officials said Monday, the New York Times reports (Pear, New York Times, 3/29). The new Medicare law allows beneficiaries with annual incomes at or less than 150% of the federal poverty level and assets that do not exceed a certain level to qualify for at least partial discounts on drug benefit premiums, deductibles and other fees.
The Social Security Administration must contact Medicare beneficiaries who might quality for the additional assistance, and the agency plans to use a pilot program to identify potential problems with the 16-question application (California Healthline, 3/22). Under the pilot program, the application has been mailed to 2,050 beneficiaries in 42 zip codes in 21 states. The rest of the 20 million applications will be mailed by late May and will coincide with a large, nationwide effort to inform beneficiaries about the new drug benefit and the subsidies, according to Mark Hinkle, a spokesperson for SSA.
CMS Administrator Mark McClellan said the forms will be widely distributed "to reach everyone who may be eligible."
James Firman, president of the National Council on Aging, said some low-income beneficiaries could be confused or intimidated by the application form. Advocates for low-income beneficiaries said the form is so complex that they expect fewer than 5% of beneficiaries to respond.
Hinkle said it is likely too late to change the application forms, but the federal government will tailor public-education efforts to address questions about the application that are raised by beneficiaries participating in the pilot program (New York Times, 3/29).
In related news, two newspapers recently examined the March 31 deadline for low-income Medicare beneficiaries to apply for a $600 subsidy available for 2005 through the new prescription drug discount card program. According to the federal government, an estimated seven million Medicare beneficiaries qualify for the $600 subsidy for 2005, but only 1.73 million of those had enrolled as of Feb. 28. Eligible Medicare beneficiaries who enroll before March 31 will receive the full $600 subsidy, and those who enroll after that date will receive a $150 to $450 subsidy for the remainder of the year based on the date of enrollment (California Healthline, 3/22). Summaries of the articles appear below.
Atlanta Journal-Constitution: According to the Journal-Constitution, experts blame "widespread confusion" and a lack of awareness for the low enrollment. Marnie McDonough, a health insurance counselor for GeorgiaCares, said, "Seniors often don't understand the process and don't know how to sign up. A lot of seniors don't have access to the Internet," which is one of the sources CMS uses to provide drug card program information (Miller, Atlanta Journal-Constitution, 3/29).
- Oakland Tribune: Oakland Tribune reports that recent publicity efforts by CMS, AARP and the federal Administration on Aging "appear to be working." In the past several weeks, between 20,000 and 25,000 Medicare beneficiaries have enrolled in the program and qualified for the $600 subsidy, according to CMS spokesperson Peter Ashkenaz (Vesely, Oakland Tribune, 3/27).
CMS on Monday announced a pilot project to test recovery audit contractors, as well as several initiatives designed to improve Medicare billing. The new Medicare law directed CMS to investigate Medicare claims payments using RACs and to collect overpayments so that they can be returned to the Medicare trust fund. The RACs will examine payments made to providers more than at least one year ago to find incorrect payments that were not detected through existing program integrity efforts, according to CMS.
Current recovery audit contracts focus largely on Medicare Part A claims, which exclude evaluation and management services. McClellan said, "We need clear and straightforward rules to assure that fair payments are made for services to Medicare beneficiaries; and second, we need effective mechanisms in place to detect and respond to inappropriate billing" (CQ HealthBeat, 3/28).
WAMU's "The Diane Rehm Show," an NPR-syndicated program, on Monday included a discussion about the financial future of Medicare. Guests on the program included Joseph Antos, a scholar in health care and retirement policy at the American Enterprise Institute; Ron Pollack, president of Families USA; Julie Rovner, NPR health policy correspondent; and Thomas Saving, a Social Security trustee (Rehm, "The Diane Rehm Show," WAMU, 3/28). The complete segment is available online in RealPlayer.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.