Some Medicare Beneficiaries Enrolled in Two Drug Plans
Some Medicare beneficiaries who have switched drug plans are actively enrolled in two plans, creating confusion for insurers and pharmacists and placing beneficiaries "at risk of being charged two premiums or incorrect copayments," the New York Times reports.
In a recent memo to insurers, the Bush administration said that government "processing systems have not always sent the enrollment and disenrollment information to the appropriate plans" when beneficiaries switch plans. As a result, "many (possibly all) of the beneficiaries who switched plans are active on enrollment files at multiple plans," the memo said. In addition, some "[p]lans have paid claims for beneficiaries who are no longer enrolled in their plan," it said.
When a beneficiary switches drug plans, Medicare is supposed to send a disenrollment notice to the original plan and a confirmation of enrollment notice to the new plan, the Times reports. However, Medicare in some cases "mistakenly sent both notices to the second plan, so the first plan did not know that the person had left its rolls," according to the Times.
The problem affects "tens of thousands" of beneficiaries and might explain why many individuals who qualify for a low-income subsidy under the drug benefit mistakenly were billed for premiums or charged high copays, the Times reports. According to the Times, "when a beneficiary switches plans, Medicare typically provides information on the person's low-income status to only one of the two plans," while the other plan might "still be providing coverage without realizing that the person is entitled to a low-income subsidy."
In addition, some drug plans have stopped processing disenrollments because they have been unable to verify the accuracy of notices they received from the government.
CMS said it is working with insurers to address the "enrollment discrepancies" but cautioned that a sweeping mass disenrollment could cause a surge of inquiries from beneficiaries to insurers and Medicare. The government also said it would work with insurers to determine which drug plan should have paid which claims, so that drug plans can reimburse each another.
Marisa Duarte of the Atlanta regional CMS office said federal caseworkers can "verify the exact plan" a beneficiary is enrolled in, adding, "We are still working out system glitches, so having someone enrolled in two plans is common."
Jane-Ellen Weidanz, Medicare project manager at the Oregon Department of Human Services, said, "There appears to be a fundamental flaw in the Medicare computer system that transmits information on enrollment of clients and their low-income status." Weidanz said that when the problem occurs, the first plan a beneficiary enrolled in will have the low-income information, but the second plan will not (Pear, New York Times, 3/1).
In other Medicare news, Democratic lawmakers on Tuesday said they would try to attach measures that would change the drug benefit to any "must-pass legislation" available, CQ Today reports. Democrats said they held 130 meetings about the drug benefit in 27 states over Presidents' Day weekend, "as part of an intensifying political effort to capitalize on the problems with the implementation of the program," according to CQ Today.
Sen. Carl Levin (D-Mich.) said, "There will be those who will argue that these bugs will be worked out over time, and maybe they will." He added, "But there are more than start-up bugs. There are structural problems."
A few Republicans have expressed support for some legislative changes to the drug benefit, including Sen. Olympia Snowe (R-Maine), who has introduced a bill (S 2168) that would extend the May 15 enrollment deadline until the end of the year.
In addition, Sen. Gordon Smith (R-Ore.) said he would support legislation that would reduce the number of plans each insurer can sponsor.
However, Sen. Trent Lott (R-Miss.) said, "There may be a need to improve it down the road, but now we need to give administrators a chance to work through the bumps in the road" (Crowley, CQ Today, 2/28).
New Hampshire Gov. John Lynch (D) planned to issue an executive order on Wednesday that would extend an emergency assistance program to pay for prescriptions for beneficiaries who have been unable to obtain medications under the drug benefit. The state had paid for medications for 898 beneficiaries as of Monday, with about 20 individuals seeking assistance daily, Lynch said (AP/Foster's Daily Democrat, 2/28).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.