About seven million people without any prior drug coverage have enrolled in prescription drug plans through the Medicare drug benefit, and federal officials are hoping to make deep inroads into the pool of eight million more who have not signed up. It’s a last minute push until the May 15 deadline.
HHS Secretary Mike Leavitt said he is hopeful that 90% of the 42 million people enrolled in Medicare nationally will have drug coverage by the close of this enrollment drive. That would include retirees who have employer-sponsored coverage, members of HMOs, and Medicaid beneficiaries automatically enrolled by the government, as well as those without any coverage who were signing up for the first time. A special enrollment drive in California is “putting a lot of effort” into a two-bus tour, starting April 18 and traveling to Stockton, Sand City in Monterey County, Westminster, Long Beach, San Francisco, Oakland and Redding, according to Jack Cheevers, spokesperson for the western region of CMS. At each stop, counselors equipped with laptops linked to the CMS Part D plan finder will be able to show Medicare beneficiaries the details of different plans and enroll them on the spot if they decide to pick a plan. Anyone already enrolled in Medicare can sign up for the voluntary Part D benefit.
California counselors have reported a slowdown in calls from the public for help. But they expect another surge as the May 15 deadline nears, according to Aileen Harper, director of the Center for Health Care Rights in Los Angeles.
There are several hot issues on the table.Subsidies for Low-Income Beneficiaries
There is a substantial group of people who qualify for extra financial help under Medicare Part D. More than 1.5 million people have been ruled eligible after the Social Security Administration sent out 19 million letters inviting people to apply for the program.
To qualify, beneficiaries must meet a two-step test for income and assets. For the maximum financial help, the income limit is $12,920 for a single person and $17,321 for a married couple. Assets, excluding a person’s home and car, are limited to $6,000 for an individual and $8,000 for a couple.
Someone who qualifies for the maximum amount of extra financial help, called a “limited income subsidy,” will be exempt from paying any monthly premiums or deductible for the prescription drug coverage under Part D. These beneficiaries will pay only $2 copayments for generic drugs and $5 copays for brand-name prescriptions.
There is a sliding scale for the amount of extra financial subsidy, depending on income and assets.
The Social Security Administration reviewed applications from about six million people and notified 1.6 million that that they were eligible for extra financial help under Part D, but beneficiaries must enroll in a Part D plan themselves to receive the subsidy. Under a policy announced this month, CMS will allow “ongoing” enrollment in the Medicare prescription drug benefit for beneficiaries who qualify for the extra financial help. This means people who are eligible for the extra assistance can continue to apply for subsidy from Social Security, and if they are approved, can select a Part D plan even after the May 15 deadline.
People who have already been certified by Social Security as eligible for the extra financial help but who have not yet selected a Part D plan, will be automatically placed in a Part D plan by CMS next month.Copayments for Dual Eligibles
Before the Medicare drug benefit took effect on Jan. 1, state residents who were dually eligible for Medicaid and Medicare received prescription drug coverage through state Medicaid programs. The 2003 Medicare law transferred drug coverage for this group to the federal government under Medicare Part D.
The Medicare drug benefit has been an improvement for residents of states where Medicaid programs had less expansive drug coverage than Medi-Cal. However, for dual eligibles in California, it can be a setback, Harper said.
Under Medi-Cal, dual eligibles received medications at no cost, but they will have to pay $1 for each generic prescription and $3 for a brand-name drug under the Medicare drug benefit.
For these people, the payments can be a hardship. Someone who has 10 or 15 prescriptions to fill each month can have difficulty coming up with the cash, Harper said. Hundreds of people call to ask for help, only to be told there is no program that will provide assistance to them in making the copays.
Federal rules say states can use their own funds to make the $1 and $3 copays on behalf of Medicare beneficiaries. Cheevers said that a number of states, including Nevada and Hawaii, have decided to cover the copays, but added that California has chosen not to cover the copays. “It is up to the governor and the Legislature if they want to do so,” he said.
The copays were placed in the 2003 Medicare law “to make people more conscious of what drugs they are taking, to be aware there are cheaper versions of brand-name drugs, to be more selective in how they purchase drugs,” Cheevers said.
California is continuing to provide emergency funding for prescriptions for dual eligibles when pharmacies are unable to collect payment from a Part D plan. This resulted from the confusion that transpired when people were automatically assigned to Part D plans and the records were incomplete or the plans didn’t have accurate information on who was enrolled.
The emergency legislation, which took effect Jan. 12 and has been continued several times on a 30-day basis, has now been extended through May 16.Unraveling Double Enrollment
A heavily publicized account from HHS Secretary Mike Leavitt about helping his parents enroll in a prescription drug plan under Part D illustrates another issue that might generate pleas for help from beneficiaries.
Leavitt, who will be on the California bus tour, spent several hours discussing medications with his parents and enrolled them in a prescription drug plan. Later, they had to disenroll because his father’s retiree coverage included prescription drugs and his enrollment in a Part D plan would have jeopardized his retiree coverage. You can’t be enrolled in two plans at once.
Some people have been automatically assigned to one Part D plan but voluntarily enrolled in another plan. The federal government is now sending letters to beneficiaries telling them they should pick one plan or the other. Understanding the letters, and acting on their instructions, could be complex and confusing, making more busy days for Medicare counselors throughout California.
After all, if the HHS Secretary makes a mistake in choosing a Part D plan for his parents, why should dealing with Part D be easy for other people?KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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