How Wrong and for How Long?

The Centers for Medicare and Medicaid Services (CMS) admitted this week that it has not yet begun processing enrollment applications into prescription drug plans. CMS explains that it has been swamped with the auto-enrollments of people transitioning from Medicaid drug coverage.

The backlog includes people now receiving Medicaid drug coverage who were assigned to a Part D plan that does not cover all their drugs and want to switch before Medicare takes over their coverage on January 1.

Last month, CMS acknowledged that the drug prices on its plan finder web tool may be wrong. The web tool, which is supposed to allow people with Medicare to compare the value of the 40 plans they have to choose from, now sports a disclaimer saying that its results may not be, well, quite right.

And all around the country, people are complaining about the service they are getting from 800-MEDICARE. The hotline operators seem unable to provide callers with the help they need to make an informed decision on the best drug plan for them. From New York to California, the CMS hotline is referring callers in droves to overstrapped community-based organizations.

Cut us some slack, CMS says. It's a big job processing all these enrollments and we're getting up to speed. We're trying to fix the errors on the plan finder. The hotline operators will get better training.

Fair enough: the White House and the Congressional leadership created an unsightly mess in designing the Part D drug benefit.

But what about older Americans and people with disabilities who are the victims of this mess? Can they catch a break?

Yes, they can.

There is a bill awaiting passage by Congress that would provide at least some help.

It would extend the open enrollment period, which now ends on May 15, through the end of next year. No one who signs up for a drug plan during 2006 would get a late enrollment penalty tacked on to their monthly premium.

Everybody would get a chance to switch plans at least one time during the year. This will protect people with Medicare who sign up for a plan based on erroneous pricing information on the CMS plan finder. It also provides some recourse against plans that curtail the drugs they cover during the course of the year or jack up prices on the drugs they do cover.

The bill also protects older Americans who could lose retiree health coverage because of all the confusion surrounding the new drug benefit. Some companies are cutting off their retirees from all health coverage-for doctor and hospital visits-if they enroll in a stand-alone drug plan. (Once the retiree switches to a stand-alone plan, the company loses the subsidy it receives for providing drug coverage.)

The bill bars any company receiving the drug subsidy from cutting off health benefits during 2006 to a retiree who enrolled in a Part D plan. This is an especially important protection for retirees who also have Medicaid coverage, often because a stroke or other health crisis put them in a nursing home. These vulnerable men and women were auto-enrolled in Part D plans by CMS, putting them at risk of losing the health coverage they receive from their former employer.

Click here to send a letter to your members of Congress telling them to cut people with Medicare a break by cosponsoring the Medicare Informed Choice Act (MICA) S. 1841/H.R. 3861.

Medical Record

The Medicare Informed Choice Act is a simple bill with three important protections:

• Delays Late Enrollment Penalties: The bill expands the existing six-month open enrollment period to the entire 2006 calendar year. This will give people added time to do the research and make the best decisions for themselves.
• Offers Some Protection Against Bad Choices: The bill gives every person with Medicare the opportunity to make a one-time change in plan enrollment at any point in 2006. Given the importance of the decision older Americans are making, it is appropriate to give them a one-time chance to correct an initial mistake made during the first year of implementation.
• Protects Employer-Provided Retiree Benefits: This provision would protect employees from being dropped by their former employer's plan during the first year of implementation, so that they have time to correct enrollment mistakes.

(The Medicare Informed Choice Act of 2005, S.1841, introduced October 6, 2005)

Medicare officials said a glitch in the Medicare Plan Comparison tool that people with Medicare use to compare prescription drug policies is artificially inflating some annual cost estimates. A computer data problem was artificially inflating drug prices for a plan called Medicare RX Rewards Premier, offered by Unicare ("Glitch Inflates Medicare Drug Costs," USA TODAY, November 29, 2005).

A test by the Government Accountability Office (GAO) in 2004 on the accuracy of Medicare's toll-free hotline found 29 percent of callers received inaccurate answers, while 10 percent got no answer at all. Only 61 percent of calls were answered correctly. The federal investigators found that the 800-MEDICARE operators "did not seem to know enough" to choose the right script to answer the caller's question or did not understand the script as it was written ("Accuracy of Responses from the 1-800-MEDICARE Help Line Should Be Improved," Government Accountability Office, December 2004).

This tool provides useful information to help people review plans based on their current drug needs. It displays estimates of a person's annual drug costs under different drug plans based on his or her current drug use and pharmacy preference. These estimates may vary based on the specific quantity, strength and/or dosage of the medication; the order in which a person purchases prescriptions; and the pharmacy one uses (Medicare Prescription Drug Plan Finder, Last Accessed November 30, 2005).

Fast Relief

The Medicare Rights Center, with support from the Brookdale Foundation, is offering an Rx hotline (877-RXHELP-0) for nonprofit professionals who serve people with Medicare.

If you need help understanding or explaining the new Medicare prescription drug benefit to your clients, call RxHelp, a national hotline dedicated for nonprofit professionals serving the Medicare population, operated from 10 a.m. to 6 p.m.

Dial 877-RXHELP-0 (877-794-3570) today!