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Oldest and Sickest at Risk as Medicare Juggles Rules

Drug Benefit Won't Be Automatically Extended to "Dual Eligibles" Next Year

By Truman Lewis
ConsumerAffairs.com

October 27, 2006

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In a change likely to sow yet more confusion around an already confusing program, the federal government has told about 632,000 elderly and disabled people they won't be automatically enrolled in a Medicare drug plan next year, unless Congress enacts a last-minute change when it returns for its lame-duck session.

These so-called "dual eligibles" -- the frailest and most vulnerable Medicare beneficiaries -- are still eligible to participate in the drug benefit, but they will have to shop for a plan and then enroll on their own rather than the government doing it for them.

To afford the benefit, many will also need to apply for a low-income subsidy. Advocates for the elderly are concerned that many will not be able to jump through all the hoops.

"I am concerned that many could fall through the cracks by missing the letter informing them of the change, and then not know they don't have coverage until they show up at their local pharmacy in January," said Ruben Burks, Secretary-Treasurer of the Alliance for Retired Americans, an AFL-CIO affiliate.

James Firman, president of the National Council on Aging, agreed.

"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," he said.

Firman said that NCOA has found that only 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."

Confusion Reigns

During the first year of the drug benefit, the dual eligibles were automatically enrolled because they participated in both Medicaid and Medicare and represented the sickest and most vulnerable among the elderly and disabled.

The federal government wanted to ensure that they did not lose access to prescription drugs.

But states have informed the federal government that some of those beneficiaries no longer are enrolled in their Medicaid programs, and thus they will no longer be automatically enrolled in a drug plan.

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, Medicare officials implied explaining the change. But 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."

The Centers for Medicare and Medicaid Services recognizes that some in the group may miss signing up for a drug plan during the next open enrollment period, November 15 though December 31.

It has granted the group an extra three months to enroll in a plan without the prospect of a penalty for late enrollment.

AARP Asks Congress to Act

AARP, the nation's largest advocacy group for seniors, is asking Congress to straighten out the latest kink in the confusing and controversial drug benefit plan.

"We urge you to ensure that ALL Medicare beneficiaries, including our nation's lowest income seniors and people with disabilities, are eligible for the new Medicare prescription drug benefit," AARP and a number of other seniors' groups asked in a letter to conferees working to reconcile House and Senate bills.

The House provision would enable dual eligibles to receive their prescription drug benefit primarily through Medicare with wrap-around benefits provided through Medicaid. The Senate bill excludes the more than 6 million dual eligibles from their bill.

AARP said that "would result in our poorest and often the sickest beneficiaries being denied good drug coverage that would be available to all others under Medicare."

Excluding coverage for the dual eligibles also sets up an administrative nightmare as Medicaid beneficiaries would be forced to switch back and forth between Medicare and Medicaid prescription drug coverage depending on the beneficiary's health status, the letter argued.

"Furthermore, it undermines the universality of the program and a promise President Bush made that all seniors should have coverage under a prescription drug plan," AARP added.

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