By KEVIN FREKING, Associated
Press Writer
Wednesday, October 18, 2006
(10-18) 13:20 PDT WASHINGTON, (AP) --
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.
These people 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.
Some advocates are concerned that many of the 632,000 could fall through
the cracks, not knowing they don't have coverage for their medicine
until they show up at their local pharmacy in January.
"We're very concerned. We believe many, if not most of the people,
simply won't respond to a letter," said James Firman, president and CEO
of the National Council on Aging. "Many won't read the letter, they
won't understand the letter, they won't know how to fill out the
application form."
During the first year of the drug benefit, the so-called "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, thus
they will no longer be automatically enrolled in a drug plan.
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 — Nov. 15 though Dec. 31. It has granted the group
an extra three months to enroll in a plan without the prospect of a
penalty for late enrollment, said Kathleen Harrington, director of
external affairs for the agency.
Harrington said the group was also told in the letter last month that
they should apply for the low-income subsidy, which could give them
access to a drug plan with little or no monthly premium. She also said
that the insurers themselves have been told who will need to apply on
their own.
"It's very much in the interest of the plans to keep them in coverage,"
Harrington said.
Firman has worked closely with federal officials to enroll low-income
seniors in the drug benefit. He has not been critical of the program, so
his qualms cannot be dismissed as just more criticism from an outspoken
opponent.
The beneficiaries he is concerned about qualify for Medicare because of
their age or disability. They also had previously qualified for Medicaid
because of their incomes.
In some cases, the people who lost their Medicaid coverage may have lost
eligibility because they're making more money and no longer qualify for
the extra help.
"But it's more likely that some states tightened eligibility
requirements, or the individual did not complete all the paperwork
needed to be recertified for Medicaid," Firman said.
Firman said that his organization's experience in reaching out to
low-income seniors is that about 20 percent will respond to a letter.
"We're talking about a population that's sick, may have low literacy.
There are a lot of challenges," he said. "What they need is one-on-one
assistance from trusted intermediaries."
He said he hoped that insurers would take some follow-up steps, too.
"We believe the plans themselves should have responsibility for helping
their customers do this. It also makes good business sense because they
could lose these customers," Firman said.
Harrington said there are no plans to follow the letter up with calls,
but advocacy groups and other government agencies will undertake
outreach efforts in communities deemed to have a large number of seniors
eligible for the low-income subsidy.
___
On the Net:
National Council on Aging:
Medicare:
www.ncoa.org
www.medicare.gov
URL:
http://sfgate.com/cgi-bin/article.cgi?file=/n/a/2006/10/18/national/w121530D45.DTL
©2006 Associated Press
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