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Medicare to Cease Automatic Medicare Part D Plan Enrollment for 632,000 former Medicaid Beneficiaries

Category: Medicaid, LIS, & Extra Help
Published: Oct, 20 2006 12:10:17

As reported by Kevin Freking, in AP/San Francisco Chronicle, (Medicare to Cease Automatic Enrollment)10/19/2006 - as many as 632,000 Medicare beneficiaries will not be automatically enrolled in a 2007 Medicare Part D drug plan.

These people were formerly covered under the Medicare Part D program as "Dual-Eligible" - beneficiaries who were eligible for both Medicare and Medicaid.  Last year, these people were automatically enrolled into a Medicare Part D plan and they also had the opportunity to switch to other Part D plans that best covered their medications.  

Although these 632,000 beneficiaries are able to participate in the Medicare Part D prescription drug plans, they will need to proactively apply/re-apply for low-income subsidy, find a plan and then enroll on their own.  They will not be automatically enrolled by either the State or Federal government.  However, these people will be sent a letter from the Centers for Medicare and Medicaid Services (CMS) advising these people to apply for low-income "extra-help" status that provides a Part D subsidy.

James Firman, president and CEO of the National Council on Aging was concerned that these thousands of beneficiaries would be without Medicare Part D coverage, noting that, "we're very concerned. We believe many, if not most of the people, simply won't respond to a letter," said . "Many won't read the letter, they won't understand the letter, they won't know how to fill out the application form."  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.

As noted in the San Fancisco Chronicle article, "the Centers for Medicare and Medicaid Services recognizes that some in the [former Dual-Eligible] group may miss signing up for a drug plan during the next open enrollment period running from November 15 though December 31 and has granted former Medicaid beneficiaries an extra three months [emphasis added] to enroll in a plan without the prospect of a penalty for late enrollment."


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