New Medicare Drug Plan Poses Major Challenges for Seniors, People with Disabilities
Feature Story by Tyler Lewis - 2/22/2006
President Bush's new private prescription drug plan has gotten off to a rough start, with reports of widespread delays, refusals, and other glitches preventing Medicare beneficiaries from being able to fill their prescriptions.Medicare is the nation's largest federal healthcare program, covering about 42 million seniors and disabled citizens. The new drug plan, Part D of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), was touted as a way for the government to cut costs and for beneficiaries to have more options and save money.
The complicated plan, which took effect on January 1, offers beneficiaries more than 40 different plans for prescription drug coverage. Each plan has a different cost, a different list of covered drugs, and a different network of pharmacies with which they work.
Advocates have received numerous complaints that beneficiaries were unable to sign up or otherwise not in the system because the labyrinth of choices was too confusing.
"Why is it so difficult for people to get information about their own plan and coverage? Informing the customer comes last in this scenario," said Clare Smith, CEO of California Health Advocates in a February 6 joine statement with the Medicare Rights Center announcing the release of a new report on Part D's problems.
In addition, advocates say that the elderly poor who lack resources and the capacity to understand every plan will have a hard time picking the plan best for them before the May 15 deadline.
"For beneficiaries who have all their drugs and doctor's recommendations, choices can be narrowed down to maybe four or five in about an hour, assuming the beneficiary is somewhat computer literate," said Gwen Gillenwater, senior director of policy and outreach for the American Association for People with Disabilities. "But I don't think anyone realized just how big a job the implementation of the plan would be."
Mark McClellan, administrator for the Centers for Medicare & Medicaid Services, acknowledged the challenges of implementation in his testimony at a February 8 Senate hearing on Part D.
McClellan said that the agency is "seeing improvements [of beneficiaries' ability to sign up] on a daily basis." But he also agreed that "simplification is absolutely the next step in the process."
Many states have complained about the burden the plan places on them because of its requirement that states reimburse the federal government for savings they incur. Several states have protested that they are reimbursing Medicare for more than they are saving.
To date, 32 states and the District of Columbia have officially implemented some form of emergency transitional coverage for low-income people who are unable to obtain drugs from the Part D drug plan.
The problems of the 7.2 million "dual eligibles"-those people who are enrolled in both Medicaid (which is state-administered) and Medicare (which is federally-administered)--have been especially troublesome, according to Gillenwater.
Before passage of MMA, disability rights advocates were concerned that the needs of dual eligibles were not being addressed by the legislators. Compared to other Medicare beneficiaries, dual eligibles are poor and more likely to have significant health conditions. However, dual eligibles were automatically enrolled in Part D and randomly assigned to a plan -- often not the best plan for their particular needs.
Democratic House members have introduced a proposal that they say would simplify administration of the plan. Under the proposal, insurance companies are barred from eliminating drugs from any plan and raising costs on any drugs.
The Democratic proposal also requires Medicare to guarantee payment for up to 60 days when pharmacists can not verify a beneficiary's plan.
