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Confusion Continues in Medicare Drug Program with
Some Seniors in Two Plans
March 1, 2006 – Confusion continues to reign in the
Medicare Prescription Drug Program as failures by government
administrators have some senior citizens enrolled in two plans and in
other cases insurers paying benefits to senior not covered by their
plan. The New York Times report of these problems and reactions are
covered by the KaiserNet.org Daily Report on Medicare news.
 Medicare | New York Times Examines How Some
Medicare Beneficiaries Are Enrolled in Two Drug Plans
Some Medicare beneficiaries who have switched drug
plans are actively enrolled in two plans, creating confusion for
insurers and pharmacists and placing beneficiaries "at risk of being
charged two premiums or incorrect copayments," the
New York Times reports.
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Medicare Officials Say Computer Glitches Main Cause of Drug Program
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Jan. 27, 2006 - At a forum sponsored yesterday by
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the computer system. CMS "SWAT Teams" are working on the problems and
others participating in the program praised them for their efforts. It
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providing drugs to the "dual eligibles" that could not get their
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Medicare Drug Plans May Be More Limited in 2007
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'These are Our Problems to Solve,' Declares HHS
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Feb. 2, 2006 – New estimates released yesterday by
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In a recent memo to insurers, the Bush
administration said that government "processing systems have not always
sent the enrollment and disenrollment information to the appropriate
plans" when beneficiaries switch plans.
As a result, "many (possibly
all) of the beneficiaries who switched plans are active on enrollment
files at multiple plans," the memo said. In addition, some "[p]lans have
paid claims for beneficiaries who are no longer enrolled in their plan,"
it said.
When a beneficiary switches drug plans, Medicare is supposed to
send a disenrollment notice to the original plan and a confirmation of
enrollment notice to the new plan, the Times reports. However, Medicare
in some cases "mistakenly sent both notices to the second plan, so the
first plan did not know that the person had left its rolls," according
to the Times.
Impact
The problem affects "tens of thousands" of beneficiaries and might
explain why many individuals who qualify for a low-income subsidy under
the drug benefit mistakenly were billed for premiums or charged high
copays, the Times reports.
According to the Times, "when a beneficiary
switches plans, Medicare typically provides information on the person's
low-income status to only one of the two plans," while the other plan
might "still be providing coverage without realizing that the person is
entitled to a low-income subsidy."
In addition, some drug plans have
stopped processing disenrollments because they have been unable to
verify the accuracy of notices they received from the government. CMS
said it is working with insurers to address the "enrollment
discrepancies" but cautioned that a sweeping mass disenrollment could
cause a surge of inquiries from beneficiaries to insurers and Medicare.
The government also said it would work with insurers to determine which
drug plan should have paid which claims, so that drug plans can
reimburse each another.
Comments
Marisa Duarte of the Atlanta regional
CMS office said federal caseworkers can "verify the exact plan" a
beneficiary is enrolled in, adding, "We are still working out system
glitches, so having someone enrolled in two plans is common."
Jane-ellen
Weidanz, Medicare project manager at the
Oregon Department of Human Services, said, "There appears to be a
fundamental flaw in the Medicare computer system that transmits
information on enrollment of clients and their low-income status."
Weidanz said that when the problem occurs, the first plan a beneficiary
enrolled in will have the low-income information, but the second plan
will not (Pear, New York Times, 3/1).
Democrats
In other Medicare news, Democratic lawmakers on Tuesday said they would
try to attach measures that would change the drug benefit to any
"must-pass legislation" available, CQ Today reports.
Democrats said they
held 130 meetings about the drug benefit in 27 states over Presidents'
Day weekend, "as part of an intensifying political effort to capitalize
on the problems with the implementation of the program," according to CQ
Today.
Sen. Carl Levin (D-Mich.) said, "There will be those who will
argue that these bugs will be worked out over time, and maybe they
will." He added, "But there are more than start-up bugs. There are
structural problems."
A few Republicans have expressed support for some
legislative changes to the drug benefit, including Sen. Olympia Snowe
(R-Maine), who has introduced a bill (S
2168) that would extend the May 15 enrollment deadline until the end
of the year.
In addition, Sen. Gordon Smith (R-Ore.) said he would
support legislation that would reduce the number of plans each insurer
can sponsor. However, Sen. Trent Lott (R-Miss.) said, "There may be a
need to improve it down the road, but now we need to give administrators
a chance to work through the bumps in the road" (Crowley, CQ Today,
2/28).
New Hampshire
New Hampshire Gov. John Lynch (D) planned to issue an executive order on
Wednesday that would extend an emergency assistance program to pay for
prescriptions for beneficiaries who have been unable to obtain
medications under the drug benefit. The state had paid for medications
for 898 beneficiaries as of Monday, with about 20 individuals seeking
assistance daily, Lynch said (AP/Foster's Daily Democrat, 2/28).
"Reprinted with
permission from kaisernetwork.org You can view the entire
Kaiser Daily Health Policy Report, search the archives, and sign up
for email delivery at
www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser
Daily Health Policy Report is published for
kaisernetwork.org, a free service of The Henry J. Kaiser Family
Foundation. © 2006 Advisory Board Company and Kaiser Family Foundation.
All rights reserved.”
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