Asclepios
A Better Option
April 3, 2008 • Volume 8, Issue 14
One of the most persistent problems in Medicare’s Part D prescription drug benefit is the instability in the coverage provided to low-income people with Medicare, most of whom had drug coverage through Medicaid prior to 2006.
In January 2008, for example, 1.19 million low-income people with Medicare were assigned a new drug plan because the plan they had in 2007 now had a premium that was too high to qualify for a full subsidy under the Extra Help program. The Centers for Medicare & Medicaid Services (CMS) picked the new plan at random—without checking whether it covered the drugs taken by the enrollee—from among the plans with premiums low enough to qualify for zero-premium coverage. As a result, many of those switched found their medicines were not covered when they went to the pharmacy this winter.
The consequence of these denials is often confusion and panic. People think their drug coverage is no longer working. They stop taking their heart or diabetes medicines, or they scrape together the money to pay for it themselves—for a while. For people who already have a hard time choosing among the bewildering array of Part D plans, the appeals system is not a realistic option, even in those rare cases when they learn of their appeal rights. Advocates, like those at the Medicare Rights Center, can help, but most people never see an advocate.
Recognizing the disruptions to care caused by these annual reassignments, CMS this week announced that it would calculate the premium subsidy with a new formula that raises the maximum subsidy and minimizes the number of Part D enrollees who will face reassignment. CMS explained that, if the new policy were in effect last year, 1.33 million low-income people with Medicare would be reassigned, more than were reshuffled under the current policy.
How is that an improvement?
It’s not. But to explain why CMS adopted this approach properly requires a highly technical explanation of the enrollment weighting, the impact of overpayments to Medicare private health plans, and CMS’ authority to reinterpret the law or ignore the law entirely by using its “demonstration” authority.
The short answer is: instability is built in to the privatized structure of the Part D benefit. Plans lowball premiums to capture market share and to qualify for a full premium subsidy and then raise their rates in subsequent years or restrict drug coverage to keep costs low.
What all people with Medicare need is a stable, Medicare-administered alternative to the private drug plans offered by insurance companies. A simple, affordable public option will provide both low- and moderate-income people with Medicare a refuge from the instability built in to the privatized Part D benefit. Unless Congress acts, however, people with Medicare will continue to be denied that choice. Please write your senator and representative and urge them to cosponsor the Medicare Prescription Drug Savings and Choice Act.
Medical Record
“People with Medicare should have the option of being able to use their red, white and blue Medicare care in any pharmacy in the country. Those who profess to believe in choice should not take this option away from older Americans and people with disabilities” (The Best Medicine: A Drug Coverage Option Under Original Medicare, Medicare Rights Center, October 2007).
"We estimate that, if the 2008 benchmarks had been calculated using the LIS weighting methodology in this final rule, the benchmarks would have been higher in 27 of the 34 regions and the number of reassignments would have been 1.33 million" (“Medicare Program: Modification to the Weighting Methodology Used to Calculate the Low-Income Benchmark Amount,” CMS, April 3, 2008).
“LIS [Extra Help] beneficiaries assigned to new benchmark plans maintain the same level of subsidy, but may face disruptions in filling their prescriptions because random assignment does not match an individual’s prescription drug use with the list of drugs covered by benchmark plans” (“Medicare Part D 2008 Data Spotlight: Low-Income Subsidy Plan Availability,” Kaiser Family Foundation, April 2008).
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Medicare Part D Appeals Help for Advocates Is Here!
MRC’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
Register for a FREE copy of this great resource.
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Medicare Part D Monitoring Project
The Medicare Rights Center (MRC) would like to hear about your experience, or that of someone you know, enrolled in a Medicare private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed.
Submit your story at http://www.medicarerights.org/partdstories.html.
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The Louder Our Voice, the Stronger Our Message
Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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The Medicare Rights Center (MRC) is the largest independent source of Medicare information and assistance in the United States. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.
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