Press Release
FOR IMMEDIATE RELEASE
Contact: Deane Beebe
Communications Director
212-204-6219
Medicare Rights Center
David Lipschutz
Staff Attorney
213-381-3670
California Health Advocates
December 8, 2005
Consumers Have Inadequate Protections Against Medicare Drug Plan Enrollment Problems -- New Report Outlines Proposals to Strengthen Protections -- Sacramento, CA - Legal protections are inadequate for people affected by drug plan enrollment and disenrollment mistakes and actions, including those caused by misinformation from Medicare drug plans and the government, according to a new report released by California Health Advocates and the Medicare Rights Center.
"Enrollment mistakes are inevitable and without adequate recourse people will suffer great harm," said Clare Smith, president and CEO of California Health Advocates, a Medicare advocacy organization.
The complexity of the new Medicare drug benefit which is administered through private plans will result in enrollment problems that leave people without drug coverage or inadequate coverage and high out-of-pocket expenses, including penalties, the consumer groups report.
Under current regulations, when enrollment problems occur, the drug plans rather than an independent entity are responsible for handling enrollment problems.
"Giving private drug plans the authority to handle these complaints is like asking the fox to guard the hen house," said Ms. Smith.
The Centers for Medicare and Medicaid Services' procedures for individuals "kept out of" or "dropped from" drug plans do not comply with constitutional requirements and Supreme Court precedent regarding loss of access to government benefits, the groups report.
"With insurers aggressively marketing drug plans, older and disabled Americans are at risk of inadvertently signing up for a plan and permanently losing retiree health coverage, or Medicaid," said Robert M. Hayes, president of the Medicare Rights Center, a national consumer group.
California Health Advocates and the Medicare Rights Center, co-authors of Consumers Face Inadequate Protections Concerning Medicare Part D Enrollment and/or Disenrollment Problems, recommend that the Centers for Medicare and Medicaid Services protect consumers from the consequences of these enrollment and disenrollment problems by:
o establishing an appeals process for enrollment and disenrollment cases;
o allowing premium penalty waivers due to gaps in coverage when the government causes an enrollment error; and
o providing Special Enrollment Periods when private plans and other entities give incorrect information that cause enrollment mistakes or inappropriate choices by consumers.
Consumers Face Inadequate Protections Concerning Medicare Part D Enrollment and/or Disenrollment Problems is available on the California Health Advocates' website at http://www.cahealthadvocates.org/advocacy/2005/1130.html.
California Health Advocates is dedicated to achieving and sustaining timely, accurate and responsive education and advocacy efforts for California Medicare beneficiaries and the pre-retirement population.