Bouncing Around

Asclepios - Your Weekly Medicare Consumer Advocacy Update - October 9, 2008 • Volume 8, Issue 41 - Medicare Rights Center The official numbers have not yet been released, but it appears that well over one million low-income people with Medicare will be randomly reassigned to a new Part D drug plan for 2009 because their current plan will no longer qualify for a full premium subsidy. This is the second year in a row that the number of random reassignments has topped one million. In New York State alone, over a quarter million low-income people, most of whom used to receive stable, comprehensive drug coverage under Medicaid, are enrolled in plans with premiums that are rising above the benchmark used to calculate the premium subsidy. Over 150,000 are in five plans that were assigned new low-income enrollees for the first time in 2008, but will be losing them to competing plans at the end of the year. About one-third of these people are getting bumped from one plan to another for the second time. That means that, in New York alone, for the second year in a row, tens of thousands of low-income people with Medicare will find themselves in a new plan, with a new list of excluded or restricted drugs. Anyone who managed to receive prior authorization for their medicines when they started a new plan last January will have to go through the same bureaucratic nightmare with the new company this January. This year’s plan is not required to transfer records to next year’s plan and next year’s plan is not required to look at the medication history of its new enrollees. This is nuts. The lives being dealt around to insurance companies like cards at a poker table include the most vulnerable people who receive Medicare. They are more likely to have a mental illness or a cognitive impairment, such as dementia. They are more likely to be widowed and live alone, without the benefit of a caregiver who could help them choose a plan that covers their drugs. An appeals system that regularly frustrates experienced advocates, including trained lawyers, is an insurmountable challenge for people who will learn at the pharmacy counter in January that their diabetes or blood pressure medicine is not covered under the new plan. There are some simple short-term solutions that the next administration can enact to lessen this problem (the Bush administration has already refused to take these steps):

• The benchmark used to determine the maximum premium subsidy should be calculated on the basis of the real cost of providing prescription drug coverage. The excess subsidies that Medicare private health plans use to buy down their drug premiums should not be used to depress the maximum premium subsidy. If the benchmark were calculated based on the real cost, it would raise the subsidy level, increase the number of full-subsidy plans and reduce the number of low-income people facing reassignment.
• People should be reassigned to the plan that covers the highest number of their drugs with the fewest restrictions. Computer-savvy consumers can use Medicare.gov to pick the plan that best suits their needs. Low-income people with Medicare who have difficulty navigating the plan selection process deserve the same care and attention when the government picks their plan for them.

These are helpful solutions, but they are band-aids at best. Instability is built into the privatized structure of Part D. Low-income people with Medicare need the same choice that all people with Medicare deserve—a stable, affordable drug benefit under Original Medicare.