Facing loss of coverage

The next open enrollment period has been extended.
WASHINGTON (AP) -- The federal government has told about 632,000 elderly and disabled people they won't be automatically enrolled in a Medicare drug plan next year.
These people are still eligible to participate in the drug benefit, but they will have to shop for a plan and then enroll on their own rather than the government doing it for them. To afford the benefit, many will also need to apply for a low-income subsidy.
Some advocates are concerned that many of the 632,000 could fall through the cracks, not knowing they don't have coverage for their medicine until they show up at their local pharmacy in January.
"We're very concerned. We believe many, if not most of the people, simply won't respond to a letter," said James Firman, president and CEO of the National Council on Aging. "Many won't read the letter, they won't understand the letter, they won't know how to fill out the application form."
During the first year of the drug benefit, the so-called "dual eligibles" were automatically enrolled because they participated in both Medicaid and Medicare and represented the sickest and most vulnerable among the elderly and disabled. The federal government wanted to ensure that they did not lose access to prescription drugs.
No longer enrolled
But states have informed the federal government that some of those beneficiaries no longer are enrolled in their Medicaid programs, thus they will no longer be automatically enrolled in a drug plan.
The Centers for Medicare and Medicaid Services recognizes that some in the group may miss signing up for a drug plan during the next open enrollment period -- Nov. 15 though Dec. 31. It has granted the group an extra three months to enroll in a plan without the prospect of a penalty for late enrollment, said Kathleen Harrington, director of external affairs for the agency.
Harrington said the group was also told in the letter last month that they should apply for the low-income subsidy, which could give them access to a drug plan with little or no monthly premium. She also said that the insurers themselves have been told who will need to apply on their own.
"It's very much in the interest of the plans to keep them in coverage," Harrington said.
Firman has worked closely with federal officials to enroll low-income seniors in the drug benefit. He has not been critical of the program, so his qualms cannot be dismissed as just more criticism from an outspoken opponent.
The beneficiaries he is concerned about qualify for Medicare because of their age or disability. They also had previously qualified for Medicaid because of their incomes.
In some cases, the people who lost their Medicaid coverage may have lost eligibility because they're making more money and no longer qualify for the extra help.
Firman said that his organization's experience in reaching out to low-income seniors is that about 20 percent will respond to a letter.
"We're talking about a population that's sick, may have low literacy. There are a lot of challenges," he said. "What they need is one-on-one assistance from trusted intermediaries."
He said he hoped that insurers would take some follow-up steps, too.
"We believe the plans themselves should have responsibility for helping their customers do this. It also makes good business sense because they could lose these customers," Firman said.
Copyright 2006 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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