Many Eligible Beneficiaries Not In Medicare Prescription Drug Benefit Subsidy Program

Main Category: Medicare / Medicaid / SCHIP
Article Date: 05 Feb 2007 - 19:00 PDT

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CMS and the Social Security Administration must improve efforts to enroll eligible Medicare beneficiaries in a subsidy program under the prescription drug benefit, Senate Special Committee on Aging Chair Herb Kohl (D-Wis.) said on Wednesday at a hearing of the committee, CQ HealthBeat reports. Medicare beneficiaries must apply through SSA to enroll in the subsidy program, which provides financial assistance to beneficiaries with low incomes and few assets. Medicare beneficiaries enrolled in the subsidy program can lose eligibility in the event that they become ineligible for Medicaid, the supplemental security income program or the Medicare savings program. In such cases, Medicare beneficiaries must reapply to enroll in the subsidy program. About 600,000 Medicare beneficiaries enrolled in the subsidy program in 2006 must reapply to enroll in 2007, Kohl said. "And since the application process is so onerous, we know that some seniors will simply give up," he said, adding, "As we enter the second year of the Medicare drug benefit, we have an obligation to make sure it is working for all seniors but particularly for our poorest seniors, who need help the most. We are not there today." According to a National Council on Aging report released at the hearing, between 3.4 million and 4.4 million Medicare beneficiaries qualify for, but have not enrolled in, the subsidy program. The report also found that about 2.9 million Medicare beneficiaries who have not enrolled in the prescription drug benefit have no other medication coverage. Kohl said the hearing marked the first of a series in which the committee will seek "to fix the problems with Medicare's prescription drug program so that seniors can finally enjoy a simple, affordable benefit."

Additional Discussion
Lawrence Kocot, a senior adviser to the CMS administrator, said that the agency has sought to enroll eligible Medicare beneficiaries in the subsidy program through partnerships with grass-roots organizations; local, state and federal agencies; State Health Insurance Assistance Programs; and other groups. Kocot said, "Our work to identify and enroll these beneficiaries is a multifaceted, continuous effort that did not stop with the end of the first enrollment period; rather it has been a sustained and ongoing effort." About 10 million Medicare beneficiaries enrolled in the subsidy program in 2006, and about 35% of beneficiaries who lost eligibility have reapplied to enroll in 2007, according to Kocot. Beatrice Disman, chair of the Medicare Planning and Implementation Task Force at SSA, said that the agency has used "any and all means at our disposal" -- such as mailings, telephone calls and computer databases -- to identify and enroll eligible Medicare beneficiaries in the subsidy program. Howard Bedlin, vice president of policy and advocacy for NCOA, said that Congress should pass legislation to eliminate the asset test for eligibility for the subsidy program because the provision disqualifies some Medicare beneficiaries with modest assets. Half of Medicare beneficiaries who fail the asset test have assets of less than $35,000, and those beneficiaries often are older, female, widowed and living alone, according to Bedlin. Sen. Gordon Smith (R-Ore.), ranking member of the committee, said that he plans to introduce a bill to simplify the asset test and reintroduce a bill to eliminate cost-sharing requirements for low-income beneficiaries who reside in long-term care facilities other than nursing homes. Ellen Leitzer, executive director of the Health Assistance Partnership, a group that works with SHIPs, said that the programs require additional funds because they address many questions from beneficiaries that CMS or Medicare prescription drug plans should address (Carey, CQ HealthBeat, 1/31).

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