Consumer Groups Say Medicare Agency Is Proposing The Wrong ApproachTo Protecting Drug Coverage For People With Low Incomes, USA

Main Category: Medicare / Medicaid / SCHIP
Article Date: 04 Mar 2008 - 2:00 PDT

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The Center for Medicare Advocacy, the National Senior Citizens Law Center, and 17 other groups that advocate on behalf of people with Medicare filed comments telling the Centers for Medicare & Medicaid Services (CMS) that their approach to prevent certain Medicare beneficiaries from having to change their Medicare drug plans will not work.

CMS asked for comments on a proposed rule that would ensure that at least five prescription drug plans in each state qualified as zero premium plans for low income beneficiaries who are eligible for assistance in paying their prescription drug premium. Under current rules, only plans whose premiums are below a benchmark amount are allowed to offer their plan for no premium to low income beneficiaries. Under the proposed rule, up to 5 prescription drug plans in each state would be allowed to provide a zero premium plan for eligible enrollees even if their actual premium did not fall below the benchmark. The goal of the proposed rule is to limit disruptions experienced by low-income Medicare beneficiaries as a result of annual changes to zero-premium plans.

In 2007 over 2.5 million low-income Medicare beneficiaries were in plans whose premiums rose above the benchmark and, therefore, no longer qualified as zero-premium plans in 2008. Two million of these beneficiaries were automatically reassigned to a new plan by CMS. The remaining beneficiaries had to switch plans themselves in order to avoid paying a premium in 2008.

"CMS' intentions are good, but their approach will not prevent or even limit reassignment," says Vicki Gottlich, Senior Policy Attorney for the Center for Medicare Advocacy. "The proposed regulation, while ensuring that beneficiaries will always have a minimum number of benchmark plans to chose from, does nothing to guarantee that those plans will be the same from one year to the next."

"We urge CMS to adopt specific protections for beneficiaries who must be reassigned," says Kevin Prindiville, Staff Attorney at the National Senior Citizens Law Center. "For example, CMS could ensure that those beneficiaries who have to be reassigned are reassigned to plans that actually cover their medications or CMS could allow beneficiaries who are reassigned to receive any drug they were receiving in the old plan in the new plan."

The groups also recommended that CMS keep its current "de minimis" policy, which allows an unlimited number of zero-premium plans whose premiums for the following year will be only slightly over the prescribed amount to continue serving as zero premium plans, and adapt the formula it uses for determining which plans qualify as zero-premium plans.

The Center for Medicare Advocacy, Inc. is a national non-profit, non-partisan organization that provides education, advocacy, and legal assistance to help elders and people with disabilities obtain Medicare and necessary health care. The Center was established in 1986. We focus on the needs of Medicare beneficiaries, people with chronic conditions, and those in need of long-term care. The organization is involved in writing, education, and advocacy activities of importance to Medicare beneficiaries nationwide. The Center's central office is in Connecticut, with offices in Washington, DC and throughout the country.

The Center for Medicare Advocacy