MARCH 3, 2006 -- Medicare officials are downplaying a drug benefit snafu reported this week—that "tens of thousands" of beneficiaries who have switched drug plans are now actively enrolled in two plans simultaneously.
Centers for Medicare and Medicaid Services spokesman Gary Karr said Friday he does not know how many beneficiaries fall into that category.
But Karr said the "vast majority" of Medicare beneficiaries who have switched drug plans aren't harmed by being simultaneously enrolled for a time in two plans. That's because most of the 800,000 Medicare beneficiaries who have switched plans so far are doing so under Medicare's program of relatively generous drug benefits for low-income beneficiaries, Karr said. That means they are going from one plan charging low or no out-of-pocket costs to another, Karr explained.
The New York Times reported March 1 that "tens of thousands" of Medicare beneficiaries are finding themselves actively enrolled in two plans at the same time, with both in the mode of paying out benefits and charging premiums and copayments. The situation leaves beneficiaries at risk of being charged premiums twice in a month, or of having to pay higher copayments when they get prescriptions filled, the story said.
Karr said, however, that Medicare officials are wary of moving too quickly on disenrolling plan switchers from their first plan because they don't want the beneficiary to be without any coverage whatsoever. The earlier in the month a beneficiary switches plans, the more likely he or she is to avoid duplicate coverage the following month, Karr said.
Karr said he did not know the percentage of plan switchers who qualify for Medicare's relatively generous benefit for low-income beneficiaries, and who therefore are switching from one relatively generous plan to another. He did say it is the "vast majority."
But the Times story said Medicare typically provides information on a beneficiary's low-income status to only one of the two drug plans involved. The result: The second plan is unaware the beneficiary is eligible for the more generous coverage, according to the story. That in turn means beneficiaries may be charged premiums they do not owe and much higher copayments than they owe.
The story also quoted a Florida pharmacist as saying that in some cases, premiums from both plans are being automatically deducted from Social Security checks. And while low-income beneficiaries may be switching from one relatively generous plan to another, they often do so because the first plan doesn't cover as many of their medications.
The story did not say how often problems from double coverage occur. Karr said he had no data on the problem, or a tally of how many beneficiaries have complained to Medicare as a result.
To the extent plans charge premiums or copayments not owed, beneficiaries can contact 1-800-Medicare for help or deal directly with the plans, he said.
Karr described periods of overlapping coverage as a normal operational issue when plan switching occurs. "These kinds of plan-to-plan reconciliations are always going to take place," he said.
Robert Hayes, president of the New York City–based Medicare Rights Center, said low-income beneficiaries are being harmed by the problem of double coverage. Hayes said his counseling operation is relatively small but that "we've had scores of complaints" from beneficiaries, including "a bunch of calls from Florida" about premiums being charged twice. Hayes said many of the complaints are from beneficiaries who have switched plans but whose new plan does not recognize them as eligible for the low-income benefit. As a result, they are subject to deductible and copayment charges they can't pay and must leave the pharmacy without getting their prescriptions filled, he said. "This is one of scores, if not hundreds, of data system breakdowns," he said.
Overlapping coverage is occurring in part because of a mix-up in the way the government sends out notifications to drug plans, according to the Times. If a beneficiary switches plans, Medicare is supposed to send a disenrollment notice to the first plan and a confirmation of enrollment to the second plan.
According to the Times in the case of a number of beneficiaries, Medicare mistakenly sent both notices to the second plan, so the first plan continued coverage.
Under the Medicare drug law (PL 108-173), beneficiaries who qualify for Medicare's low-income benefit can switch plans once a month, Karr said. This year, other beneficiaries can switch once if they do so before May 15 and again in the fall 2006 open enrollment period for 2007. After this year, however, beneficiaries who qualify for the regular drug benefit will only be able to switch plans during the fall open enrollment period.