In touting the addition of a long-awaited prescription drug plan to Medicare, the Centers for Medicare and Medicaid services have made many claims regarding the plan’s effectiveness and ease of use.  Certainly nobody denies that a well-planned prescription drug program is a fine addition to Medicare.  However CMS and their agents, in trying to convince beneficiaries and advocates of the effectiveness of this plan, have made statements that are inaccurate or simply untrue.

• The $600 credit included for low income beneficiaries in the discount drug card program will count toward a spend-down for eligibility for Medicaid
  
  Untrue – CMS officials, at talks around the country, have said that the $600 transitional assistance credit will count toward the spend-down of excess income by medically needy beneficiaries trying to qualify for Medicaid.  In reality, for beneficiaries trying to qualify for Medicaid, the $600 transitional assistance included in the Medicare prescription drug card program will NOT count toward the spend-down.  The $600 credit is completely comprised of federal money, which, by law, cannot be counted toward a spend-down for eligibility for Medicaid.
  
  
• Discount drug card sponsors can’t decrease the discounts they offer
  
  Untrue – CMS officials, at talks around the country, have said that once a beneficiary has been locked into a card, that card’s sponsor cannot take adverse action to reduce discounts on drugs.  In reality, drug card sponsors are not obligated to maintain the discounts that they initially offer.  In fact, sponsors may increase or decrease various discounts as often as weekly.
  
  
• Discount drug card sponsors can’t change the list of drugs on which they offer discounts
  
  Untrue – Closely related to the change in discounts, CMS officials have said that a plan may not remove drugs from their formularies once a beneficiary is locked into their card.  In reality, drug card sponsors are not required to maintain their formularies and, as with the discounts offered, may change them as often as weekly.
  
  
• Medicare beneficiaries will have all necessary information regarding discount drug cards readily available to them so that they can make informed choices
  
  Untrue – Though improvements have been made, complete information on prescription drug cards, sponsors, fees, and contact information is still not available at www.medicare.gov.  The toll-free phone line 1 (800) MEDICARE often can’t be reached, has immense hold-times, or offers operators who are not familiar with many questions.  Many beneficiaries are referred back to the website, which is problematic as many beneficiaries do not have web access.  In addition, many pharmacists are unsure of which cards are even being accepted at their own pharmacy, and some pharmacies may already offer better discounts to seniors, a fact which may be lost in the shuffle of cards.
  
  
• The Part D prescription drug benefit is voluntary
  
  Misleading - In fact, the public has been told since the time of its passage that despite being titled a "voluntary" program, Medicare beneficiaries who fail to sign up for the prescription drug benefit and who also fail to have alternative creditable prescription drug coverage for a period of 63 days or longer, will be subject to a financial penalty for each month that was spent out of a plan.  The precise amount of this penalty has never been made clear (click HERE for more information).
  
  
• Beneficiaries enrolled in Medigap policies H, I and J will not be penalized for later Part D registration
  
  Untrue – It has now been revealed, contrary to CMS’ statements, that beneficiaries who choose to keep Medigap policies H, I or J, which include prescription drug coverage, WILL BE PENALIZED if they do not sign up for Part D in 2006, but choose to do so at a later time.  This contradicts CMS’ earlier inclusion of these Medigap policies in the “alternative creditable coverage” category.  Letters to beneficiaries enrolled in these Medigap policies informing them of these restrictions are being drafted now, and will be sent sometime in 2005.

Information on the new prescription drug program is still changing rapidly.  Many sources may still be trying to convince beneficiaries and advocates that the program is sound, and many may simply not be up to date.  Beneficiaries and advocates should verify any information they receive, and be aware that even when verified, that information may not be accurate the next time they need it.

© Copyright, Center for Medicare Advocacy, Inc. 05/02/2008