September 23, 2004 Contacts:      

Judith Stein, Esq.
(860) 456-7790

Recognizing the need to communicate directly with Medicare beneficiaries, the Centers for Medicare & Medicaid Services (CMS) announced on September 22, 2004, that it will send a targeted mailing about the Medicare-approved discount drug cards to the 1.8 million low income Medicare beneficiaries who are eligible for the Medicare Savings Programs (MSPs) [QMB, SLMB, QI]. The letters will be sent by CMS during the last two weeks of October. These individuals are deemed eligible for the programís $600 transitional assistance credit towards the cost of drugs. According to the Associated Press, only 1.3 million low-income people out of  more than 7 million who are eligible have signed up for a drug card.

According to CMS, individuals will be randomly assigned to one of 19 national cards.  This will have the benefit of limiting the vast number of card choices that have been daunting the Medicare population and discouraging participation in the drug card program.

The targeted individuals, however, will not actually be automatically enrolled in the discount drug card program. Instead, the letter they receive from CMS will tell people the name of the card in which they can be enrolled if they take action.  They will still need to call either 1-800-MEDICARE or the 1-800-number of their card sponsor in order to activate card enrollment and the $600 credit. Those who do call will then be asked whether they have other insurance that would make them ineligible for the $600 transitional assistance, and whether they have enrolled in another discount card.  They will also be asked to verify their income so CMS knows the amount of co-insurance for which they will be responsible. Individuals who do not call to activate their cards will not be enrolled and will not receive the $600 credit towards the cost of their drugs.

Because assignment to drug cards is random, CMS will not determine whether participants in rural areas are assigned to cards which include rural pharmacies in their networks.  The random assignment to a drug card also will not take into account whether a beneficiary is served by an Indian Health Service, Tribal, or Urban Indian pharmacy, or whether the individual resides in a nursing home. MSP-eligible individuals who act on these mailings will be given the opportunity to switch to a different drug card from the one to which they are assigned by calling 1-800-MEDICARE.

Individuals who call to activate their drug card can begin using their drug card and the $600 credit in November, 2004. Individuals will still be eligible for the $600 credit for 2004 as long as they activate the card by December 31 of this year. These individuals will also receive a $600 credit towards the cost their prescriptions in 2005; any of the $600 that remains for 2004 will be carried over to 2005. CMS is contemplating a second targeted mailing in 2005 to people who do not respond to the initial mailing.

Copyright © Center for Medicare Advocacy, Inc. 08/19/2013