NOT ALL WE'VE BEEN TOLD
ABOUT THE PRESCRIPTION DRUG PLAN IS TRUE
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
$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.
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
drug card sponsors can’t change the list of drugs on which they offer
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
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.
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).
enrolled in Medigap policies H, I and J will not be penalized for later Part
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
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.
Center for Medicare Advocacy, Inc.