Center for Medicare Advocacy and Other Beneficiary Groups Comment on Medicare Rules:
Proposed MMA Regulations Raise Further Concerns About New Medicare Law

Contact: Judith A. Stein, Esq.
Center for Medicare Advocacy, Inc
Willimantic, CT

On October 4, the Center for Medicare Advocacy, Inc., and other beneficiary groups, filed comments on proposed regulations to implement the prescription drug provisions of the Medicare Modernization Act (MMA) (December 2003).  The Center for Medicare Advocacy, a non-profit, non-partisan national organization based in Connecticut, provides education and advocacy for the rights of Medicare beneficiaries.  The staff of the Center has analyzed this complicated law and proposed regulations and is appalled at how unworkable Medicare will be if this law is implemented as the government proposes.  The Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare, did nothing in the regulations to simplify this complicated law or to make it helpful for beneficiaries.

According to Judith Stein, Executive Director of the Center for Medicare Advocacy, “the new law and its proposed regulations are far too complicated and are likely to yield little in terms of a meaningful drug benefit.”  For nearly 40 years, Medicare has provided benefits to all of its beneficiaries, regardless of where they live or how much money they have.  “The new regulations present a confusing array of choices that bear no resemblance to the type of service that Medicare beneficiaries have come to appreciate and expect,” said Ms. Stein.

In its face-to-face meetings in Connecticut and elsewhere, the Center staff has found that many Medicare beneficiaries are dismayed and confused by the new drug discount card program, the precursor to the prescription drug benefit.  Beneficiaries have chosen not to participate in the program and are frightened at the prospect of figuring out how to make choices about prescription drug plans.  This is particularly difficult for Medicare beneficiaries as the federal government is using a website as its primary information outlet, when, according to the
Pew Research Center, only 22% of Medicare beneficiaries have access to the Internet.  Vicki Gottlich, a Center for Medicare Advocacy attorney and Medicare expert, who has written and lectured extensively about the new law, states that she fears “the new drug program will only bring more confusion and disillusionment.”

Under the new law, the poorest and sickest of all Medicare beneficiaries will actually see their coverage decline.  The more than 6 million low-income individuals who are eligible for both Medicaid and Medicare will lose their Medicaid drug coverage on January 1, 2006.  Under the proposed regulations, some of these beneficiaries may be without any drug benefit at all for a lengthy period of time. Center attorney Patricia B. Nemore, an expert in obtaining health care services for low-income persons eligible for both Medicare and Medicaid, warns “those dually eligible persons who do get coverage will no longer be assured access to all medically necessary drugs, and most will be required to pay co-payments, including those who live in states like Connecticut, where co-payments are not currently required.”

Private insurance companies offering drug plans will be allowed to develop their own multi-tiered, cost-sharing schemes, leading to all kinds of plan variations.  The only requirement is that their plans come up with approaches that are “actuarially equivalent” and meet certain standards such as a large initial deductible, co-payments, and a second deductible known as the “doughnut hole.”  "This will make plan comparisons difficult, if not impossible," says Ms. Stein.

With respect to drug formularies, the lists of medications that each of the private plans decides to cover, “we fear that private insurers will have too much discretion in the formularies they develop, and that many of these formularies will fall short of meeting the needs of Medicare beneficiaries,” Ms. Gottlich says.

“It’s easy to see the value of the new Medicare law for private insurers,” continues Ms. Gottlich, “but what will America’s seniors get for their trouble?”  She notes that when one considers the deductibles and co-payments that beneficiaries have to meet every year, beneficiary out-of-pocket expenses will remain high, and the complexity of the new system makes it highly unlikely that most Medicare beneficiaries will have greater access to prescription drugs.

According to Ms. Stein, “Americans need to scrap this law and end the pretense that it creates a fair, realistic prescription drug program.”  She suggests a more honest approach to a Medicare prescription drug benefit, similar to Part B, that is comprehensive, comprehendible, and truly meets the needs of Medicare beneficiaries.

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