CMS’s Medicare and You 2006 Contains Significant Error that Affects Low Income Beneficiaries Enrolling in Part D Plans
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CMS’s Medicare and You
2006 Contains Significant Error
that Affects Low Income Beneficiaries Enrolling in Part D Plans
by Alison Hirschel,
MPLP Elder Law Attorney
The Centers for Medicare and Medicaid Services (CMS) has
recently acknowledged that the Medicare and You 2006 handbook it sent
to more than 40 million Medicare beneficiaries contains a significant error
that may be detrimental to beneficiaries with income below 150 percent of the
Federal Poverty Level. The handbook, which is considered a major tool in educating
beneficiaries about the complicated new Part D program, erroneously states that
the full premium for beneficiaries who qualify for the Low Income Subsidy will
be paid for the beneficiary in all prescription drug plans. In fact, approximately
60 percent of the plans would require additional payment from these low income
participants. Currently, the Handbook is the only comprehensive list of drug
plan choices that CMS plans to send to beneficiaries, so this significant error
could cause great confusion and additional expense for these needy beneficiaries.
Among the estimated 14 million Low Income Subsidy recipients are almost 7 million
dual eligibles, all of whom qualify for the subsidy. These individuals will
be automatically enrolled in a prescription drug plan in which their full premium
is covered, but since the enrollment is random, the plan in which they are enrolled
might not meet their needs. These beneficiaries will be permitted to select
different plans at any time and are likely to want to do so if the plan into
which they are enrolled does not cover their medications or work with their
local pharmacy. However, if they rely on the erroneous information in the handbook,
they might unwittingly choose to switch to a plan that better meets their needs
but which will obligate them to pay premiums. Other Low Income Subsidy recipients
will not be automatically enrolled in plans and will need to choose a plan to
receive Part D benefits. Many of these individuals might be misled by the handbook
and fail to realize that the majority of available plans will require them to
pay premiums.
Although CMS has acknowledged its mistake and posted information about it on
its website, it is not clear that beneficiaries will learn the truth about premium
costs in the different plans. Individuals calling Medicare’s toll free
line will only be given specific premium information if they ask about a specific
plan. Callers will also be told that they may contact the organizations offering
the plans for more information but some advocates fear these calls will result
in beneficiaries being subjected to sales tactics and marketing ploys instead
of straightforward information about premium costs.
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