November 04, 2005
Friday

With the starting date for the federal government's new Medicare prescription drug plan approaching, the program has begun randomly enrolling beneficiaries who are also on Medicaid into approved drug plans.

Medicare this week began sending beneficiaries letters telling them which plans they have been assigned to effective Jan. 1. The action affects about 5.5 million people who are eligible for both Medicare and for Medicaid, the federal health care program for low-income individuals.

Each "dual eligible" beneficiary has been put in a plan with no premium, no deductible and low copayments.

Medicare beneficiaries who are not eligible for Medicaid have to sign up for the program and choose a plan. Enrollment begins Nov. 15.

About 5.5 million "dual eligibles" have randomly been assigned a plan with no premium, no deductible and low copayments.

The federal government opted to automatically enroll dual eligibles - who tend to be among the poorest and sickest and often include nursing home residents - so they do not lose coverage during the transition.

"We needed to get the letters out now, so people know they will either need to take action come Nov. 15 or not take any action and be automatically enrolled in a plan," said Peter Ashkenaz, spokesman for the Centers for Medicare and Medicaid Services.

Dual-eligible recipients can change plans every month, as many times as they'd like. Medicare recipients who are not on Medicaid can change only once within the enrollment period.

Some health advocates are concerned dual eligibles will be assigned plans that don't cover their drugs or don't contract with their local pharmacies.

"You have coverage, but you might not have the right coverage," said David Lipschutz, staff attorney for California Health Advocates, a nonprofit group.

Program officials say that by Nov. 15, recipients will be able to compare menus of drugs offered by different plans using Medicare's comparison shopping tool at www.medicare.gov. Currently, beneficiaries must contact individual plans for drug coverage information.

Pharmacist Fred Mayer, who runs an advocacy group in California, said Medicare beneficiaries, especially those on Medicaid, should ask their doctors to prescribe them a 100-day supply of medications in case they encounter problems with the new program.

For more information, contact the Health Insurance Counseling and Advocacy Program at (800) 434-0222 or the Centers for Medicare and Medicare Services at (800) 633-4227.

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