May 11, 2006
Thursday

WASHINGTON - A six-month roller-coaster ride for America's seniors concludes Monday - the last day to sign up for Medicare prescription drug coverage without financial penalty.

About 10 million people likely will have signed up, meaning roughly 90 percent of the Medicare population will enjoy coverage from some source. It is a historic level of enrollment for a new government program, according to Health and Human Services Secretary Mike Leavitt.

Medicare Part D Prescription Drug Coverage Scripps Howard News Service - Who's eligible: All seniors and disabled people eligible for Medicare, about 43 million. - What it is: Government-sponsored private insurance plans that cover at least some drugs of almost every class. Most plans are only for drugs, others are HMOs that include drug benefits. No one is required to enroll. - What it costs: Everything depends on where you live and the level of coverage you want, but in many places, the basic plans cost as little as $5-$10 a month. - Low-income subsidy: People enrolled in state drug assistance programs were automatically rolled over to the new coverage; people with incomes less than $14,712 and financial assets of less than $11,500 are generally eligible for a reduced or no monthly premium and small co-pays and deductibles, with the asset level doubled for couples and the income cap at $19,812. The Social Security Administration has to do an asset test to determine who qualifies. - The deadline: Anyone who's not eligible for the subsidy must sign up by May 15 or pay a 1 percent a month penalty on the premiums they pay. Low-income people can continue enrolling beyond the deadline, as can anyone who loses other drug coverage they have now and those who turn 65. Written applications for coverage only have to be post-marked by midnight Monday. - How to enroll: At any of thousands of outreach and aging assistance centers around the country; online at www.Medicare.gov; or by calling 1-800-MEDICARE. Medicare drug coverage enrollment after May 15 Scripps Howard News Service - Next open enrollment period: Nov. 15 through Dec. 31. Coverage won't begin until 2007. - Penalty: Premiums are supposed to go up by 1 percent of the national average per month, or 7 percent, for anyone who signs up after May 15, unless they meet low-income thresholds. - Amnesty: The deadline won't be extended, but there's a still a chance in an election year that Congress will allow people who sign up in the next enrollment period to avoid some or all of the penalty. - Creditable coverage: If you have drug coverage now from an employer or former employer, or through another government program, that's as generous as the Medicare plan, but then for some reason lose it, you can enroll with no penalty. - Medgap coverage: These Medicare supplemental plans aren't as good as Medicare Part D and you'll pay the penalty if you stay in them and enroll later. - Help in signing up: The big outreach effort will shrink after Monday, but aging agencies, consumer groups and Medicare operators will still be available in reduced force, particularly for low-income disabled and seniors. - Drug assistance programs: These programs that provide free or low-cost brand name drugs, run by pharmaceutical companies, will continue after May 15, but it's uncertain for how long. (Distributed by Scripps Howard News Service, http://www.shns.com)

But the massive $1.3 trillion benefit has been a work in progress as bureaucrats have tinkered with flaws and struggled to assemble a competent workforce of telephone and in-person counselors able to guide thousands of seniors daily through menus of up to 40 possible plans.

Outside government investigators reported that they were given incomplete and sometimes wrong information from the 1-800-MEDICARE operators most of the time they called the hotline several months ago. Medicare officials insist the program has gotten better since then.

"The first few months of the program's implementation was widely acknowledged to be a mess," said Judith Stein, executive director of the Center for Medicare Advocacy, one of many advocates who urged that the May 15 deadline be extended. "People need time to get over that rocky start."

But the deadline has stayed in place because administration officials have always felt that relatively healthy seniors with low drug costs need to be part of the risk pool to make the coverage affordable. And they think that the best market for competition among plans will come from having as many customers in as early as possible.

"We are taking every measure possible to ensure that everyone who wants to join a Medicare drug plan can do so," Leavitt said.

The government itself is sponsoring more than 1,000 enrollment events around the country this week, and various advocacy groups are setting up thousands more.

"We're seeing more organizations that want to get us out, and more traffic at the events we're doing," said Wendy Zenker, outreach director for MyMedicareMatters, a program sponsored by the National Council on Aging and the Access of Benefits Coalition.

Zenker said she's noted, along with other outreach organizations, that more children, grandchildren and other family and friends of the elderly are getting involved in the final week as they try to help seniors who may have been too confused to navigate the process on their own.

"Mother's Day is one more good opportunity to have a conversation about this," she said.

Background noise for the individual, personal decisions that Medicare beneficiaries have to make has been provided by scores of reports from critics and advocates of the program about how many or how few are covered, how good or how weak the benefits are and whether the neediest seniors are getting help.

Foes regularly find seniors confused by the plans; proponents cite surveys that show most beneficiaries like the coverage and that they're saving money.

One report, issued Tuesday by the health advocacy group Families USA, claimed that fewer than one in four low-income seniors eligible for special drug premium subsidies have signed up for them, and that another 6.3 million people who formerly had drug coverage under Medicaid are now paying more in drug co-payments than they did before.

HHS came back Wednesday with new figures that showed all but about 3 million of those eligible for "extra help" in the form of zero or reduced premiums and low co-pays have coverage either through new or existing programs. "We're trying to concentrate the additional dollars on beneficiaries that need the help the most," said Medicare administrator Dr. Mark McClellan.

Enrollment for low-income people is, the government admits, more cumbersome than other Medicare claimants because they have to fill out a form to verify to Social Security officials that assets and income don't exceed a threshold, and then move on to choosing a drug plan.

That's why the enrollment deadline for this group has been extended indefinitely beyond May 15, without any financial penalty, the administration announced Tuesday. "It's a hard-to-reach population," said McClellan.

Anyone who doesn't meet the low-income and asset threshold and seeks to sign up for a plan during the next enrollment period that begins Nov. 15 will face a penalty based on a seven-month delay.

The penalty is supposed to equal 1 percent of the national average premium for each month an eligible beneficiary goes without drug insurance. With the national average monthly premium now at $33.50, that means those who miss the Monday deadline would face a minimum surcharge of $2.31 a month on their drug premium for the rest of their lives.

While officials from President Bush - who says "deadlines help people understand there's a finality" - on down insist there will be no more extensions, many lawmakers, including key Republican leaders, say unofficially that they're looking for a way to waive the penalty for stragglers at all income levels during at least the next enrollment period.

The Center for Medicare and Medicaid Services also has tweaked the rules for drug plans. One major change, announced last week, requires that a plan can change the list of drugs it covers only once a year, unless new generic drugs become available, or if safety issues raise concerns about one of the drugs. Before, plans could change their coverage lists whenever they wished, even though enrollees could only shift plans once a year.

But even if penalties are not imposed on Medicare enrollees until after the first of the year, officials inside and outside government urge seniors to act sooner than later, if for no other reason than that, as McClellan put it "maximum support is available right now if you have questions."

Zenker said the MyMedicareMatters operation will stay active after Monday's deadline, "but we won't be operating at anywhere near the level that we are now."

On the Net:

http:/www.medicare.gov

www.mymedicarematters.org

www.familiesusa.org

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