The plans of inaction on Medicare
By ELIZABETH SIMPSON, The Virginian-Pilot
© December 27, 2005
Most people on Medicare still have a few months to decide whether to enroll in the federal insurance’s new prescription drug coverage, but others will be shifted to a plan on Sunday whether they’re ready or not.
As elsewhere, some Hampton Roads residents may find the change a bit of a jolt.
These “dual eligible” beneficiaries qualify for both Medicare and Medicaid, the state-federal insurance for low-income people. Unless they have already chosen one of the 40-plus Medicare drug plans available in this area, the d.e. people are automatically, and randomly, enrolled into a plan by the government. Instead of having their drugs covered by Medicaid, as is the case now, their coverage will switch to Medicare in January.
Norfolk resident Julie Marshall is among the 6.4 million Americans who fall into this category. The 58-year-old woman with disabilities takes medications for diabetes, glaucoma, neuropathy and asthma. When she received a letter this fall saying the government automatically signed her up for one of the new Medicare plans, she figured it would be one that fit her needs.
Her pharmacist, however, checked the plan against her drugs and found out half of them weren’t covered. He helped her find a plan that covered all of her drugs. Marshall said she wants others in her situation to know they need to check their plans or they may face an unwelcome surprise come Sunday.
Their drugs may no longer be covered, and the pharmacy they regularly use may not be part of their new plan.
Pharmacists are bracing for an onslaught of questions, problems and reality checks from people who show up at their counters in the early weeks of January to fill prescriptions that might not be covered.
All Medicare beneficiaries can begin drawing benefits from the new drug plans starting Sunday, but most can wait as long as May 15 to enroll. Because of confusion surrounding the massive program, many people are choosing not to sign up right away.
However, that isn’t an option for dual-eligible beneficiaries. They must quickly find out about the plans they’ve been automatically enrolled in or risk suffering setbacks. This includes many people who live in nursing homes and people with mental disabilities and other developmental conditions that make them more vulnerable to a change in coverage than the average person.
There are some safety valves.
People in the dual-eligible category can change plans multiple times to something that works better, with the plan going into effect the first of the following month.
The government has told insurance companies and pharmacists that these beneficiaries are to receive all their prescriptions the first month to give dual-eligibles time to make adjustments. Pharmacists also will be able to find out what plan dual-eligible people have been assigned if they either didn’t get a letter or misplaced it.
That should make for an interesting January for pharmacists.
“As bad as the past month and a half has been, it’s going to be worse come January,” said Jay Levine, a pharmacist at Atrium Pharmacy in Norfolk.
He worries that some people who are dual-eligible may be lost in the shuffle.
A Government Accountability Office report released this month raised concern that some dual-eligible people are going to fall through the cracks. The report said Medicare’s contingency plans have yet to be fully tested, publicized or implemented.
Pharmacist David Halla, owner of Gray’s Pharmacy in Norfolk, has spent the past month and a half trying to educate customers. He has talked to church groups, printed out customers’ drug lists, even worked on his home computer at night to see what options would work for longtime customers.
He dreads the first weeks of January, pointing to a stack of government documents and drug company instructions that are long on computer jargon, short on clear direction.
Meanwhile, those who work closely with Medicare beneficiaries – especially those who are also enrolled in Medicaid – have been trying to head off disaster at the pass. George Pratt, executive director of Norfolk Community Services Board, said many of that agency’s mentally disabled clients are dual-eligible.
Case managers have been helping them get enrolled as they come in for appointments, b ut he worries about those who didn’t come in, for whatever reason. If the plan they were assigned doesn’t cover all their medications, they might stop taking the medicine and fall into crisis situations.
He said the state pharmacy has agreed to cover a person’s first set of prescriptions past Jan. 1 to provide time to make adjustments, if need be.
Paula Drake, services coordinator at Sullivan House, a senior housing unit for people of limited incomes in Virginia Beach, said many of its residents receive both Medicare and Medicaid. Only about 20 of the 130 people who live there have a computer, which is helpful in choosing a plan. Residents have been trickling into her office for help choosing a plan, but she fears many will just take whatever they’re given.
Nursing home residents, too, are a concern, because about two-thirds of them across the United States are beneficiaries of both Medicare and Medicaid. Some nursing homes are struggling to find out which plans their residents have been assigned.
Mark DeAngelo, the pharmacist for Sentara Life Care, said staff at that system’s nursing homes and assisted living facilities have been working with residents and their families for months to educate and sign them up for appropriate plans.
“We’ve tried to be proactive about it,” he said.
Reach Elizabeth Simpson at (757) 446-2635 or elizabeth.simpson@pilotonline.com.