Part D enrollment deadline draws near

Washington -- In the coming days, physicians may find themselves fielding last-minute questions from seniors hastening to sign up for Medicare drug coverage before it's too late.

The White House and federal health officials are urging the millions of Medicare beneficiaries who have not yet enrolled in Medicare Part D strongly to consider doing so before May 15, the last day of enrollment for 2006 coverage. A new sign-up period for calendar year 2007 is scheduled to begin in November, but patients who are Medicare-eligible now but wait to sign up will be subject to plan premiums that are 1% higher for every month they delay.

Out of the 43 million seniors and disabled people eligible for the benefit, roughly 30 million were receiving Medicare assistance with their drug costs as of April 18. An additional 5.8 million were enrolled in an outside coverage plan as good as Medicare's, meaning they can switch to the federal program without penalty in the future.

During a recent speech in Virginia, President Bush encouraged the remaining 7 million eligible people to avoid paying higher premiums in the future by joining a Medicare drug plan right away.

"The reason I've come today is to urge every senior here in the room and around the country who might be listening on TV that if you have not signed up for the Medicare Part D program, you really need to do it," Bush said.

For weeks, Medicare officials have been predicting a rush of eleventh-hour sign-up attempts, leading to possible strains on drug plan phone lines and Web servers. By traveling around the country to publicize the benefit as well as communicating in these final weeks that the doors remain open, Bush administration officials hoped to help spread out the requests so plans aren't overwhelmed.

"The May 15th deadline is fast approaching," said Centers for Medicare & Medicaid Services Administrator Mark McClellan, MD, PhD. "We urge everyone who has not signed up to act now to avoid a last-minute rush."

Advising patients

This desire for Medicare beneficiaries to take action and secure drug coverage for the future resonates with AMA Trustee Edward L. Langston, MD, a family physician in Lafayette, Ind. Doctors are well aware that just because a senior has no major drug needs now doesn't mean that this situation won't change very quickly, even in a matter of months, he said.

"As we naturally age, conditions can change and they can change abruptly. That's when you're going to see more manifestations of diabetes, heart disease, high blood pressure, cancer," he said. "So we're encouraging seniors to look at the products that are available and consider signing up for one that meets their [current] needs."

Dr. Langston said he was advising his own patients at minimum to sign up for the least expensive plan that they can find. If their medication needs become more intense in the future, they can find a more appropriate plan then without worrying about the premium penalty.

Because most seniors and disabled people can expect to be placed on potentially pricey drug regimens at some point in their lives, the AMA is offering online resources to their members to give Medicare beneficiaries as much enrollment information as possible for them to make informed decisions (link). When presented with the details, many eligible patients already have come to the conclusion that the benefit could provide much needed help with their drug bills.

Dr. Langston said busy physicians would do well to point their patients toward entities dedicated to walking enrollees through the process, including Area Agencies on Aging and local pharmacies.

More time for some

The pressure is on to reach the remaining beneficiaries who are eligible for extra government subsidies based on their income levels. Of the 7 million beneficiaries who had not signed up by April 18, nearly half were eligible for some level of additional help, which can amount to thousands of dollars per year. Groups such as AARP warned that seniors who passed up this opportunity would be effectively taking a pass on free money.

In an effort to capture as many of these people as possible, officials last month opted to extend the May 15 deadline indefinitely only for those beneficiaries who qualify for the low-income subsidies. The move allows poorer beneficiaries to sign up later in the year without waiting for the next open enrollment period or paying the premium penalty for waiting.

Seniors and the physicians advising them, however, should not count on this extension, a CMS spokesman said. Millions of seniors who thought they were candidates for the extra assistance applied for the benefits after signing up for drug coverage but later found that their income levels were higher than the cutoff.

Scores of lawmakers from both sides of the aisle repeatedly have called on the administration to extend the deadline for all undecided beneficiaries in an effort to make up for the glitches and confusion that marked the benefit's opening weeks. A group of 48 senators last month sent a letter to Senate Majority Leader Bill Frist, MD (R, Tenn.), calling on him to bring legislation to a vote that would keep enrollment open through the end of the year.

But President Bush said he would not extend the deadline administratively, noting that deep price discounts negotiated by Medicare drug plans were contingent on a limited sign-up period. Dr. McClellan also said millions of seniors would continue to hold off on enrolling if the deadline were lifted.

Dr. Langston said any extension likely would need to come from Congress and predicted that pressure to enact such a change could mount in the days leading up to May 15.