Part D off to better start this year, but some problems remain

Washington -- A new plan year for the Medicare drug benefit started Jan. 1, and government officials said that things are going much more smoothly than they were at this time last year. But Medicare Part D has not completely gotten over its enrollment problems.

The Centers for Medicare & Medicaid Services reported that more than 39 million program enrollees, or about 90%, are getting drug coverage through Part D or from another source that is just as good. More than 300,000 people joined a drug plan for the first time in the final six weeks of last year. Pharmacies are filling more than 3 million prescriptions per day, and the level of complaints from beneficiaries is relatively low, the agency said.

This stands in contrast to the early weeks and months of 2006, when Medicare first began paying for outpatient prescription drugs. CMS was besieged with complaints from tens of thousands of patients and their physicians who could not get their first prescriptions filled due to widespread technical glitches and bureaucratic barriers. Federal officials at the time characterized the events as the "growing pains" of a major new entitlement and predicted that enrollment issues would be much less prevalent going forward.

But some Medicare seniors and people with disabilities continue to experience problems. More than 250,000 people who were signed up for plans in 2006, for instance, did not receive required information last fall from their insurers describing their 2007 benefits. This information is especially important for people who might have wanted to switch plans for the new year to receive a different benefits package. They can make that change only during the open enrollment period, which ran from Nov. 15 through Dec. 31.

To compensate for the insurers' error, the government decided that enrollees who did not receive the required notice of benefits by the end of October will have until Feb. 15 to change their plans if they desire. Beneficiaries who are happy with their current package automatically are signed up for another year of drug benefits if they do nothing during the open enrollment period.

CMS identified Minneapolis-based UnitedHealth as one of the insurers that failed to meet the fall deadline for sending benefit information to enrollees. It and the other plans, which the agency declined to name, were required by the government to send letters to all affected beneficiaries letting them know that they had an additional 45 days of open enrollment.

UnitedHealth spokesman Peter Ashkenaz said that all of the insurer's enrollees who were affected by the error received their benefits notices last month.

CMS Acting Administrator Leslie Norwalk pointed to the government's move as an indication that a top administration priority during the transition between plan years was to make sure that beneficiaries had all the information needed to pick the plan that was going to work the best for them.

But patient advocates are worried that some seniors might not get the message. The agency was relying on insurers who had committed the errors in the first place to publicize and correct them, said Vicki Gottlich, a senior policy attorney with the Center for Medicare Advocacy. Some patients whose plan benefits have changed might not realize it until they try to fill their first prescription this year.

Troubles for low-income beneficiaries

Missing benefits information is not Medicare's only problem so far in 2007. The center has been receiving other complaints, the first one arriving Jan. 2, that some low-income people who remained eligible for extra government subsidies this year were asked to pay the full, nonsubsidized amount for their drugs. Others report being listed by their insurers under the wrong plans or the wrong co-payment structures.

The American Medical Association is working with beneficiary advocacy organizations to identify and report any such problems, especially those that impact people who are eligible for both Medicare and Medicaid, said Edward L. Langston, MD, chair-elect of the AMA board.

"We are particularly focused on issues that affect dual-eligibles and other low-income patients, such as those who may have to pay premiums this year because their plans' premium exceeds the government subsidy that covered the full cost last year," he said. "We are also monitoring for problems that may arise if low-income patients are inappropriately charged high co-pays and deductibles, due to computer or other glitches that prevent patients from being able to get their prescriptions filled."

Medicare Part D is starting up much more smoothly than it did as a brand-new program in 2006, but some of that change could be a result of more people simply giving up when subjected to health plan errors and denials instead of appealing their cases, Gottlich said.

"People are just used to being turned down," she said.