Switch to Drug Plan Can Be Tricky for 'Dual Eligibles'
Posted on: Tuesday, 27 December 2005, 15:00 CST
By Phil Galewitz, The Palm Beach Post, Fla.
Dec. 24--It was supposed to be automatic.
The 6.2 million people getting both Medicare and Medicaid benefits, including 360,000 in Florida, were going to be automatically and randomly assigned to one of the new Medicare prescription drug plans by Dec. 31.
These "dual eligibles" who qualify for both government health insurance programs were supposed to switch easily from having their medicines paid for by state Medicaid programs to the federal Medicare program.
But with the transition date a week away, there are some lingering concerns.
The problem is that the state and federal governments may fail to notify some eligible people about the change. And some may be involuntarily enrolled into a drug plan that doesn't cover their medications or doesn't contract with the pharmacy they use.
At nursing homes, where about two-thirds of residents receive benefits from Medicare and Medicaid, administrators are shouldering the brunt of the change.
"We have a lot of work to do in the next week," said Scott Hansel, chief development officer for Palm Beach Gardens-based Home Quality Management, which owns 54 nursing homes, including 14 in Florida.
In addition to making sure the drug-coverage transition is smooth for their residents, there is a worry that if a patient's new drug plan doesn't cover medications, the nursing home might have to pick up the bill, Hansel said.
As of this week, Home Quality didn't know which plan two-thirds of its residents had been assigned to. The company is trying to find out by asking its residents and their families. About 80 percent of its residents are dual eligibles.
The good news for dual eligibles is they can switch Medicare prescription drugs plans anytime and they pay no monthly premiums or co-payments.
In addition to the people on Medicare and Medicaid, about 17,400 Floridians in the state's Medically Needy program also are being switched into the Medicare drug plans Jan. 1. The Medically Needy program is for people who have incomes too high to qualify for Medicaid but have large medical bills.
Fred Smolin, 63, of Delray Beach is in the Medically Needy program because of the $60,000 in annual drug costs he has following a heart transplant in 2002. He said the state failed to enroll him in one of the new Medicare programs and he had to do it himself.
"I was neglected," he said. He worries others in his position will be lost in the transition.
State officials say about 30,000 Medically Needy patients who don't qualify for Medicare will continue getting their medications through the state program.
Meanwhile, administrators at the Joseph L. Morse Geriatric Center in West Palm Beach were more upbeat about the switch to Medicare drug coverage. About 70 percent of the 280 residents at Morse are dual eligibles. Spokeswoman Darryl Miller said most of the residents who were automatically enrolled in Medicare prescription plans already have changed to other plans that cover all their medications and contract with the geriatric center's pharmacy.
"We are confident no one is falling through the cracks," Miller said.
At Jupiter Medical Center's Pavilion nursing home, about 40 percent of the 120 residents are dual eligibles. The Pavilion has made arrangements with its pharmacy and private drug plans for all of its residents to be able to continue receiving their current medications. If problems with coverage are found after Jan. 1, the nursing home will work with residents to switch drug plans.
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Source: The Palm Beach Post
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