Medicare Prescription Drug Plan Part D Encounters New Glitch

By Nancy K. Crevier

On Wednesday, December 27, The New York Times reported the failure of certain prescription drug plans to tell Medicare beneficiaries of benefits changes in a timely manner. The failure to do so may have resulted in beneficiaries not having adequate information to determine the best prescription drug plan under Medicare Prescription Drug Plan Part D before the penalty free enrollment period for 2007 ended on December 31.

As of Thursday, December 28, Dawn Macary of Western Connecticut Area Agency on Aging (WCAAA) CHOICES program said that while a few calls had come in concerning this issue, presently it did not appear to be a big problem in Connecticut. She did, however, express concern that enrollment in the Part D Prescription Drug Plan for 2007 had been slow. “I think a lot of people are with ConnPACE and felt they didn’t need to change. But others really should have been watching for changes in their plans and looking into other plans.”

For example, she said, people who have Humana paid prescription plan should be aware that the cost of that plan went up for 2007 and may no longer be the best plan for some in the new year. “There will be changes in what is covered with that plan,” said Ms Macary.

It is not only an increase in cost that can change in a plan, said Ms Macary. Whereas last year the Humana plan and others covered a lot of brand name prescriptions, this year they may cover more generic brands of drugs, dropping brand name prescription drugs. Humana is not one of the drug plans that failed to properly inform people of benefit changes, but Ms Macary said that she would have liked to have seen evidence that more beneficiaries were alert to the changes. The slow enrollment indicated that not all of those eligible for Medicare Prescription Drug Plan Part D took advantage of the plan that, despite its problems, has saved money for most of those enrolled.

Joanne Klopfenstein, a caseworker with Newtown Social Services, also expressed reservations that not many people had contacted the office to review their plans for 2007. “I think a lot of older people, rather than change their plan, just go along with what their plan has been,” she said. Newtown Social Services recommended to anyone who called the office during the November to December enrollment period that they check that their plan was still the best fit for the new year.

“I think that people read the dark print in those notification letters that says if they are happy with their plan they don’t need to change, and don’t read the whole letter to understand that the premiums or benefits may be different in 2007,” said Ms Klopfenstein.

Despite television and radio commercials that attempted to get the word out concerning the need to review Medicare prescription plans during the enrollment period this fall, Newtown Social Services did not have a lot of requests for help in doing so, Ms Klopfenstein said, nor had Newtown Social Services received any calls regarding the lack of timely notification by any companies to beneficiaries.

“Unfortunately,” she said, “for those who just did not read about any changes to their plan, it is too late to change this year. The next enrollment period starts in November of 2007. I think there are going to be a lot of surprised people. We’ll see what happens this month.”

For those people who did not receive adequate notice and would like to enroll in a different prescription drug plan after the December 31, 2006 deadline, said Ms Macary, WCAAA has been informed by the Center for Medicare and Medicaid Services that a special enrollment period will be provided. The extension will allow for the selection of a new prescription drug plan without penalty. Ms Macary also noted that if people change plans and find out that the drug they take is not on the new plan, they are entitled to a 30-day supply of their prescription drug until their doctor is able to provide them with a prescription for an alternative drug. WCAAA can be contacted at 800-994-9422.

“I just hope everything goes smoothly come January,” said Ms Macary.