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Medicare Compliance & Reimbursement

Drug Coverage:

Auto-Enrollment May Ease Transition For Dual Eligibles

Published on Fri Jan 28, 2005

But no such luck for the lowest-income patients

Beneficiaries dually eligible for both Medicare and Medicaid will be automatically enrolled in a drug plan by September or early October. Bottom line on getting hard-to reach low-income enrollees into the program, according to the Centers for Medicare and Medicaid Services: Congress clearly intended each beneficiary to choose his or her own drug plan.

But the law does allow what the agency dubs "facilitated enrollment" of people who'll qualify for low-income financial assistance - all beneficiaries with incomes at or below 150 percent of the federal poverty level. This means that CMS and partners, including the Social Security Administration, will start intensive outreach now to find and inform these beneficiaries about the benefit, and, to the extent possible, "pre-fill out low-income subsidy applications," said CMS Administrator Mark McClellan.

There are two other consequences of Congress' nix on automatic enrollment by agents other than the beneficiary. State Pharmaceutical Assistance Programs won't be allowed to automatically enroll their current members into a single plan, as states had requested.

And Medicare's automatic enrollment of dual eligibles into plans will occur early enough this year for beneficiaries and their families to review plan options and switch to plans they like better before the benefit launches in January, McClellan explained. Most dual eligibles depend heavily on pharmaceuticals to treat chronic conditions, and it's especially important that their transition from Medicaid to Medicaid drug coverage be seamless.

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