Medicare Drug Aid No Longer Automatic

By Christopher Lee
Washington Post Staff Writer
Friday, October 20, 2006

More than 600,000 low-income elderly and disabled people who automatically received federal help to pay for their Medicare drug coverage this year will have to actively apply to get such assistance in 2007, Medicare officials said yesterday.

The change affects people who were automatically enrolled in the inaugural year of the drug benefit and got the low-income subsidy in 2006 but who are no longer eligible for Medicaid or two other government assistance programs.

Some advocates say the affected seniors may not have understood a letter about the change that the Centers for Medicare and Medicaid Services sent last month. And even beneficiaries aware of the change might have trouble completing the six-page application, they said.

"Just sending these folks a letter and an application doesn't mean they necessarily are going to apply for the extra help even though they may need it," said Marisa Scala-Foley, associate director of the Access to Benefits Coalition at the National Council on Aging. "These are still likely to be low income folks who need all the help they can get. . . . These folks are going to need a lot of hand-holding."

There is no danger of them losing Medicare drug coverage. Even if they do nothing, they will be automatically enrolled in their current plan for 2007. But in January, most would be charged a monthly premium for the first time.

Kathleen Harrington, director of external affairs for the Medicare agency, said it has provided drug plans and community organizations with information about the affected seniors and encouraged greater outreach. The open enrollment period is Nov. 15 to Dec. 31, and the affected group will have three extra months to switch to a plan with no monthly premium, she said.

"We're very concerned about this," Harrington said. "We want to ensure that they know and that they've been contacted by plans, by us, by advocates, by community resources to make sure that they apply for this low-income subsidy, so if they have a premium liability they can minimize it."

More than 9 million of the 23 million people enrolled in Medicare drug plans this year qualified for the low-income subsidy, which meant they paid no monthly premiums and only $1 to $5 in co-payments for their prescriptions. Of those, about 7.2 million were automatically enrolled in the program and the subsidy, while the rest applied and got it, Medicare officials said.

Medicare drug plan beneficiaries qualify for special help if their annual incomes are at or below 150 percent of the poverty level, which is $14,700 for individuals and $19,800 for married couples. Also, individuals must have no more than $11,500 in assets, and married couples no more than $23,000 in assets.

Some of the affected people who no longer automatically qualify for a subsidy might have had a change in income but could still qualify for premium assistance under the drug benefit, officials said.

"The worst outcome will be someone getting surprised that they have a premium and then dropping their coverage," Harrington said. "We want to do everything we can to keep them in coverage."

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