the part d benefit: casualties coming?
DESCRIPTION
The Part D Benefit: Casualties Coming?. Robert M. Hayes President Medicare Rights Center January 27, 2005. Who Are “Dual Eligibles”?. People who tend to be: Sick Cognitively Impaired Underserved Dependent on Multiple Medications Institutionalized Extremely Poor. - PowerPoint PPT PresentationTRANSCRIPT
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The Part D Benefit:
Casualties Coming?
Robert M. HayesPresident
Medicare Rights CenterJanuary 27, 2005
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Who Are “Dual Eligibles”?
• People who tend to be:– Sick– Cognitively Impaired– Underserved– Dependent on
Multiple Medications– Institutionalized– Extremely Poor
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Upheaval for “Full Duals”
• Dramatic change in coverage– New networks,
formularies, private sector cost-containment tools
– Increased copayments• Appeals Process
Inadequate– Difficult to navigate– No emergency supply of
medications
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Upheaval for “Full Duals”
• Access to medications disrupted– Deluge in doctors’ offices and
pharmacies in January 2006– Suffering, death: hyperbole or
reality?• Unlikely that plans will
accommodate existing treatment plans– No grandfathering of
formularies– No requirement for open
formularies
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Upheaval for “Full Duals”
Nursing Home Residents• Access to medications
in nursing facilities will be dependent on market forces
• Facility staff must manage residents in multiple plans, with different formularies and networks
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No Medicaid? Automatic
Enrollment Is Key
• Part B Enrollment versus Medicare Savings Programs
• Transitional Assistance and Discount Card Experiences
• Automatic enrollment in Low-Income Subsidy
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Complex Enrollment and
Eligibility Procedures
• Asset tests• Joint bureaucracy creates
additional hurdles– MSP screening/enrollment– Single application for all
programs
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Renewal and Retention
• Failure to renew enrollment may lead to penalties
• Renewal procedures may vary across states, SSA
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Individualized Assistance
• Simplification better choice
• Resource-intensive– Counseling on plan
choices and effect on other benefits
– Additional funding necessary
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Looking Forward
• Medicaid coverage for an additional 6 months to one year
• Intensive education and individual counseling
• Automatic enrollment: dump asset test