Join California Health Advocates in Supporting “The Medicare Informed Choice Act” H.R. 3861

Join California Health Advocates in Supporting “The Medicare Informed Choice Act” H.R. 3861

With the rapid implementation of Medicare Part D, the complexity of the benefit, and the overwhelming amount of choices between plans, California Health Advocates is concerned that Medicare beneficiaries may make wrong decisions and find themselves in a bad situation that is difficult to remedy. This concern is especially true of beneficiaries without family or friends to help them, and/or those who have limited English proficiency. With some exceptions, under current law people who enroll in a Part D plan cannot switch plans until the annual enrollment period of November 15 through December 31 of each year. In addition, those who miss the initial enrollment period deadline of May 15, 2006 must not only wait until November to sign up for a plan effective January 2007, but also pay a lifetime premium penalty of one percent for every month they were eligible for the benefit but did not enroll. Introduced by California Representative Pete Stark, “The Medicare Informed Choice Act” (H.R. 3861) addresses these concerns with three important protections:

  • Delays late enrollment penalties: As beneficiaries need adequate time to make an informed choice, this bill expands the existing six-month initial enrollment period to the entire year of 2006. More time gives people a chance to learn more about their options and make the best decision for themselves.
  • Protections against bad choices: This provision gives people with Medicare the opportunity to make a one-time change in plan enrollment at any point in 2006. With so many plans to choose from, with difficulty obtaining clear and accurate information on plans’ covered drugs, and with some plans’ aggressive marketing campaigns, having an opportunity to correct an initial mistake during the first year of implementation of Part D is both reasonable and fair.
  • Protections for employer-provided retiree benefits: Many retirees may not understand that purchasing Part D coverage could cost them their retiree health benefits. This provision would protect employees from being dropped by their former employer’s or union’s plan during the first year of implementation, thereby giving beneficiaries time to correct enrollment mistakes. While the Centers for Medicare and Medicaid Services (CMS) has asked retiree plans not to drop people who enroll in Part D, official legislation would provide sure and needed protection.

On March 21, 2006, the California Assembly Health Committee also voted to adopt Joint Resolution 40 which endorses this federal legislation. Seeing H.R.3861 as a critical safeguard for all Medicare beneficiaries and their families, California Health Advocates asks you to write to your Congressperson urging her/him to support this important bill. Reviewed below are a few other significant bills in need of support as well.

Other pieces of legislation in the works…

In addition to H.R. 3861, several Democrats are proposing other pieces of legislation to modify the Medicare drug benefit. “The Medicare Prescription Drug Savings and Choice Act of 2005” (H.R. 752), co-sponsored by Representatives Pete Stark and Barbara Lee, would let Medicare beneficiaries enroll in a uniform, Medicare-administered drug benefit and allow Medicare to negotiate prices with pharmaceutical firms. Currently Medicare Part D is only offered through private insurance companies. This bill would amend title XVIII of the Social Security Act to require the government to both offer one or more Medicare-administered drug plan(s) available in all states, and negotiate drug prices with pharmaceutical manufacturers to reduce the cost of drugs. Just as beneficiaries can now choose Original fee-for-service Medicare for Parts A and B, H.R. 752 would ensure that they can choose an ‘Original Medicare’ option for Part D as well.

Similar to H.R. 3861, the “Ensure Prescription Drug Coverage Act of 2005” (H.R. 3940) also extends the initial enrollment period for Medicare Part D but would extend enrollment to June 30, 2007. In addition, it would extend the Medicare drug discount card program through December 31, 2007, and allow Medigap policies with prescription drug benefits to be sold until 2008.

The Pharmaceutical Market Act of 2005 (H.R. 328), introduced by Representative Gilbert Gutknecht, would allow all Americans to re-import lower-priced prescription drugs from abroad – as long as strict safety standards are met. On average, Americans are currently paying more than 50 percent more for the same prescription drug as people living in Canada.

Another bill, the “Medicare Prescription Drug Emergency Guarantee Act of 2006” (H.R. 4685), co-sponsored by Nancy Pelosi and Pete Stark, calls for numerous revisions that would guarantee beneficiaries have uninterrupted access to the drugs the need. Some of the proposed revisions include:

  • All PDP and MA-PD plans must offer a ‘minimum standard’ of transition drug coverage to new enrollees. This ‘minimum standard’ is defined as providing a 60-day supply (or a 90-day supply in the case of an individual who is a resident of a long-term care facility) of the drug, or, if less, a supply of the drug that is the full amount of the prescription, regardless of whether the drug is on the plan formulary or if there are coverage limitations or restrictions on the drug (e.g. prior authorization, step therapy, quantity limits).
  • All PDP and MA-PD plans must provide people receiving transition drug coverage with a standard notice developed by CMS that explains: the plan’s limitations and restrictions on the drug; the person’s rights to request an appeal; and their right to change to a different plan.
  • All PDP and MA-PD plans must provide drug refills during a beneficiary’s pending appeal.
  • All PDP and MA-PD plans must offer a ‘minimum standard’ of drug coverage when pharmacists are unable to verify a beneficiary’s enrollment in a plan. This ‘minimum standard’ is the same as that for the transition drug coverage.
  • The Secretary of Health and Human Services must reimburse pharmacies for any costs incurred in providing necessary prescription drugs, including acquisition costs, dispensing costs, and other overhead costs.
  • All PDP and MA-PD plans must use standardized forms and procedures for reconsideration and appeals. The Secretary of Health and Human Services will develop the forms and procedures of this standardized process to be implemented no later than January 1, 2007.
  • Beneficiaries are allowed to switch plans once each year outside of the annual election period (November 15 – December 31).
  • All PDP and MA-PD plans are prohibited from imposing additional coverage limitations and restrictions (e.g. such as changes in the formulary, and usage restrictions, step therapies, prior authorization, or a quantity limitations applied to drugs) during the plan year.

All of these proposed bills provide both important protections for beneficiaries and some necessary provisions to make Medicare Part D a viable benefit for the Medicare population. Let your Congressperson know how you feel and urge them to support these important pieces of legislation.

Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.

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