Care homes brace for Medicare plans | The Honolulu Advertiser

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Care homes brace for Medicare plans | The Honolulu Advertiser | Hawaii's Newspaper

Posted on: Thursday, December 22, 2005

Care homes brace for Medicare plans

By Julie Appleby
USA Today

With two weeks before the new Medicare drug benefit begins, concerns are growing about its effect on some of the nation's 6.4 million people — many of whom are in nursing homes — who qualify for both Medicare and Medicaid.

Those beneficiaries, called "dual eligibles" in Medicare parlance, will lose their state Medicaid drug coverage on Jan. 1, but automatically will be enrolled in Medicare drug plans chosen at random. At issue:

Some nursing home operators say they don't know which plans their residents are enrolled in, and a special telephone line set up for them to get the information has been backlogged. The Medicare program says the Web site is fully updated with the enrollment assignments, and the telephone backlog is two or three days.

Each nursing home is likely to have residents enrolled in several different plans, each potentially covering different drugs, with differing rules and varying pharmacies, which might not be contracted to serve that nursing home.

Automatic dual-eligible enrollees who also have private retiree health insurance might lose those benefits if they stay in the Medicare drug plan. About 1 percent — or 65,000 people — have such coverage, according to a report from the Medicare Payment Advisory Commission, a government advisory body.

"This situation has a particularly severe impact on (those) ... whose spouses count on their retiree benefits for all health coverage," says a letter to Medicare chief Mark McClellan sent last week by advocacy groups, including Consumers Union, The Center for Medicare Advocacy and the National Senior Citizens Law Center.

To avoid losing benefits, some of those patients will need to call Medicare and say they don't want to be in the drug program. Medicare administrators said Monday they are working with employers to try to identify affected members.

Patient advocates say some of the Medicare/Medicaid eligibles could face problems as they are switched from a program with standard statewide benefits to one where the drugs covered vary by insurer. Some also will begin to pay a co-payment for drugs for the first time.

Nursing home residents take an average of eight or nine medications.

"They had good coverage under Medicaid, which they are losing," says Mike Conners, long-term care advocate at California Advocates for Nursing Home Reform, a nonprofit organization. "It's a headache for residents, family and friends who have to make these difficult and complicated decisions."

Compounding the difficulties, many nursing home residents have dementia, and not all have family members who can help select a plan, Conners says.

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