Currently, there are approximately six million individuals considered "dual-eligibles," e.g., people who are enrolled in both the Medicare and Medicaid programs to provide their healthcare needs. Currently, Medicare and Medicaid work together to provide a comprehensive medical plan: Medicare covers basic health services, while Medicaid helps to cover the cost of Medicare premiums and to cover important benefits that Medicare does not offer, such as prescription drug costs and long-term care. Individuals who use both programs have limited financial means and more extensive medical needs. Many individuals living with HIV/AIDS use both programs and are considered to be in the dual-eligible category.
Beginning in Fall 2005, individuals who are in the dual-eligible category will be asked to identify and enroll in one of a minimum of two prescription drug plans offered through Medicare Part D. Understanding the options that will be available is extremely important for dual-eligibles, because if a plan is not self-selected before January 1, 2006, those individuals will be automatically enrolled in a randomly selected prescription drug plan. The drug coverage offered through Medicare Part D will not necessarily be the same benefits afforded through Medicaid, so it is most important for dual-eligibles to understand the changes in order to make an informed decision.
All private prescription drug plans utilized by Medicare, regardless of the company, will include a monthly premium and an annual deductible. To help offset these additional costs, there will be substantial assistance offered through subsidies to those individuals who are considered dual-eligible and have restricted financial resources. One major concern to be aware of in choosing a plan: Prospective enrollees are not given information about whether specific drugs are covered or what the costs will be before they have a chance to decide whether or not to enroll. There is a one-year commitment for each prescription drug plan; every year between November 15 and December 31, enrollees will have the opportunity to change plans, if necessary.
Advocates for individuals accessing both Medicare and Medicaid have concerns with this new law. The worry is whether the new Medicare drug plan will be able to provide the comprehensive coverage necessary to give dual-eligibles the quality of service similar to the Medicaid benefits it will replace. Furthermore, individual companies will be able to control all aspects of the plan, including drug prices, program costs and preferred drug formularies.
The following two questions are ones often asked by consumers and community members and addressed by the Kaiser Commission of Medicaid and the Uninsured.
|President George W. Bush signs HR-1, the Medicare Prescription Drug Improvement and Modernization Act of 2003, at Constitution Hall in Washington, D.C., December 8, 2003. Program changes created by the legislation will have some impact on those currently eligible for dual coverage under Medicare and Medicaid. (Photo: Paul Morse, The White House.)|
With transition to the new Medicare prescription drug plan approaching, it is important for current beneficiaries to begin considering what they will need to do before the end of the year to ensure that this process of change is successful. From November 15 through December 31, 2005, individuals affected by this new law will have the opportunity to learn about the new prescription drug programs available through Medicare. It is important for current beneficiaries to make their decision before the end of year so that the best program for their needs is chosen -- and to avoid having a program chosen for them. The transition process could be overwhelming and it's a good idea for each affected individual to talk with his or her physician or pharmacist for help in understanding the health plans being offered and which is the best choice for their own health care.
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