A: On January 1st of this year, millions of low-income Medicare beneficiaries who formerly received prescription drug benefits through state-sponsored prescription drug programs, began to receive their drug benefits through Medicare Part D drug plans.  Although your friend had coverage through a state pharmacy assistance program last year, by law state Medicaid drug coverage, ended on December 31, 2005, and thus she no doubt required the new Medicare Part D coverage. 

The automatic assignment to Medicare Part D plans affected almost 6 million beneficiaries and became effective January 1, 2006.  Early implementation of the confusing new program went anything but smoothly.  In early January, hundreds of thousands of beneficiaries, had difficulties getting their prescriptions filled, were overcharged, or left their pharmacies empty handed.  Millions of these seniors and their families undoubtedly felt they had been “dumped” into a drug plan that stinks.

The Centers for Medicare and Medicaid Services (CMS) issued a special rule requiring plans to cover all medications of enrollees during the first 90 days.  That period, which is over now, was intended to allow beneficiaries to either change prescriptions to others covered by their plan, or switch to a drug plan more appropriate to their needs.  As you point out, that’s no easy feat for a nursing home patient.

The New York Times recently reported that many Medicare beneficiaries say they continue to have difficulty getting the drugs they need.  Pharmacists and doctors are struggling to figure out what drugs are covered by which plans.  Each plan has its own policies and procedures.

As a nursing home patient automatically assigned to a Part D drug plan, however, your friend very likely receives full assistance to cover the costs of her prescriptions.  She undoubtedly pays no premium, no deductible, and no co-insurance for her coverage.  In addition, she would receive full coverage for the “doughnut” hole gap in coverage.  If your friend is having problems getting coverage for one or more of her prescriptions, she can switch to a more appropriate drug plan.  Medicare benefits counselors, working with the staff of her nursing home, undoubtedly could be a big help if she needs it.  The family member responsbile for your friend’s medical and financial decisions can also get one-on-one counseling for finding the best plan by contacting the closest Area Agency on Aging.  The number is listed in your phone book.
 
Sources:  “37 Million Medicare Beneficiaries Now Receiving Presciption Drug Coverage,” Department of Health and Human Services, May 10, 2006.  “In Texas Town, New Drug Plan Baffles Patient and Provider Alike,” Robert Pear, The New York Times, June 11, 2006. “Additional Help To Those Who Need It Most,” Centers For Medicare and Medicaid Services, January 21, 2005.

August 2006