Changes ahead for Medicare drug program

By KEVIN FREKING, Associated Press Writer - Sat Nov 3, 2007
WASHINGTON - Nearly 2 million low-income Medicare participants could be switched to different insurance plans for their prescription drug coverage next year.

Millions more will have to shop around if they want to avoid double-digit increases in their monthly premiums.

The reassignment of the poorest beneficiaries and the higher premiums for many others are just two reasons why seniors and the disabled may want to look into other plans as the Medicare drug benefit enters its third year.

The shopping season officially begins Nov. 15 — the first day of an open enrollment period that continues through Dec. 31.

Advocacy groups warn the benefit's 24.5 million participants to take nothing for granted even if they're happy with their current coverage.

"Everybody needs to shop around every year," said Patricia Nemore, senior policy attorney at the Center for Medicare Advocacy. "Just because you like your plan this year doesn't mean that plan will work the same next year."

Under the drug benefit, Medicare subsidizes insurance plans that cover an enrollee's prescription drug buys. The government pays insurers extra for covering the very poor.

The plans adjust their coverage to reflect the changing marketplace. They change which drugs they will cover for safety and financial reasons. They also make adjustments to the monthly premiums they charge customers, trying to maximize demand for their product and profitability.

On average, Medicare Part D plans will charge a monthly premium of $28 in 2008, but the premiums vary widely across the nearly 1,800 plans around the country. The premiums range from $9.80 for a basic benefit to $107.50 for enhanced coverage.

About a quarter of the poorest beneficiaries don't pay any monthly premium. They will still be entitled to that extra benefit next year, but they will have to get their coverage though other plans meeting Medicare's requirements for offering coverage to low-income beneficiaries. Medicare officials sent letters this past week to nearly 2 million people to inform them that they will be moved to a new plan.

Kerry Weems, administrator for the Centers for Medicare and Medicaid Services, said those beneficiaries can opt to stay with their current coverage if they like, but would have to start paying. He anticipates that the government will make changes to the drug benefit in future years to reduce the number of people "pingponging" from insurer to insurer with each new year of coverage.

"It's not good for them," Weems said. "There's some things we could have done this year to avoid that, but it would have meant changing the business rules after companies had bid. That didn't seem like the right thing to do."

Most of the low-income beneficiaries being reassigned participate in plans offered through UnitedHealthcare and Humana, according to an analysis from Avalere Health, a consulting firm based in Washington. Two companies, Silverscript and Medco, should pick up many of the reassignments.

The poorest participants can switch their drug plans at any time, so if they get a reassignment notice from the government, they should make sure their new plan covers all their medicine, Nemore said. They can do that by consulting 1-800-Medicare, or by contacting the State Health Insurance Assistance Program, which has counselors in every state.

But it's not only the poor facing major changes, officials note. Enrollment in the drug benefit is highly concentrated, and some of the most popular plans will charge considerably higher monthly premiums next year.

For example, the most popular plan, the AARP Medicare RX Preferred Plan, will increase its monthly premium by 16 percent. Humana Inc. will increase the premium for its standard plan by 71 percent. And the AARP Medicare RX Save Plan will jump 65 percent, according to Avalere Health.

Silverscript, the ninth largest plan, lowered its monthly premium by 24 percent.

Weems said he had not seen Avalere's analysis, but he pointed out that beneficiaries have a wide array of choices and more than 90 percent of participants can move into a plan with a lower premium than they are currently paying. They just need to shop around, Weems said.

The open enrollment season lasts until Dec. 31, but officials warn beneficiaries that it's safer to make a decision sooner rather than later, if they want to be sure their new coverage is in effect when they pick up their first prescriptions in January.

While the drug benefit affects people differently depending upon their incomes, their health and where they live, the standard benefit looks like this: Participants pay the first $275 in drug costs. Then, the plan pays 75 percent of the tab until total drug costs reach $2,510. That's when beneficiaries hit the so-called doughnut hole, where they pick up all cost until they've paid $4,050 out of pocket. After that point, they only have to pay 5 percent of the tab for their medicine.

About a quarter of the plans offering the drug benefit do cover generic drugs when customers hit the doughnut hole.

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CAPITAL HIGHLIGHTS: Community college health coverage restored

By Ed Sterling - Wilson County News - Oct. 31, 2007
AUSTIN — Back in June, Gov. Rick Perry used the line-item veto to kill funding passed by the Texas House and Senate that would have continued paying for health benefits of most people who work at community colleges. Perry’s veto prompted criticism from community college employees, state lawmakers, students, and students’ families who faced tuition and fee increases to make up for the loss in funding.

On Oct. 23, Perry, Lt. Gov. David Dewhurst, and Speaker Tom Craddick announced an agreement to allocate $99 million for the state’s share of health benefits, a one-time $55 million transitional payment for fiscal year 2009, and the development of an incentive funding program for community colleges.

As part of the agreement, the governor’s office said, community colleges are asked to rescind tuition, fee, or tax increases adopted for fiscal year 2008 and any tuition, fee, or tax increases under consideration for fiscal year 2009 meant to offset the original veto.

Capitol tape case
Closed-circuit security cameras record human activity in the halls of the state Capitol. Texas’ 3rd Court of Appeals heard arguments in the Texas Observer’s attempt to get access to videotape recordings of activity in the back hallway outside the House Chamber on May 23, 2005.

The Texas Observer, a biweekly investigative journal based in Austin, filed a request with the Texas Department of Public Safety (DPS) to view the tapes under the Texas Public Information Act, a law that makes most government documents available to all citizens. The Texas Observer argues that it would be in the public’s interest to release the tapes, but the DPS has consistently refused, saying that releasing them would compromise Capitol security.

What makes May 23, 2005, so interesting? It is the day Republican activist and campaign donor James Leininger of San Antonio allegedly met with lawmakers in the hallway when a vote on legislation to allow a pilot school voucher program was up for a vote. The Texas Observer wants to see if the tapes reveal interaction between Leininger and lawmakers.

Now, after many months in the legal process, the matter may take the 3rd Court of Appeals’ three-judge panel days, weeks, or months to rule on the matter.

Early voting
Registered voters can take advantage of early voting through Nov. 2.

Computer users can easily determine polling locations and hours, by going to the Secretary of State’s Web site. www.sos.state.tx.us.

Read more in the Wilson County News