The New Medicare Prescription Drug Law: Issues for Enrolling Dual Eligibles into Drug Plans(2005년 1월)

by Richard Jensen, Independent Health Policy Consultant

Issue paper, Kaiser Commission on Medicaid and the Uninsured, January 2005.

Executive Summary

I . Background

"Close to one in four dual eligibles lives in a nursing home."

The Medicare Prescription Drug, Improvement and Modernization Act of 2003 establishes a new “Part D” in Medicare that gives people access to a private Medicare prescription drug plan. The new Medicare law has particular relevance for the six million low-income Medicare beneficiaries also enrolled in Medicaid. These Medicare beneficiaries – often referred to as “dual eligibles” – typically have income of less than $10,000 a year and often face serious health challenges such as diabetes, heart disease, dementia or a severe mental illness. Close to one in f our dual eligibles lives in a nursing home. 

Like all other Medicare beneficiaries, dual eligibles will have access to the universal

Medicare prescription drug benefit when it goes into effect on January 1, 2006.

However, dual eligibles are the one group whose current drug coverage is directly

terminated by the MMA. Medicaid will no longer pay for prescription drugs for dual

eligibles as of January 1, 2006. They are to obtain their drug coverage by enrolling in

one of the new Medicare drug plans. Dual eligibles can sign up for a Medicare drug plan

on their own, but, if they do not do so, the Secretary of Health and Human Services is

r equired to automatically enroll them in a plan on a random basis.

As with any major shift in health care services for a vulnerable population, there is some

concern about potential glitches as dual eligibles transition from Medicaid to Medicare

for their drug coverage. The purpose of this issue paper is to identify “risk points” in the

transition that if addressed upfront could minimize disruptions in drug coverage. It is

based on a review of the MMA, along with the proposed regulations on the MMA

released in August of 2004 by the Department of Health and Human Services. The report

describes the characteristics of dual eligibles and then discusses four key elements of the

transition:

• Timeframe for Education and Enrollment

• The Automatic Enrollment Process

• Assistance for Dual Eligibles After Enrollment

• Ongoing Education and Outreach Efforts

자료: http://ww.health08.org/medicare/upload/The-New-Medicare-Prescription-Drug-Law-Issue-for-Enrolling-Dual-Eligibles-into-Drug-Plans-Issue-Paper.pdf