05.15.06

As Medicare Drug Plan Deadline Arrives, Cantwell Works to Eliminate Enrollment Penalty and Help Seniors Left Behind

Senator working to eliminate penalty fees, extend enrollment period, and reach out to the millions of seniors still without adequate drug coverage

WASHINGTON, DC – On Monday, the deadline for seniors to enroll in the new Medicare prescription drug program, U.S. Senator Maria Cantwell (D-WA) vowed to continue working to get seniors the care they need. Currently, all seniors who sign up for the program after Monday’s deadline will face penalty fees for as long as they remain enrolled in the Medicare prescription drug program. Those penalty fees are just one of the things Cantwell is working to change for seniors under Medicare.

“All seniors should have fair access to the medications they need without the fear of paying a penalty for the rest of their lives,” said Cantwell. “We must also make sure that we’re providing the tools needed to reach out to all seniors still struggling to understand their options under this confusing program. All across Washington, volunteers have been working overtime to answer the increased calls for help as seniors attempt to sort out the details of this program. If we want this program to keep its promise to our seniors, we need to get serious about making it accessible, practical, and affordable, and we must reach out to seniors who are unaware of their options.”

For months, Cantwell has worked with a bipartisan coalition of senators pushing to extend the program’s enrollment deadline through the end of the year and eliminate late enrollment penalties. In March, Cantwell joined Senator Bill Nelson (D-FL) to champion an amendment to a pending budget bill that would have extended the deadline through the end of 2006 and allow seniors to change plans once during the first year of the program without a fee. The amendment failed narrowly on a 49-49 vote. In April, Cantwell joined 47 other senators in a letter to Majority Leader Bill Frist (R-TN) calling on him to bring legislation extending the deadline to the Senate floor. Last week, in a separate letter to President Bush, Cantwell and a bipartisan group of 39 other senators called for an immediate extension of the deadline. The Republican majority and the Bush Administration have refused to take action to help seniors struggling to understand this complicated program.

As of May 1, 54 percent of seniors who were deciding whether to enroll in the Medicare prescription drug program were unaware of the late enrollment penalty. Currently, enrollment in Washington state lags behind the national enrollment rate of 58 percent. These seniors will all face a penalty equal to one percent of the premium of the plan they eventually select for every month they delay.

Of the 548,000 Washingtonians now covered under the program, only 160,000—or 29 percent—were previously without prescription drug coverage, meaning that much more needs to be done to extend coverage to those whom the program was meant to help. The program, triggered by the Medicare Modernization Act signed into law on December 3, 2003, is so confusing that calls from seniors to programs that help them navigate insurance options have skyrocketed to unprecedented levels. Late last year, the Washington State Health Insurance Assistance Program was reporting over 5,000 requests for assistance each month. Due to the high volume of requests for help, volunteers and state officials have been unable to reach out to many seniors and explain drug coverage options to many of those not previously covered.

Most of the new beneficiaries were automatically enrolled and did not choose a plan for themselves. Nationwide, there are 53 Medicare prescription drug plans that vary according to medications covered, pharmacies used, and costs. Cantwell is working to extend the deadline, end late fees, and provide additional resources to states so they can help them reach out to seniors with insufficient drug coverage and extend coverage to the seniors who need it most. She has also worked to give the federal government the ability to negotiate with drug plans to lower prices to make sure the new program becomes as affordable as possible for seniors struggling on tight budgets.

Cantwell continues to advocate changes that would eliminate gaps in prescription drug coverage and provide life-saving medications to low-income and disabled seniors left behind by the new Medicare program. Seniors eligible for both Medicare and Medicaid often have chronic illnesses and the lowest incomes. These “dual eligibles” were automatically assigned to drug plans based on zip code, with no regard for which plan would actually fit them best. Dual eligibles who decide to switch plans are not covered by the new plan until the first day of the following month, leaving many without access to medications for up to 30 days. There are over 96,000 dual eligibles in Washington state.

The Medicare Informed Choice Act, introduced last October, and the REPAIR Act, introduced in January, would address the duel eligibles gap by guaranteeing seniors access to a 30-day transitional supply of prescription drugs and making it easier for pharmacists to help them. Cantwell is a co-sponsor of both bills. The REPAIR Act came up for a vote on the Senate floor in February, but fell eight votes short of the 60 votes needed at the time.

Of the 30 million Americans currently enrolled in the program:

  • 6.3 million were already covered under Medicaid, oftentimes with better coverage for lower costs;
  • 10 million are federal or military retirees or retirees with coverage through their former employer;
  • 4 million were already enrolled in Medicare Advantage plans that included prescription drug coverage; 20.3 million had other coverage prior to the start of the Medicare prescription drug program; and
  • 8.6 million have new coverage under the Medicare prescription drug program nationwide
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