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Health Insurance & Affordable Care Act

Fewer Delays for Medicare Drug Benefit

Government Sees Improvement After Rocky Start to Rx Plan

WebMD Health News

Feb. 13, 2006 - Fewer seniors are having problems getting their new Medicare prescription drug benefits, though up to one in 20 new beneficiaries still face delays, a top Bush Administration health official said Monday.

As many as 10% of the 6.4 million seniors eligible for both Medicare and Medicaid have been denied or delayed access to covered drugs under the new Medicare Part D program. Officials have cited lagging computer records that did not include updated information on all patients.

Those numbers have now been cut about in half, with about 3% to 5% of the seniors experiencing problems, Health and Human Services Secretary Michael O. Leavitt said.

"I can't say it has disappeared, but it has diminished substantially," he told reporters.

The delays forced more than 30 states to step in with emergency funds and medicine supplies for seniors who were improperly denied benefits. Medicare officials say they've boosted manpower at call centers designed to help pharmacists settle benefit questions.

Still, more seniors are expected to face similar problems at the beginning of March, when new benefits kick in for seniors who signed up for a plan in February.

Capitol Hill Perspective

The problems led to increased calls on Capitol Hill to extend Part D's May 15 sign-up deadline. A majority of senators voted earlier this month to extend the deadline, though the measure did not achieve the 60 votes it needed to pass.

Many lawmakers want to extend the deadline to give seniors more time to choose a plan before facing penalties for late enrollment.

Federal officials have resisted the extension as unnecessary. "We have three more months" until the May 15 deadline. "That's a long time," Leavitt said.

Many pharmacists have experienced problems when trying to contact the private insurance companies that carry the drug benefit. Officials are encouraging seniors who were forced to pay higher than expected out-of-pocket costs to contact their health drug plans for a refund.

"If a person paid a co-pay that was higher than they should have, we encourage them to contact their plan and make a claim," Leavitt said.

A report issued Monday by the consumer health group Families USA concludes that only 5% of low-income seniors have applied for subsidies covering the majority of out-of-pocket costs.

"The seniors who need it the most are the ones facing the biggest obstacles," Ron Pollack, the group's executive director, said in a statement.

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