Successful transition to Medicare Part D

Maine has a solid history of helping its most vulnerable citizens get prescription drugs to stay healthy. As of Jan. 1, the new Medicare prescription drug benefit (Part D) will be available to 240,000 Maine seniors and people with disabilities who are enrolled in Medicare. For many it will make affordable drug coverage accessible for the first time. These new plans are voluntary for most. But low-income Mainers currently enrolled in MaineCare (the state’s Medicaid program) and Medicare must enroll. They will no longer be covered by MaineCare. Instead, they will be covered by Part D and for these individuals this new program poses new problems.

Will these dual eligibles (beneficiaries of both MaineCare and Medicare) be ready for the changes? Part D relies on private insurance companies to administer the benefit. The simplicity, reliability and affordability of their current coverage will be replaced by a complex system with many prescription drug plans, each offering different drugs with different costs at different pharmacies. Most important, not all drugs are covered by all plans.

Across the country, low-income seniors and people with disabilities are overwhelmed by the blitz of advertising from these private plans and the difficulty in navigating unfamiliar computer technology required to enroll. In most states, they have to fend for themselves. But in Maine they will find some help.

For months now the state has been meeting with people who work closely with seniors and people with disabilities to develop a transition plan. I have been a member of this team, serving on the stakeholder group. What has emerged from this collaboration is a creative, comprehensive and cost-effective plan to give the most protection we can to Maine’s most vulnerable citizens.

Most immediately, the key to a successful transition is to ensure people are enrolled in the plan that best meets their needs before Jan. 1. Sounds simple, but across the nation seniors and their children, along with people with disabilities, have been struggling mightily to meet this deadline. Getting our vulnerable citizens enrolled in the best plan for them has been a challenge.

During late October to mid-November the federal government automatically enrolled 45,000 eligible MaineCare members in a Part D plan in order to ensure no lapse in coverage. However, this was a random assignment, simply spreading out the number of participants over the number of plans operating in the state. There was no consideration of whether the assigned plan met the participants’ needs.

On closer inspection, the state’s MaineCare agency found that one in four of these randomly enrolled individuals were placed in a plan that covered, on average, fewer than 15 percent of their current prescription drugs. These individuals typically have incomes less than $9,600 a year and are simply unable to buy costly drugs on their own. The state quickly sought permission from the federal government to re-enroll these individuals into plans that provided them with better coverage. To date, the state has re-enrolled its most vulnerable MaineCare-Medicare members, approximately 12,000 into a more appropriate plan and notified thousands more of a plan that could better meet their needs.

To date, Maine is the only state in the nation to re-enroll low-income seniors and people with disabilities served by Medicaid into a plan that will best meet their needs. This means our citizens will have more hope of adequate prescription drug coverage than any others in the nation come Jan. 1.

Members in the state’s popular Drugs for the Elderly Program (DEL) (approximately 41,000 seniors and people with disabilities) also must enroll in a plan by Jan. 1 or lose coverage under this program. They face the same confusing landscape as those Medicare eligible in MaineCare. By November, information was pouring in showing large numbers of these low-income individuals were not enrolling in Part D.

The state made an urgent call to the federal government requesting permission to automatically enroll DEL members in Part D too, using computer records of their prescription drug usage to pick the best plan. This request was granted and a letter went out informing DEL members that the state would enroll them in a plan unless they contacted the Department of Health and Human Services saying that they didn’t need this help.

With a federally mandated change of this magnitude on a fast track to implementation, problems are inevitable. Come Jan. 1 there is no doubt that many around the nation will go to their pharmacies to pick up their medications and be told they can’t get them; or they are not enrolled in any program; or that they will need authorizations they aren’t aware of. It will be a mess. But in Maine, thanks to the collaborative efforts of many, a plan is in place to make this transition smoother.

Things will not work perfectly; there will still be problems. But we in Maine can be proud that the mess will be much less, affecting many fewer than it might have been without the state’s foresight and hard work.

Jean Lavigne, of Orono, is a member of the Part D Stakeholders Committee that was formed by the Legislature last session. She represents the Maine AIDS Alliance.