Medicare makes drug card enrollment easier

Apr 19 2004

Mark B. McClellan, M.D., Ph.D., administrator of the Centers for Medicare and Medicaid Services, today announced two new steps to help Medicare beneficiaries enroll in the Medicare drug card program.

First, Medicare has issued guidance that allows state pharmacy assistance programs, in certain circumstances, to enroll low-income Medicare beneficiaries automatically into the transitional assistance benefit of the Medicare Modernization Act (MMA). States that have the authority to act as an "authorized representative" of a beneficiary (as defined by state law) would be permitted to enroll beneficiaries in drug cards on the beneficiary's behalf. This step will make it easier for low-income beneficiaries in states with pharmacy assistance programs to get $600 in additional help.

Second, Medicare will issue a standard enrollment form that will be accepted by all Medicare Approved Discount card programs. This standard form will make it easier for community-based organizations, health professionals, and consumer groups to assist beneficiaries with the enrollment process.

"The Discount Drug Card is an important step in the implementation of the Medicare Modernization Act and an important benefit for seniors. Making it easier to enroll and receive the benefit is another example of our commitment to helping seniors lower their drug costs, " said Health and Human Services Secretary Tommy G. Thompson.

"We intend to make it as easy as possible for Medicare beneficiaries to get the information they need and to enroll in the drug card program, so that they can get the most assistance possible from the new law," McClellan said. "These two important steps will make it easier for people who want to help beneficiaries to work with us to achieve this urgent goal."

CMS will soon provide a standard enrollment form for the Medicare-approved drug discount card program for use by State Health Insurance Programs (SHIPs), and other partners and organizations that assist beneficiaries with their health care decisions.

The standard form will be made available on www.medicare.gov, and by a variety of other means, and will include instructions for its use as well as access to the information needed to complete it, ensuring ease of use and that existing drug card program activities and responsibilities will be supported by it.

Approved card programs will still be able to print their own enrollment forms - which incorporate standardized elements of the form - but which may have additional questions on them or personalized elements - such as a crest or seal. Now, in addition to accepting their own personalized forms, the card sponsors will also accept the standard form which may be used across all cards.

The automatic enrollment policy will help many states coordinate their own drug benefits for low-income Medicare beneficiaries with the new Medicare drug benefit by making enrollment easier for the states and the beneficiaries.

Twenty states have large programs that already provide drug benefits to these beneficiaries. Many of the beneficiaries will be eligible for the new transitional assistance benefit under MMA. Individuals may be enrolled in both types of programs at the same time.

Beneficiaries who are signed up for MMA transitional assistance get $600 to pay for drug costs. Depending upon how the State plan is organized, this could mean state programs would not have to pay the first $600 for each of these beneficiaries, thus freeing up money to help states pay for their own programs.

Medicare-Approved Drug Discount Card and transitional assistance regulations require a beneficiary or authorized representative, under penalty of perjury, to sign an enrollment form in order to apply for the $600 credit.

This signature ensures that the information the government is receiving is correct and that the $600 is distributed to those truly qualified for it. However, many state enrollees may view themselves as already having drug coverage, and therefore be reluctant to apply for the $600 because they fear losing their current benefit. The CMS guidance to the states recognizes that CMS regulations have always permitted an authorized representative to sign the enrollment form on an individual's behalf. To the extent a state has the authority to act as the beneficiary's representative, the state could automatically enroll the beneficiary into a card.

The CMS guidance also ensures that beneficiaries are not enrolled against their choice. For example, states would be required to explain what is happening and the consequences of the enrollment. Individuals must be given an opportunity to decline the enrollment.

States that are able to automatically enroll Medicare beneficiaries into the new program will be able to identify which card a beneficiary is enrolled in so that the individual can return to the state program after the $600 is used without losing any coverage.