Some Part D Beneficiaries Could Face Difficulty Getting Psychiatric Drugs

Most Medicare Part D beneficiaries are expected to encounter only small increases—an average of 6 percent—in their insurance premiums in 2010. However, some low-income participants could be shifted automatically to lower-cost plans if they don't indicate that they wish to remain with their current plan when Medicare officials notify them about the impending change.

The Centers for Medicare and Medicaid Services (CMS) announced in August that early plan bids indicated that the majority of beneficiaries enrolled in Part D prescription drug plans would have monthly premium increases that average only $2. That increase would bring the average monthly premium to $30 next year.

However, the changes could seriously affect some beneficiaries, particularly low-income subsidy (LIS) beneficiaries in plans with 2010 premiums that are higher than the subsidy the federal government will pay toward their coverage. In such cases, CMS automatically assigns beneficiaries to new lower-cost plans unless they ask not to be switched. Medicare officials estimate that about 800,000 LIS beneficiaries will need to move to a plan charging at or below the benchmark subsidy amount or face automatic reassignment. LIS beneficiaries can opt to stay in the same plan, but they must pay any costs above the subsidy amount.

Nearly 10 million beneficiaries receive prescription drug coverage through the LIS benefit, and it can amount to substantial financial assistance. Generally, Part D beneficiaries are responsible for paying monthly premiums, an annual deductible, and copayments. Those who qualify for full LIS assistance pay no deductible or monthly premiums, however, and they are not subject to falling into Part D's “donut hole”—the coverage gap in prescription-drug costs that begins when the beneficiary has paid $2,700 out of pocket and ends when the beneficiary reaches $4,350.

Any reassignment to a new plan could seriously impact Part D beneficiaries with mental illness because not all drug plans cover psychotropic medications equally.

CMS officials said they would release further details on Part D changes as well as on premiums and benefits for Medicare Advantage plans in late September.

“Although most Part D plans should have relatively stable premiums, all beneficiaries should compare their current coverage with the plans that will be offered in 2010 when information becomes available in October,” said Jonathan Blum, acting director of CMS's Center for Health Plan Choices, in a written statement.

More information on 2010 Part D enrollment and related topics can be accessed at<www.medicare.gov>.▪