Drug plan reshuffling for dual eligibles could occur next year

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The government is concerned about a disruption in Medicare drug-plan coverage for dual eligibles next year if certain plans lose their eligibility to serve this population.

This week, an official with the Centers for Medicare & Medicaid Services said that plans that offered bids low enough to be eligible to enroll dual eligibles this year may not make bids low enough next year, according to the Bureau of National Affairs. Approximately 70% of all nursing home residents are considered dual eligibles, or those eligible for Medicare and Medicaid coverage.

Starting this year, a competitive pricing process determines payment rates to health plans. Plans submitted bids to CMS indicating the payment per enrollee they were willing to accept to provide benefits. Only those plans with bids that fall below the applicable regional benchmark -- and can offer low and small copayments -– are auto-assigned dual eligibles. Plans bid anew every June. Higher bids and industry consolidation may eliminate certain plans from serving dual eligibles next year.
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