Most dual eligibles assigned to Medicare Part D drug plans

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The Centers for Medicare & Medicaid Services has enrolled most dual eligibles in a Medicare prescription drug plan.

The agency has identified 6,130,120 dual eligibles and has assigned
5,498,604 of them to randomly chosen Medicare prescription drug plans, according to news reports. Beneficiaries assigned at random to plans have been notified of their new coverage by mail and are given the option to switch to another plan.

Speaking to a group of state health officials, Administrator Mark McClellan this week addressed concerns that dual eligibles will "fall between the cracks" when their prescription drug coverage switches from Medicaid to the new Medicare prescription drug plan this January.

Individuals who qualify for both Medicare and Medicaid – so called dual eligibles – will be automatically enrolled in a Medicare drug plan so they will not be denied medications because they have not selected a drug plan, according to McClellan. Dual eligibles, who make up about 70% of nursing home residents, are considered the most vulnerable of the elderly population.
 
Pharmacists will be able to file eligibility inquiries with CMS to determine a beneficiary's coverage if dual eligibles do not know their plan. In addition, CMS has created a "point of sale mechanism" to ensure coverage if there is a lag time of eligibility when a beneficiary is first assigned to a plan. This will allow providers to immediately confirm eligibility and facilitate enrollment, if necessary.
(Published 11-10-05)

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