Eyecare Tips

Americans Locked Into Medicare-Approved Drug Plans That Refuse Assistance

March 21, 2017

Older and disabled Americans must be allowed to switch out of Medicare private drug plans because confusion, misinformation from the government, and deceptive drug plan marketing practices have led many people to enroll in plans that do not cover their medications, reports the Medicare Rights Center.

"Secretary Leavitt can and must lift the 'lock in' provision and allow people with Medicare to change drug plans when they discover their plan doesn't cover the medicines their doctors' prescribed," said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service organization.

"It's time that the Administration recognizes the drug benefit should be about meeting human need, not just pleasing the insurance industry," he said.

As of May 15, people are "locked in" to their Medicare private drug plans through the end of the year. People who have drug coverage through Medicare Advantage HMO's are locked into their drug and health plans beginning July 1.

The Medicare Rights Center, which has received a flurry of calls from consumers discovering that they cannot get needed medications from the plans they enrolled in, reports that up until May 15 changing drug plans was the only solution for people to get prescriptions filled.

Marketing abuses, the Medicare Rights Center found, led countless numbers of people with Medicare to enroll in plans that cannot provide the coverage they need. The new report found:

-- Plan representatives have told prospective enrollees that their drugs were covered when they were not, and neglected to tell them some drugs are subject to utilization management restrictions;

-- The Centers for Medicare and Medicaid Services' provided inaccurate drug plan coverage information on its web-based plan finder and via 1-800-MEDICARE operators;

-- The appeals process does not work in a timely or fair manner for people whose drug plans limit and change formularies and place restrictions on covered drugs; and

-- Systems failures have resulted in chronic enrollment and disenrollment break-downs.

Secretary Michael Leavitt has the authority to call a "Special Enrollment Period" (SEP) and lift the lock in provision through the end of the year, reports the Medicare Rights Center in People Must Be Allowed to Change Their Drug Plan.

The consumer group says that if the Secretary refuses to act, then Congress should eliminate the lock in provision in conjunction with extending the May 15 enrollment deadline.

The Bush Administration does allow people with Medicaid and Medicare, as well as those in Medicare Savings Programs or receiving Social Security Income, to switch plans throughout 2006.

The Medicare Rights Center is the largest independent source of health care information and assistance in the United States for people with Medicare.

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