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Zero-Premium Medicare Plans To Change

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By CAROL GENTRY, The Tampa Tribune

Published: November 9, 2007

More than half of Florida's low-income Medicare beneficiaries who now pay no premiums for their prescription-drug plans will be forced to change plans for 2008 to keep the full subsidy, a consumer group said Thursday.

That means about 312,000 Floridians will have to switch to keep a zero-premium plan, according to the National Senior Citizens Law Center of Oakland, Calif. The center estimates that 1.7 million low-income beneficiaries will be affected nationwide.

Florida has the highest percentage of low-income beneficiaries who will have to switch plans, said Kevin Prindiville of the law center. That's because eight of the 10 Florida plans that now have full-subsidy enrollees raised their premiums so much they don't qualify for the program in 2008, he said.

Among the dropouts are two of the largest in the state - Humana PDP Standard and United/AARP Medicare Rx Plan Saver, he said.

The only plans now participating that qualified again for 2008 are Health Net Orange Option 1 and WellCare Classic, said Anne Swerlick of Florida Legal Services in Tallahassee.

While enough new plans qualified for participation in the program to give the patients a choice of eight plans, the legal advocates say most don't take advantage of it, and wind up being randomly assigned to another plan by computer.

Beneficiaries who qualify for low-income assistance often are very sick or frail, and frequently mentally ill. Shifting their plan assignment can mean a forced change of medications, which can be dangerous, Swerlick said.

It took one of her clients 20 months to navigate the Humana appeals process to win approval for her psychiatric medicine, Swerlick said. She received the OK a few days after receiving a letter from CMS saying she is going to be reassigned to another plan; to stay in Humana she will have to pay a premium.

Beneficiaries qualify for low-income assistance if their income equals or is less than 135 percent of the federal poverty line. For an individual, that comes to $1,149 a month, Swerlick said.

For information on how to qualify or switch plans, beneficiaries may call the state-supported volunteer SHINE program at 1-800-963-5337.

Reporter Carol Gentry can be reached at cgentry@tampatrib.com or (813) 259-7624.

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