Medicare Compliance & Reimbursement

Confusion is no longer the biggest problem with Part D.

Millions of seniors who are still struggling to understand their Medicare drug coverage now have hard numbers to defend their frustration. Most adults who participated in a recent Ipsos Public Affairs poll find the Medicare prescription drug plan difficult to understand--and many are experiencing claim denials.

Of the 1,000 adults who participated in the survey, 52 percent consider the drug plan somewhat hard or very hard to understand, whereas only 16 percent find it somewhat easy or very easy to understand. "Most [enrollees] are vulnerable and frail," notes the National Senior Citizens Law Center's Jean Finberg. "Our government is not protecting these people, and the new plan is too complicated."

Although the poll's findings speak to eligible senior's enrollment challenges, only one in five survey respondents were eligible for the Medicare prescription drug program. In addition, only a third of those who were eligible had actually enrolled in a Part D plan. But in spite of the sample population's eligibility and enrollment status, nearly two-thirds feel that the new plan provides no significant cost savings.

Nearly one in five respondents experienced coverage problems under the Part D program--a troubling figure in light of the coverage problems states have reported within the dual eligible population. Among those respondents who had themselves enrolled in a Part D plan or who were closely related to a Part D enrollee, 18 percent encountered denials when attempting to fill their prescriptions. Of these individuals, 37 percent believed to the best of their knowledge that the denial was erroneous. "We certainly acknowledge there have been some problems," says CMS spokesperson Gary Karr. "This is a $30 [to] $40 billion program. It's a big transition for many people."