A surge in enrollment before the May 15 deadline for signing up for the Medicare prescription drug benefit could mean that more than 90% of Medicare beneficiaries will have prescription drug coverage in the first year of the program, CMS Administrator Mark McClellan said on Monday, CQ HealthBeat reports. The Bush administration last Wednesday said about 37 million Medicare beneficiaries -- or 85% of the approximately 43 million total beneficiaries -- had some form of prescription drug coverage. According to CQ HealthBeat, "Breaking 90% would put that figure at about 38.7 million" (Reichard, CQ HealthBeat, 5/15). CMS spokesperson Lorraine Ryan said about 72,000 beneficiaries signed up for the drug benefit online on Friday, three times the number who enrolled online the previous Friday (Salganik, Baltimore Sun, 5/16). Over the weekend, five times as many beneficiaries enrolled online than had the previous weekend, McClellan said. In addition, as many as 40,000 to 50,000 people were on the Medicare Web site at any given time over the last few days, he said. Calls to 1-800-MEDICARE averaged about 300,000 per day last week, compared with 200,000 to 250,000 the week before, McClellan said (CQ HealthBeat, 5/15). The agency was receiving about 140,000 calls per day two months ago, Ryan said. Better estimates of final enrollment figures should be available Tuesday, she said (Baltimore Sun, 5/16). McClellan said, "We've seen a real surge. The deadline is making a difference" (Freking, AP/Long Island Newsday, 5/16).

Enrollment Efforts
Across the U.S. on Monday, state and local governments, advocacy groups, seniors' organizations, insurers and pharmacies held enrollment events to encourage beneficiaries to sign up before the deadline, after which most beneficiaries will have to pay a penalty (Baltimore Sun, 5/16). Beneficiaries who were eligible to enroll in the drug benefit Monday who did not sign up will have to pay a penalty of a 1% premium increase for each month of delayed enrollment. Because the next enrollment period begins Nov. 15, beneficiaries would pay a minimum late-enrollment penalty of 7%. Beneficiaries who qualify for a low-income subsidy under the drug benefit are exempt from the penalty. Hurricane Katrina evacuees also will be allowed to enroll without a late-enrollment penalty for 63 days after May 15 but will have to pay a 2% penalty beginning the 64th day (Kaiser Daily Health Policy Report, 5/15). In Washington, McClellan, HHS Secretary Mike Leavitt and first lady Laura Bush attended an enrollment event at a church. Administration officials and other groups participated in about 1,000 similar events across the country in the last week, CMS spokesperson Peter Ashkenaz said (CQ HealthBeat, 5/15). Nationwide, My Medicare Matters, an affiliate of the National Council on Aging, held more than 3,000 events (Baltimore Sun, 5/16). In addition, at least 12 Republican House members planned to keep their offices open until midnight Monday to help beneficiaries enroll, while other lawmakers held events in their congressional districts (Wolf, USA Today, 5/16).

Phone Lines, Incomplete Applications
Meanwhile, calls to insurers -- which had been urged by the Bush administration to add extra phone operators to handle the last-minute enrollment surge -- showed varying wait times Monday, the New York Times reports. Calls to UnitedHealthcare generally were answered in less than two minutes, but callers to Humana often had waits of more than 30 minutes, according to the Times. Calls to 1-800-MEDICARE often took more than 15 minutes (Pear, New York Times, 5/15). Beneficiaries who called the Medicare phone line on Monday but were unable to get through could leave their names and phone numbers, and they would be called back within a few days to enroll without penalty, Ryan said (Baltimore Sun, 5/16). Medicare officials also told insurers they could accept incomplete applications on Monday if beneficiaries provided the missing information soon after the deadline. On Humana's phone line, callers were told they could "meet enrollment deadline requirements" by leaving their names and phone numbers on an answering machine. Callers were told that a Humana representative would "call [them] back in the next few days" to help choose a drug plan (New York Times, 5/16).

Penalty Waiver
Meanwhile, House Ways and Means Health Subcommittee Chair Nancy Johnson (R-Conn.) on Monday said she was drafting legislation that would eliminate the late-enrollment penalty for beneficiaries who missed Monday's deadline. The bill would maintain Nov. 15 as the start of the next enrollment period but would waive the late-enrollment penalty for beneficiaries who were eligible this enrollment period who did not sign up. A press release from Johnson's office said she will introduce the bill as "quickly as possible" for consideration before the current legislative session adjourns (CQ HealthBeat, 5/15). Jill Gerber, a spokesperson for Senate Finance Committee Chair Chuck Grassley (R-Iowa), said the senator will not make a decision on whether he supports eliminating the penalty until after he sees final enrollment figures, which could be as early as Tuesday (Schuler, CQ Today, 5/15). Karen Ignagni, president of America's Health Insurance Plans, said her group supports waiving the penalty, adding that doing so would act as an incentive to encourage more beneficiaries to sign up (CQ HealthBeat, 5/15). AARP also has expressed support for waiving the penalty (Alonso-Zaldivar, Los Angeles Times, 5/16).

Comments
Johnson said, "We might be closer to 100% coverage if the Democrats had put the welfare of our seniors ahead of their own political ambition," adding, "Although the penalty in existing law is not harsh, it is more the principle that no senior should be made to pay for the Democrats' posturing over the past year" (CQ Today, 5/15). House Minority Leader Nancy Pelosi (D-Calif.) said, "After months of ignoring the pressing needs of seniors, Republicans are running for political cover by claiming they want to waive the penalty they imposed. Waiving the penalty does not do enough" (AP/Long Island Newsday, 5/16). Pelosi said Democrats also want to "extend the deadline," and "allow seniors the opportunity to opt out of a plan if it doesn't work for their health needs" (CQ HealthBeat, 5/15). Drew Altman, president of the Kaiser Family Foundation, said the late enrollment penalty and the so-called "doughnut hole" gap in coverage under the drug benefit "are going to be hitting around the time of the election." He added, "It will be a lot easier to solve the enrollment penalty than to plug the doughnut hole" (Los Angeles Times, 5/16). Meanwhile, the Bush administration remained "noncommittal" on Monday about whether it would waive the penalty or extend the deadline, the Sun reports. White House spokesperson Tony Snow said, "I'm not going to give you a categorical answer. The deadline is the deadline" (Baltimore Sun, 5/16).

States
In other drug benefit news, California legislators on Monday approved an emergency bill to allow the state to continue covering the costs of medications for dual eligibles who have been unable to obtain prescription drugs under the Medicare drug benefit. The legislation would authorize the state to continue until the end of January 2007 paying for medications for beneficiaries in Medi-Cal, the state Medicaid program, who had their prescription drug coverage transferred to Medicare under the drug benefit. Many dual eligibles were incorrectly charged copayments or experienced other problems obtaining medications after the drug benefit began. As of May 9, California has spent $65.7 million to pay for prescriptions for dual eligibles. The state has set aside $120 million for the program, which would expire on Tuesday without the emergency measure. The state Assembly voted 56-5 to continue the program. The bill, which included amendments from the state Senate, is expected to be signed by Gov. Arnold Schwarzenegger (R) (Lawrence, AP/Contra Costa Times, 5/16). Separately, Illinois officials said low-income and disabled Medicare beneficiaries who did not meet Monday's enrollment deadline can receive prescription drug coverage through the state pharmaceutical assistance plan through Dec. 31. To qualify for the program, called Illinois Cares Rx, beneficiaries must have annual incomes of $19,600 or less or $21,218 for beneficiaries with cancer or certain other conditions. For beneficiaries already enrolled in the Medicare drug benefit and Illinois Cares Rx, the state program will pay for any premiums, copayments or coverage gaps not covered by Medicare. Beneficiaries already enrolled in the drug benefit who have not signed up for Illinois Cares Rx will not be eligible for the state program (Graham, Chicago Tribune, 5/16).

Broadcast Coverage
Several broadcast programs reported on the enrollment deadline for the drug benefit:

• APM's "Marketplace Morning Report": The segment includes comments from Robert Laszewski, political analyst and health consultant for the insurance industry, and Joe Paduda, a health care consultant (Tong, "Marketplace Morning Report," APM, 5/15). The complete segment is available online in RealPlayer.
  


• CBS' "Evening News": The segment includes comments from Medicare beneficiaries (Andrews, "Evening News," CBS, 5/15). The complete segment is available online in RealPlayer.
  


• KCRW's "To The Point": The segment includes comments from McClellan; Tricia Neuman, a Kaiser Family Foundation vice president and director of its Medicare Policy Project; Ron Pollack, executive director of Families USA; Rob Pollock, member of the Wall Street Journal editorial board; and Medicare beneficiaries (Olney, "To The Point," KCRW, 5/15). The complete segment is available online in RealPlayer.
  


• PBS' "NewsHour with Jim Lehrer": The segment includes comments from Dan Mendelson, president of Avalere Health, a health care consulting firm, and Pollack (Suarez, "NewsHour with Jim Lehrer," PBS, 5/15). The complete segment is available online in RealPlayer.