Medicare Part D: Life Changes and Marketing Changes

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Medicare Part D and the Marketing Changes

When the Medicare Part D program took effect in January 2006, it was with the best of intentions. Over two years later, the main question would be, has the Medicare Part D made substantial changes to the lives of seniors?

If we go by current statistics, it can be said that Medicare Part D has made some improvements in the lives of seniors, but there have been no revolutionary changes thus far.

Over 50% of Medicare beneficiaries are enrolled in Medicare Part D. And since the program began, the number of Medicare beneficiaries who do not have drug coverage decreased, from 38% to 10%.

However, even with Medicare Part D coverage, there are still seniors who are skipping on medicines because of their high rates. In 2006, after the Medicare Part D program was set up, 11.5% of Medicare beneficiaries still skipped medicines because of the high cost. But this was a minimal decrease from 2005, when 14.1% of Medicare beneficiaries skipped on medicines. In 2006, 7.6% of Medicare beneficiaries scrimped on their basic needs so they could buy medicines. This is a slight decrease in 2005, when 11.1% of seniors also scrimped on basic necessities to pay for medicine. The sickest Medicare recipients skipped pills but did not forego their basic needs. Their numbers were the same prior to and after the enactment of Medicare Part D.

Studies also show that many Medicare beneficiaries do not understand the Medicare Part D program.

CMS Guidelines On Marketing

On May 8, the Centers for Medicare & Medicaid Services (CMS) proposed a new rule requiring Medicare Part D plan providers to intensify their marketing efforts on their Part D medical insurance plans: stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage (MA) plans. The proposed new ruling also targets the tightening of MA Special Needs Plans (SNPs).

With the new ruling, the CMS would be more flexible at determining the penalties against prescription drug plans that violate Medicare rules, which adversely affect Medicare beneficiaries. The new rule gives the CMS the author to impose a penalty of $25,000 for every enrollee who is adversely affected by the violation.

The proposed new rule also set a limit to the sales and marketing activities of plan providers, including:

  • Prohibition of cold calls and expanding the existing prohibition on door-to-door marketing. Part D plan providers would have to set an appointment with Medicare beneficiaries in advance.
  • Prohibition of cross-selling products unrelated to healthcare to a Part D enrollee.
  • Prohibition of active sales activities at information fairs, community meetings and waiting rooms of health clinics.
  • Medicare Advantage organizations using independent agents for their marketing must employ only state-licensed agents.
  • Medicare Advantage organizations should set up level commission structures for their brokers and sales agents across all Medicare advantage products.
  • Medicare Advantage organizations need to make sure that 90% of all new SNPs enrollees must be individuals with special needs. The proposed new rule of CMS will also outline the standards for delivery of services.