NRAA Acts to Reduce Proposed Copayments

Potential financial disaster for dialysis facility Medicare beneficiaries was lessened by the quick action of NRAA and Gwen Gampel, NRAA Government Relations Consultant. In late October, several Medicare+Choice plans sent information to their enrollees regarding the 2002 benefits package which included a $50 copayment for each dialysis treatment and high drug copayments. While Medicare+Choice plans are allowed to charge copayments, they cannot charge more than the 20% coinsurance that is charged on the fee-for-service side of Medicare. As a result, Gwen Gampel along with others helped persuaded the Centers for Medicare and Medicaid Services to negotiate a compromise with the PacifiCare Secure Horizons plans to only allow them to charge $25 per treatment and reduce most drug coinsurance to zero except EPO administration would require 20% coinsurance.

However, we all recognize this is not a long term solution. CMS, NRAA and others in the renal community are sorting through regulatory and legislative options to ensure that Medicare+Choice plans cannot charge exorbitant copayments for dialysis treatments and ESRD-related drugs. In terms of helping to solve the problem, the NRAA has decided to support Rep. Stark’s (D-CA) bill H.R. 3267, which would allow Medicare beneficiaries to disenroll from a Medicare+Choice plan if their plan reduced benefits (i.e. raised coinsurance requirements) or their provider, like a dialysis facility, withdrew from plan participation and instead return to fee-for-service and purchase Medigap insurance. The NRAA plans to work with CMS and Congress next year in addressing how best to protect ESRD Medicare+Choice enrollees from high copayments and dialysis facilities from increased bad debt.

Medicare+Choice Consumer Protection Act, H.R. 3267, by Rep. Pete Stark (D-CA), would eliminate the Medicare+Choice “lock-in” scheduled to go into effect in January 2002, which would prohibit seniors from leaving a Medicare+Choice plan at the time of their choosing. Additionally, it extends existing Medigap protections that allow beneficiaries guaranteed access to certain Medigap plans if their Medicare+Choice plan leaves Medicare and would allow ESRD and other Medicare beneficiaries age 65 and over whose plans decrease benefits, increase cost-sharing, or whose health care providers leave the plan to disenroll and purchase Medigap insurance. And of particular note, the bill would prohibit Medicare+Choice plans from charging higher cost-sharing for Medicare-covered services than the amount charged in the fee-for-service program.