Public Employee Press

Confronting a glitch in Medicare Part D
Union restores drug coverage for hundreds of retirees

Against their desire, hundreds of DC 37 retirees have recently had their union drug benefit blocked because the federal government automatically enrolled them in the new Medicare Part D prescription program.

Amid the generally mismanaged and chaotic opening of the new Bush administration program, the coverage problem for DC 37 retirees has arisen because the new Medicare program automatically enrolls low-income seniors into Part D plans unless they indicate their wish to remain in their existing plan or choose another one.

An estimated 6,000 DC 37 retirees with annual incomes, including Social Security, of up to $14,000 are classified as low-income. In addition, retirees may be enrolled in Medicare Advantage health insurance plans that now include an approved Medicare drug benefit.

Medicare Part D programs are primary for enrolled retirees, with the DC 37 drug benefit providing a “wrap around” benefit for these retirees. The Centers for Medicaid and Medicare Services (CMS) informs DC 37 when union retirees are enrolled in Medicare Part D plans. Upon receiving that information, the DC 37 Health and Security Plan “wraps around” the Medicare benefit by providing coverage after the retiree has met the annual maximum or coverage gap.

DC 37 Health and Security Plan staff are working furiously with affected retirees to correct bureaucratic glitches and provide advice to retirees. Meanwhile, the plan is ensuring that the affected retirees receive their medication while their cases are being resolved.

“We won’t let anyone slip through the cracks,” said Rosa R. Esperon, administrator of the DC 37 Health and Security Plan.

The union coverage is a better deal for most retirees, but in some instances, low-income retirees who qualify may be better off with a low-income Medicare Part D plan, which doesn’t have a premium and deductible and has a lower co-pay structure ($2 for generics, $5 for brand-name drugs) than the union plan.

Retirees should call the plan to evaluate whether they should remain in or dis-enroll from the Part D plan or transfer to another Medicare plan.
Another Medicare Part D problem affecting some retirees occurs when a DC 37 retiree’s spouse is covered by another municipal union that provides a retiree drug benefit only through the purchase of a Medicare Part D rider.

GHI for example, charges $170 a month for family coverage under its Med D drug rider; since all Medicare Part D enrollees are registered with CMS, the DC 37 Plan is notified that our retiree and spouse have other Med D coverage. Our retiree and spouse may be paying for unnecessary coverage and adversely affecting the DC 37 benefit. DC 37 Health and Security Plan staff are helping retirees work with their health insurance plans, CMS representatives and the City’s Employee Benefits Program to resolve coverage problems. Any retirees with problems or questions about their drug coverage should call the Inquiry Unit at (212) 815-1234 for assistance.

“Mass confusion, with seniors unsure of what plan to choose and whether they should even sign up at all, has greeted this program from the beginning,” said DC 37 Executive Director Lillian Roberts.

“It is outrageous that untold numbers of seniors have been left in limbo, unable to fill their prescriptions,” she said. “But I guess this chaos was predictable, given that Medicare Part D is a program brought to us by a party that prides itself on being anti-government.”