Medicare Drug Deadline Looms with Millions Unsigned

Monday is the deadline to sign up for the new Medicare drug benefit. People joining the program past the deadline will receive a reduced benefit. But the deadline may be extended because of how many people have yet to sign up, a number that could be as high as 10 million.

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Monday is the deadline for most Medicare beneficiaries to sign up for the program's new Prescription Drug Benefit. Those who miss the deadline will have to pay higher premiums for life, and can't start coverage until next January. The Bush administration says there's no need to extend the deadline, because most people are already covered. But critics say the administration is manipulating the numbers.

NPR's Julie Rovner reports.

JULIE ROVNER reporting:

There's one number everyone agrees on. There are 43 million people with Medicare. So how many of those have drug coverage? That depends who you ask. Health and Human Services Secretary, Mike Leavitt, reported the administration's latest figures to reporters from a Medicare drug sign-up bus, somewhere between Detroit and Lansing, Michigan. He said enrollment in the program has been strong.

Secretary MIKE LEAVITT (Secretary, Health and Human Services): Where a million more beneficiaries have signed up since we last spoke, bringing the total to 37 million.

ROVNER: Of course, that also includes everyone who had drug coverage before the new program began, not just those who've signed up in the past six months. Still, Medicare administrator Mark McClellan said that by Monday, coverage could reach a milestone.

Dr. MARK MCCLELLAN (Director, Medicaid/Medicare): We've got the opportunity to get 90 percent of people, with Medicare prescription drug coverage, in the first month of the benefit. That's unprecedented.

ROVNER: According to the administration, about half the beneficiaries yet to enroll are presumed to have low incomes, and the deadline doesn't apply to them. So they say extending the sign-up deadline is not only unwarranted, it's not necessary. But not everyone takes the administration's totals at face value.

Ms. DIANE ARCHER (Founder, Medicare Rights Center): The numbers don't make any sense. They don't add up.

ROVNER: Diane Archer is the founder of the nonprofit Medicare Rights Center. She says the administration is padding the numbers. It's not only counting those who are getting direct benefits from the drug program, it's also counting another nearly six million people who the administration assumes have drug coverage; either through the Department of Veterans Affairs, the Indian Health Service, or from jobs where they're still working.

Ms. ARCHER: So we said all right, maybe half of them do. That's three million who don't, and another seven million who the government admits don't, and said, 10 million have still no drug coverage today.

ROVNER: In other words, not the 90 percent coverage the administration is claiming, but more like 77 percent. At some level, the argument is a continuation of the political jousting that's gone on about the program all year. But with the deadline approaching, knowing who's covered and who isn't is more than just academic, says Dan Mendelson. He's president of Avalere Health, a Washington consulting firm.

Mr. DAN MENDELSON (President, Avalere Health): This decision about whether or not to extend the deadline is a political decision, that's made on a judgment, regarding how many beneficiaries have enrolled.

ROVNER: Mendelson looked at the numbers from a different angle. The number of people who didn't have previous drug coverage and who had to sign themselves up. By that count, he says more than a third remain un-enrolled. At the same time, he says it's likely that the enrollment numbers the administration is using are inflated. That's not because anyone is lying, but because double counting is unavoidable.

Mr. MENDELSON: All they can see is the person coming, signing up for a benefit. And if they drop, they are typically not excluding that person from their calculations.

ROVNER: But if that person then drops and joined in another plan, that plan is going to count them, too.

Mr. MENDELSON: Right.

ROVNER: Thus, every time a person changes plans, he or she is likely to get counted again. And the numbers will probably keep going up, he says.

Mr. MENDELSON: I wouldn't be surprised to see these totals continue to rise over the number of eligible Medicare beneficiaries.

ROVNER: All of which, in the end, leaves policymakers deciding about the deadline with little more than educated guesses. If they guess wrong, they'll likely know next November.

Julie Rovner, NPR News, Washington.

YDSTIE: This is NPR News.

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