By Mike Lillis - 08/25/10 06:05 PM EDT
New rules surrounding Medicare's prescription drug benefit could force more than 3 million seniors to adopt different plans next year, according to an analysis by a leading healthcare group.
Republican critics of healthcare reform are already pointing to the report as evidence that the White House was disingenuous in its claims — heard often during the health reform debate — that consumers who like their plans can keep them.
At issue are new "meaningful differences" rules issued in April by the Centers for Medicare and Medicaid Services (CMS). Next year, under those guidelines, CMS will accept Part D bids only for plans that differ dramatically from other plans offered by the same company.
As a result, "many Part D sponsors will have to reduce their plan offerings and potentially make changes to the benefit package and cost sharing in order to meet the new requirements and continue to offer multiple plan offerings," according to analysts at Avalere Health, a Washington-based healthcare consultant group.
Specifically, the group estimates:
• About 2.75 million seniors in basic Part D plans will have to choose a new plan next year because the new rules prevent sponsoring companies from offering more than one basic plan in any one region.
• About 350,000 seniors in enhanced Part D plans without gap coverage will be forced to shift into new enhanced plans — the result of new rules limiting companies to two enhanced plans per region.
• An additional 645,000 beneficiaries in enhanced plans with some 2010 gap coverage "may" have to choose new plans in 2011, "depending on whether or not those enhanced plans meet the CMS definition of 'meaningfully different,'" Avalere writes.
The group was quick to note that its figures are approximate estimates, given that analysts didn't have access either to details about 2010 out-of-pocket costs or to information about 2011 plan offerings.
"Given those limitations," Avalere said, "our estimates represent a conservative approximation of the potential impact of plan changes to meet the new requirements on beneficiaries."
Still, the office of Rep. Dave Camp (Mich.), senior Republican on the Ways and Means Committee, shot out the analysis to reporters Wednesday.
Avalere's figures were based on an examination of Part D beneficiaries who, as of last February, were enrolled in standalone plans offered by the top 10 Part D sponsors.