New Settlement To Provide Relief For Low-Income Medicare Beneficiaries

When the Government promises something and fails to deliver the goods, what do you do? Go to the court. This is what the Bush administration faced when it failed to provide medical assistance to millions of Medicare beneficiaries.

As a result of a class-action lawsuit on behalf of the large numbers of Americans who faced problems in receiving the medical attention they required, the Bush administration agreed to a settlement promising to provide new protections for low-income Medicare beneficiaries Thursday.

Under the 2003 Medicare law, more than six million people across the USA, eligible for both Medicare and Medicaid, are entitled to medicines at lower rates. However, in many cases, these people either did not receive the drugs they needed, or experienced long delays.

In early 2006, it was reported that low-income beneficiaries were often overcharged. Some were even sent back from pharmacies empty-handed. Several states declared public health emergencies. Individuals had to step in to pay for prescriptions that should have otherwise been covered by the federal Medicare program.

Finally, the National Senior Citizens Law Center, along with another nonprofit group, the Center for Medicare Advocacy filed a nationwide class-action lawsuit on behalf of the millions of people who were having hard times getting what was their due.

The proposed settlement, filed with the United States District Court in San Francisco, would now enable low-income Medicare beneficiaries to acquire their prescription drugs promptly and at minimal cost.

The onus is now on the federal Medicare officials to take every measure to make this process faster and hassle-free. They would also need to ensure that registration of people into this scheme was completed faster, possibly in days rather than the weeks and sometimes months it took earlier.

Private insurers on contract with Medicare normally deliver the drug benefits. Under the terms agreed to in the settlement, the insurers would now need to provide medications at a nominal cost to any Medicare recipient who can prove they have low incomes and qualify for extra help.

For people with incomes less than $10,400 a year (the normal poverty level), the maximum co-payment is $1.05 for a generic or preferred brand-name drug and $3.10 for other prescription drugs.

However, many beneficiaries have been asked to pay much higher amounts, from $30 to $75 or more, because the evidence of their low-income status was not properly shared among federal and state agencies, insurance companies and pharmacies.

Welcoming these developments, Kevin Prindiville, lawyer at the National Senior Citizens Law Center said, “This settlement agreement is a victory for many of the nation’s most vulnerable citizens, who have faced life-threatening delays in obtaining vital medications.”

The Center was instrumental, along with the Center for Medicare Advocacy, another non-profit organization, for filing the lawsuit.

Gill Deford, a lawyer at the Center for Medicare Advocacy, said the settlement would “help hundreds of thousands of people a year get their prescription drugs more quickly, at nominal cost.”