Drug benefit snags unwary

Janet Taggart's problem was as baffling as it was alarming: Someone kept signing up her developmentally disabled daughter for Medicare prescription-drug coverage without her consent.

As soon as the retired University of Washington employee managed to disenroll her daughter, Naida, 51, from one plan, another insurer would send a letter confirming her membership. Meanwhile, Taggart's UW-retiree health plan dropped Naida's long-standing coverage, saying she had duplicate insurance.

Taggart never suspected the culprit: the federal government.

The Lake City resident was one of thousands of Americans across the nation who have seen their health coverage disrupted by arcane rules involving Medicare Part D plans, the federal prescription-drug program for seniors. The rules have caused grief for unwary older employees, retirees, low-income seniors and the disabled by automatically assigning them to a Part D plan or terminating their existing coverage.

In Taggart's case, the system enrolled her daughter in 14 Part D plans in all, one after another, despite her repeated "cease and desist" letters. It ultimately took a desperate plea to U.S. Rep. Jim McDermott's office to halt the enrollments.

"This, I think, might be where the system [has gone] crazy," said Taggart, a youthful 78-year-old.

Naida Taggart's troubles were triggered by a controversial provision under a federal Medicare program that in 2006 gave seniors and others prescription-drug benefits for the first time. Among the new beneficiaries were more than 6 million Americans who, like Naida Taggart, were covered by both Medicaid and Medicare.

Such "dual eligibles" already had good drug coverage through Medicaid. But the federal government required them to switch to one of the Part D plans sold by commercial insurers — or to be assigned to one randomly.

But Taggart, her daughter's legal guardian, never knew she needed to choose a Part D plan or to alert the federal government about her second, private-insurance coverage. So she was startled to receive a welcome letter from Humana, an insurer she hadn't heard of. Taggart wrote back immediately, insisting that she hadn't signed up and accusing Humana of a scam.

That stopped Humana. But it only opened the door for SilverScript, UniCare and a dozen other insurers to successively step in and claim Naida as a member.

The arbitrary Part D assignments often leave patients stuck with poor matches that don't cover all the medication they take, said Deane Beebe, a spokeswoman for Medicare Rights Center, a patient-advocacy group in New York.

Others snagged, too

On top of that, disabled and poor elderly face another hitch: They can be forced out of even the Part D plans of their choice if the annual premiums rise by too much. That's because the federal government, which picks up their premiums, sets a cap on what it will pay. If the premium increase exceeds the ceiling price, the patient must switch to a cheaper plan.

"Everyone goes back to square one," Beebe said.

The poor and the disabled aren't the only ones getting snagged. When workers or retirees with employer coverage become eligible for Medicare and obtain drug coverage, they may jeopardize their existing coverage unwittingly.

That's because the federal government subsidizes both Part D coverage and equivalent drug benefits offered by employers. A person can't be enrolled in both.

Angelo Locsin's mother almost fell into that trap when she retired from the payroll department at Harborview Medical Center in Seattle. Locsin, a Part D expert with the National Asian Pacific Center on Aging in Seattle, warned his mother that she'd be better off staying put with her generous state-employees health plan. Had Locsin's mother switched to Part D coverage, she would have been unable to return to her employer's plan.

Misinformed intent

Since 2006, almost 300 people in the state-employees medical plan signed up for Part D coverage, either as a stand-alone plan or as part of a comprehensive Medicare Advantage plan. But after the state contacted them to verify their intent, it turned out that only five of them had wanted to permanently give up their state coverage, said Michelle George, a spokeswoman for the Washington State Health Care Authority.

In Naida Taggart's case, the state-employees plan eventually reinstated her coverage. But the family's two-year bureaucratic tussle lives on. Just last month, Humana sent Janet Taggart yet another letter "confirming your request to disenroll."

Taggart, a feisty disabled-rights advocate, sat before her word processor to retort that Naida can't be disenrolled because she hadn't enrolled in the first place. She concluded her letter with this: "Please correct your records and cease sending me any more material."

Kyung Song: 206-464-2423 or ksong@seattletimes.com