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Medicare Drug Program News
Medicare Drug Program Beats Nothing, but Not As Good
as VA, Employer Plans
Large survey finds more seniors covered but some
vulnerable to high costs
 Aug. 21, 2007 Senior citizens enrolled in
Medicare Part D the drug program fared better than seniors without
drug coverage, but not as well as those who relied on other coverage,
such as the Department of Veterans Affairs or employer-sponsored
coverage, according to a study released today.
The share of seniors without drug coverage dropped
significantly under Medicares new drug benefit, according to a
Health Affairs Web Exclusive article based on a Kaiser Family
Foundation, Commonwealth Fund and Tufts-New England Medical Center
survey of more than 16,000 seniors.
Seniors with drug coverage from any source were
less likely to face high monthly drug costs or to skip prescribed
medications due to cost than seniors who remained without drug coverage.
However, seniors who enrolled in a Medicare Part D plan did not fare as
well as those who relied on other sources of drug coverage, such as
employer-sponsored coverage or benefits from the Department of Veterans
Affairs (VA).
The random-sample survey of more than 16,000
seniors nationally provides an in-depth look at how the Medicare drug
benefit affected seniors. Conducted in fall 2006 by the Kaiser Family
Foundation, the Commonwealth Fund and the Tufts-New England Medical
Center, the survey provides a comprehensive look at seniors
out-of-pocket spending and cost-related experiences, broken out by type
of drug coverage, with a more in-depth look at the experiences of
seniors with low incomes.
The Medicare drug law achieved its primary goal of
providing drug coverage to most seniors who previously lacked it, said
Kaiser President and CEO Drew E. Altman, Ph.D. But the survey found a
significant number of seniors in Part D plans paying sizable amounts
out-of-pocket for their medications and delaying or not filling their
prescriptions for cost reasons.
As Congress considers potential changes to the drug
benefits low-income subsidy provisions, the new study also highlights
the significant financial protections that the subsidies provided to
those who received them. But among low-income seniors not receiving
those subsidies, nearly one in three reported that they spent at least
$100 per month for their prescriptions. Also, many low-income seniors
who were not receiving low-income subsidies said that they were unaware
of such assistance. Other studies have estimated that there are 3.4
million to 4.7 million beneficiaries who are eligible for low-income
subsidies but not receiving that extra help.
In addition to covering more seniors, its
important that coverage be adequate to ensure financial protection and
access to prescription drugs, said Commonwealth Fund President Karen
Davis. We still have a lot of work to do to make sure that Medicare
beneficiaries particularly those who are most vulnerable because of
low incomes or chronic illness can get the drugs they need and are not
subject to burdensome out-of-pocket costs.
Key findings include:
● In 2006, 8% of seniors lacked drug coverage
compared to about 33% of seniors without drug coverage in 2005, prior to
implementation of Medicare Part D.
● Those who lacked drug coverage in 2006 fell
into two groups: those who are potentially vulnerable but hard to reach
i.e., age 75 and older, African American, income at or below 150% of
the federal poverty level, no education beyond high school, or rural
residence and seniors in good health, including those who did not take
any prescription drugs and those with no chronic conditions.
● Overall, half of all seniors (50%) received
benefits through a new Medicare Part D drug plan either a Medicare
Advantage or a stand-alone plan. The majority of Part D enrollees (60%)
had drug coverage previously from another source such as Medicaid or a
Medicare Advantage plan. Nearly one-third (31%) of seniors received drug
coverage through an employer plan, and about 3% received medications
through the VA.
● One in four seniors in a Part D plan (26%)
reported spending at least $100 per month. In addition, 8% of seniors in
a Medicare Part D plan spent at least $300 per month on their
medications a share smaller than that for seniors without any drug
coverage (11%), but larger than for seniors with employer or VA coverage
(5% in each group). This may be because employer plans typically do not
have a gap in coverage, unlike most Medicare drug plans, and because VA
coverage has relatively low cost-sharing requirements.
● One in five seniors in a Part D plan (20%)
reported that they had not filled, or had delayed filling, a
prescription due to costs during the past 12 months. Part D enrollees
had slightly lower rates of cost-related skipping than seniors without
any drug coverage (23%), and substantially higher rates than seniors
getting prescriptions from an employer plan (8%) or the VA (12%).
Experiences of Low-Income Seniors
The survey highlights the positive effects of the
Medicare Part D low-income subsidy program that was designed to provide
additional help to Medicare beneficiaries with limited financial
resources.
These additional subsidies limited out-of-pocket
spending among low-income seniors who received them: a smaller share of
low-income Part D enrollees receiving subsidies spent more than $100 per
month on their drugs (7% of seniors also receiving Medicaid benefits and
11% of other low-income seniors) than low-income Part D enrollees who
did not receive these additional subsidies (32%).
The survey findings also indicate that lower than
expected participation rates may be at least partly attributable to lack
of awareness among low-income beneficiaries. Among low-income seniors
who were not receiving the extra subsidies, just over half (52%) said
they were aware of the low-income subsidy program. Even among low-income
enrollees enrolled in Part D plans but not receiving the subsidy, only
about half (53%) said they were aware of the low-income assistance.
Low-income subsidies really make a difference for
those seniors who receive them, but there are still millions of
low-income seniors who are eligible for this help but not getting it,
said study lead author Tricia Neuman, Sc.D., a Kaiser vice president and
director of the Foundations Medicare Policy Project. Our study
confirms the importance of doing more to get additional assistance to
low-income seniors.
Dually Eligible Seniors
Dually eligible seniors receiving both Medicare and
Medicaid were assigned by the government to a Part D plan to receive
Medicare drug benefits at the start of 2006. The study found that these
seniors faced some of the biggest challenges in the transition to
Medicare Part D.
Among dual-eligible seniors, one in five reported
that they had been required to obtain special permission to fill one of
their prescriptions during the previous year the highest rate among
any group. They were also more likely than others to say that they had
switched Medicare Part D plans since the start of the year.
Editor's Notes:
The full article, Medicare Prescription Drug
Benefit Progress Report: Findings from a 2006 National Survey of
Seniors, was written by Patricia Neuman, Sc.D., and Michelle Kitchman
Strollo, Dr.P.H., of the Kaiser Family Foundation; Stuart Guterman,
M.A., of the Commonwealth Fund; William H. Rogers, Ph.D., Angela Li,
M.P.H., and Angie Mae C. Rodday, B.A., of the Tufts-New England Medical
Center; and Dana Gelb Safran, Sc.D., of Blue Cross Blue Shield of
Massachusetts, who is also an associate professor of medicine at Tufts-NEMC.
It is available from
Health Affairs or through Kaiser via a
free link.
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