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THE
COMMONWEALTH
FUND
Medicare Part D:
What Are The Concerns?
Stuart Guterman
Director, Program on Medicare’s Future
The Commonwealth Fund
Association of Healthcare Journalists
March 17, 2006
(revised to reflect new data May 16, 2006)
What Do We Want From
The New Drug Benefit?
• Continuity—Will beneficiaries with
coverage before have corresponding
(or better) coverage under Part D?
• Availability—Will beneficiaries be able
to find a plan that’s best for them?
• Access—Will beneficiaries be able to
get the drugs they need?
THE
COMMONWEALTH
FUND
Concern About
Vulnerable Populations
•
•
•
•
•
•
Medicaid recipients
Other low-income beneficiaries
Nursing home residents
Frail and disabled beneficiaries
Chronically ill beneficiaries
Racial and ethnic minorities
THE
COMMONWEALTH
FUND
Source of Prescription Drug Coverage
for Community-Dwelling
Medicare Beneficiaries, 1998-2000
Percent
50
45
40
34.8
35
30
25
24.7
16.5
20
15
11.8
10.5
15.8
10
5
0
None
Medicare
Medicaid
Employer
Medigap
Other
HMO
Source: B. Stuart, et al. “Riding the Roller Coaster: The Ups and Downs in Out-of-Pocket
Spending Under the Standard Medicare Drug Benefit.” Health Affairs. 24(4). (July/August 2005):
1025.
THE
COMMONWEALTH
FUND
Source of Prescription Drug Coverage for
Medicare Beneficiaries Residing in
Nursing Homes, 2001
No Rx coverage
20%
Other
supplement
with Rx
coverage
9%
Full Medicaid
56%
Other supplement
with Rx coverage
unknown
15 %
Source: Stuart, B. et al. “Coverage and Use of Prescription Drugs in Nursing Homes:
Implications for the Medicare Modernization Act.” Medical Care. 44(3). (March 2006): 243.
THE
COMMONWEALTH
FUND
Coverage, Income, and Chronic Illness
Are Factors in Adherence to
Prescribed Drug Regimens
Percent of Seniors Not Adhering to Prescribed
Drug Regimens
50
36.8
40
30
35.2
34.9
Low income
Three or more chronic
26.3
20
10
0
All seniors
No prescription drug
coverage
conditions
Source: Safran, D. et al. “Prescription Drug Coverage and Seniors: Findings From a 2003
National Survey.” Health Affairs Web exclusive. April 19, 2005.
THE
COMMONWEALTH
FUND
Beneficiary Out-of-Pocket Costs Under
the Medicare Part D Standard Benefit,
2006
Out-of-Pocket Cost
10000
9000
Total
Out-of-pocket
Out-of-pocket+premium
8000
7000
6000
5000
4000
3000
2000
1000
0
0
1000
2000
3000
4000
5000
6000
7000
Total Covered Drug Cost
8000
9000
10000
THE
COMMONWEALTH
FUND
Deductibles Offered by Medicare StandAlone Prescription Drug Plans, 2006
$250
34% of plans
$0
58% of plans
$150-$175
0%
$50-$100
8%
Source: CMS, PDP Landscape of Local Plans Source File as of November 15, 2005.
THE
COMMONWEALTH
FUND
Availability of Coverage in the
Part D “Coverage Gap”
Generics only
13% of plans
Generics and
Brand
3% of plans
No coverage
84% of plans
Source: CMS, PDP Landscape of Local Plans Source File as of November 15, 2005.
THE
COMMONWEALTH
FUND
Average Plan Premiums by Deductible
and Availability of Coverage in the
Part D “Coverage Gap”
Plan Premium
$70.00
$61.28
$60.00
$48.09
$50.00
$35.91
$40.00
$30.74
$30.00
$20.00
$10.00
$0.00
$250
deductible and
no coverage
$0 deductible
and no
coverage
$0 deductible
and generics
only
Source: CMS, PDP Landscape of Local Plans Source File as of November 15, 2005.
$0 deductible
and generics
+brand
THE
COMMONWEALTH
FUND
Reported Enrollment in Medicare Part D
or Equivalent Coverage, by Category,
As of May 7, 2006
No identified source of
creditable coverage
6.1 million
Other creditable
coverage
5.8 million
Federal retiree
3.5 million
Retiree subsidy
6.9 million
Prescription Drug
Plans (PDPs)
8.9 million
Dual eligibles
(in PDPs)
5.9 million
Dual eligibles
(in MA plans)
0.5 million
Medicare Advantage
(MA) plans
5.9 million
Source: DHHS News Release, “37 Million Medicare Beneficiaries Now Receiving Prescription Drug
Coverage,” May 10, 2006.
THE
COMMONWEALTH
FUND
Medicare Part D Enrollment With LowIncome Subsidy, as of March 31, 2006
(Not Including Dual-Eligibles)
10
9
8.2
8
7
6
5
4
3.8
3
1.6
2
1
0
Projected eligible
Applications approved
Applications received
Source: Kaiser Family Foundation, Medicare Prescription Drug Coverage Enrollment
Update, April 2006.
THE
COMMONWEALTH
FUND
Disposition of Applications
for Low-Income Subsidies, as of
December 30, 2005
Denied,
excess
income and
resources,
Received
but not
processed,
12%
7%
Approved,
Denied--
27%
excess
resources,
34%
Denied-excess
income,
20%
Kaiser Family Foundation, Tracking Prescription Drug Coverage Under Medicare,
February 2006.
THE
COMMONWEALTH
FUND
So Where Are We?
• The Medicare Drug Benefit holds promise for
improving access, coordination, and quality of
care
• It has a long way to go until it achieves that
potential
• The experience in the first few months has been
plagued with political and public relations
battles, instead of focusing on improving how the
policy works
• The new program needs to be monitored for
indications of how it can be improved for its
beneficiaries—particularly its most vulnerable
groups
THE
COMMONWEALTH
FUND
An Alternative: Medicare Extra
• Comprehensive benefits option for Medicare
beneficiaries
• Single $250 deductible
• Part B coinsurance reduced from 20% to 10%
• No coinsurance for long hospitals stays,
home health, selected preventive care
• Prescription drugs:
– No separate deductible
– 25% coinsurance
– No doughnut hole
• Ceiling on out-of-pocket costs
• Lower premiums, lower total out-of-pocket
costs, than Medicare fee-for-service plus
Medigap
THE
COMMONWEALTH
FUND