One Program, Two Populations: A Comparison of Disabled Workers and Retirees in Medicare

Size: px
Start display at page:

Download "One Program, Two Populations: A Comparison of Disabled Workers and Retirees in Medicare"

Transcription

1 One Program, Two Populations: A Comparison of Disabled Workers and Retirees in Medicare Jae Kennedy, PhD Darren Liu, DrPH Josh Engle, MHPA Liz Blodgett, MHPA (cand) WSU Dept. of Health Policy and Administration

2 Research Support Funding National Institute of Disability and Rehabilitation Research Field Initiated Research Project Project Title Assessing the Impact of Medicare-D on SSDI Beneficiaries (H133G070055) Study Sites Spokane WA & San Diego CA Three year project FY 07 $199,955; FY 08 $199,706; FY 09 $199,830 Methodology study uses a multimethod, repeated-measures approach

3 Program and Policy Overview SSDI and Medicare

4 Medicare program Established in 1965 (benefits extended to SSDI beneficiaries in 1972). Insures ~43 million elderly and disabled Americans at an annual cost of over $375 billion. Part A - inpatient hospital care. Part B - physician services, preventive services, and outpatient care. Part C - established in 1997, allows private HMOs to offer Medicare Advantage (MA) plans. Part D - introduced in 2006, creates private prescription drug plans (PDPs).

5 Medicare Part D The most significant change in Medicare coverage since the program s inception Beneficiaries receive drug benefits by enrolling in private PDPs or MAPs There is considerable variability in premiums, costsharing requirements, and coverage The most notorious limit is the doughnut hole: beneficiaries receive partial coverage for prescription drugs up to an annual cap of $2,250, but are fully responsible for the next $2,850 in drug costs. If they exceed $5,100 in total drug costs in a given year, beneficiaries become eligible for catastrophic coverage.

6 SSDI program Established in 1956, SSDI now provides cash benefits to over 6.8 million American workers and 1.8 million dependents, at a total annual cost of about $92 billion. Applicant must go through a multi-stage evaluation to demonstrate the inability to engage in any substantial gainful activity because of a medically determinable impairment. Preliminary SSA review of applications takes about four months more than half of the applications are denied. Appeals, which can take a year or longer, push the allowance rate for applicants to about 62% Average monthly benefits in 2006 were $978 for disabled workers and $1,044 for retired workers.

7 SSDI and Medicare eligibility SSDI beneficiaries become eligible for Medicare 24 months after they are deemed eligible for Social Security benefits. Roughly 19% of SSDI beneficiaries are currently in this waiting period, and 32% of those beneficiaries have no health insurance at all. About one out of six SSDI beneficiaries have incomes low enough to qualify for Supplemental Security Income (SSI), and are consequently eligible for Medicaid benefits.

8 Policy relevance of disabled workers in Medicare Younger adults (age 18-65) currently comprise about 17% of the total Medicare population. Growth in Medicare enrollment for disabled workers has consistently outpaced overall program growth. Younger beneficiaries often have higher needs, and higher service costs, than retirees. Younger beneficiaries are more likely to encounter problems with access to needed care.

9 Disabled workers have proportionally higher annual enrollments than older beneficiaries driving up Medicare costs 10.0% 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Aged Disabled

10 Study Methodology The Medicare Current Beneficiary Surveys

11 The Medicare Current Beneficiary Survey (MCBS) An ongoing national panel survey conducted by the Centers for Medicare and Medicaid Services (CMS) participants are interviewed multiple times over a three year period. Data divided into two annual files Access to Care (A2C) and Cost and Utilization (CU)

12 MCBS Sampling Strategy Sample included both community- and facilitydwelling beneficiaries. Stratified multistage sampling strategy, drawn from 107 primary sampling units (PSUs). Oversampling of younger beneficiaries (aged 18-64) and older beneficiaries (age 85 or older). Total sample includes 2,907 beneficiaries aged and 12,862 beneficiaries age 65 or older

13 Statistical analysis The data set includes sample weights derived from the 2000 Decennial Census. Weighted population estimates are calculated using Professional Software for SUrvey DAta ANalysis for Multi-stage Sample Designs (SUDAAN). Estimates with high relative standard errors (>30%) are collapsed or flagged. Group comparisons are tested with the Wald X 2

14 Study limitations Self report (possible recall bias, social desirability, etc.) Policy analyses often contain a disclaimer like: This analysis is a snapshot of a rapidly changing system, but it s literally true in this case enrollment in part D was occurring while the survey was being conducted.

15 Key Findings Differences between disabled workers and retirees on Medicare

16 Sociodemographic attributes According to estimates derived from the 2006 MCBS, about 6.6 million adults under age 65 receive Medicare. Within this group, less than half (47.2%) are near retirement age (55-64). Compared to retirees, beneficiaries under age 65 are more likely to be male (51.9% vs. 42.6%), black or African American (17.8% vs. 7.8%), and Hispanic or Latino (10.3% vs. 7.1%). Younger beneficiaries are less likely to be married than retirees (41.5% vs. 56.2%), limiting social and economic support.

17 Sociodemographic attributes age or older est. N % est. N % TOTAL 6, % 33, % age , % <.001 age , % - age , % - age , % age 75 or older - 15, % Male 3, % 14, % 43.1 <.001 Female 3, % 19, % White or Caucasian 4, % 28, % 15.5 <.001 Black or African-American 1, % 2, % Asian % % Native American or Alaska Native % % Native Hawaiian or Pacific Isla nder % % Other race % % More than one race % % Hispanic or Latino origin % 2, % Married 2, % 16, % <.001 Never married 1, % % Divorced/seperated 1, % 2, % Widowed % 9, % Source: 2006 Medicare Current Beneficiary Survey, Fall (2006) Supplement, Access to Care; RSE> 30% X 2 p

18 Socioeconomic status and health insurance coverage Beneficiaries under age 65 are less likely to have a college degree than retirees (14.4% vs. 21.4%). They are also much more likely to be poor than retirees (67.5% have annual incomes of less than $20,000, compared to 38.4% of older Medicare beneficiaries). Because of their lower incomes, younger beneficiaries are much more likely than retirees to be eligible for Medicaid as well as Medicare insurance coverage (42.6% vs. 11.5%).

19 Socioeconomic status age or older est. N % est. N % TOTAL 6, % 33, % Income <.001 $10,000 or less 2, % 4, % $10,001 to $20,000 1, % 7, % $20,001 to $30, % 6, % $30,001 or more 1, % 12, % Education 12.9 <.001 not HS graduate 1, % 7, % HS graduate 1, % 8, % some college 1, % 6, % college graduate % 6, % Currently working % 4, % Source: 2006 Medicare Current Beneficiary Survey, Fall (2006) Supplement, Access to Care; RSE> 30% X 2 p

20 Health insurance coverage e st. N % est. N % Total 5, % 29, % Medicare health insurance coverage A only % 1, % 49.2 <.001 A and B 5, % 28, % Supple menta l health insurance covera ge age or older Private supplemental 1, % 18, % <.001 Medicare HMO % 6, % 36.8 <.001 Medicaid 2, % 3, % <.001 Source: 2006 Medicare Current Beneficiary Survey, Fall (2006) Supplement, Health Insurance X 2 p

21 Health and disability status Beneficiaries under age 65 are much more likely to describe their health as fair or poor (57.5% vs. 20.9%) and report limitations in one or more basic activities of daily living (29.8% vs. 15.0%). Nearly 90% of both age groups reported being diagnosed with one or more chronic conditions, but the specific conditions varied by age group. Of particular note is the relatively high rate of psychiatric conditions in the younger population (45.9% vs. 11.8%).

22 Health and disability status age or older est. N % est. N % Hype rtension/ High blood pre ssure 3, % 20, % 54.0 <.001 Arthritis 3, % 18, % Cardiovascular disease 2, % 13, % 28.3 <.001 Cancer 1, % 10, % <.001 Diabetes 1, % 7, % 20.4 <.001 Psychiatric conditions 3, % 3, % <.001 Emphysema, asthma or COPD 1, % 4, % 64.9 <.001 Neurological disease % 2, % 42.0 <.001 Number of limits in activities of daily living (ADLs) 61.0 <.001 none 4, % 28, % one % 1, % 2 or more 1, % 3, % Gene ral health (compared to others same age) <.001 Excellent % 5, % Very good % 9, % Good 1, % 10, % Fair 2, % 4, % Poor 1, % 1, % Source: 2006 Medicare Current Beneficiary Survey, Fall (2006) Supplement, Health Status and Functioning (community) X 2 p

23 Prescription drug coverage Disabled workers have similar rates of prescription drug insurance coverage (73.4%) to retirees (72.6%). Disabled workers were more likely to receive Medicare part D (38.3% vs. 11.0%). Because of their high rates of Medicaid coverage, disabled workers were much more likely to be auto-enrolled in Medicare Part D (29.4% vs. 8.7%). Disabled workers were more likely to apply for and receive a Low Income Subsidy (LIS) for their Part D benefits

24 Prescription drug coverage age or older est. N % est. N % Total 5, % 29, % Prescription drug coverage (any) 4, % 21, % Private supplemental 1, % 10, % <.001 Medicare HMO % 5, % 36.0 <.001 Part D 2, % 3, % <.001 Auto-enrolled in Part D 1, % 2, % <.001 Source: 2006 Medicare Current Beneficiary Survey, Fall (2006) Supplement, Health Insurance Note: Prescription insurance status collected during implimentation phase of Medicare D X 2 p

25 Part D Low Income Subsidy (LIS) age or older (1000s) % (1000s) % Did you apply for supplemental coverage (low income)? 43.0 <.001 yes % % no 2, % 14, % If yes, what is the status of the application? accepted % % denied % % pending % % Source: 2006 Medicare Current Beneficiary Survey, Winter (2007) Supplement, Prescription Drug Plans Note: Counts do not include autoenrolled beneficiaries X 2 p

26 Prescription drug access Younger beneficiaries are much more likely to deviate from their prescription drug regimen than retirees (36.5% vs. 13.6%), due primarily to cost. Younger beneficiaries also more likely to engage in other strategies to reduce drug costs. Prescription medication nonadherence has declined with the advent of Medicare D for younger and older beneficiaries.

27 Prescription drug access age or older (1000s) % (1000s) % Total 5, % 29, % Did not adhere to prescription regimen 2, % 4, % <.001 dela yed getting Rx because of cost 1, % 1, % <.001 took smaller doses to make Rx last longer 1, % 1, % <.001 decided not to fill Rx because of cost 1, % 1, % <.001 skipped doses to make Rx last longer 1, % 1, % <.001 Other Rx cost containme nt stra tegies asked for generic form of Rx 2, % 13, % 26.5 <.001 asked for Rx samples 2, % 13, % purchased Rx via mail/internet % 8, % <.001 shopped for best price s 1, % 4, % 29.5 <.001 spent less $ on other household ne eds 1, % 1, % <.001 purchased Rx from outside the US % % Source: 2006 Medicare Current Beneficiary Survey, Fall (2006) Supplement, Access to Care X 2 p

28 Prescription medication nonadherence: Percent of Beneficiaries reporting PMNA 30.0% 25.0% 20.0% % 10.0% 5.0% MCBS Survey Year

29 2005 Prescription Medicine Cost & Use (Pre-D) Working-age Medicare beneficiaries report higher annual total prescription costs ($3,206 vs. $2,048) and overall utilization (43 PMEs vs. 31), compared to the elderly Medicare population. Based on the standard benefit structure for Part D prescription drug plans, roughly 47% of working-age beneficiaries report total costs that would exceed the doughnut hole threshold, versus only 34% of the elderly. A greater proportion of younger beneficiaries also would qualify for catastrophic coverage (21.1% vs. 8.8%).

30 Conclusions Differences between disabled workers and retirees on Medicare

31 Disabled workers are a distinct beneficiary population They tend to be poorer, less educated, than retirees On average, disabled workers are less healthy, and more limited Psychiatric conditions are common in this population Despite these problems, many disabled workers say they would like to return to work

32 Disabled workers are more reliant on supplemental programs Dual eligibility receipt of Medicaid and Medicare is much more common among disabled workers Low income subsidy disabled workers are more likely to seek out and receive a Part D LIS

33 Disabled workers have more difficulty getting medical care Along with prescription drugs, disabled workers are more likely to postpone other forms of medical care due to cost Although satisfaction in both groups is quite high, disabled workers report more problems and less satisfaction with their drug plans, HMOs, and health care providers

34 Further research Differences between disabled workers and retirees on Medicare

35 The Medicare waiting period The waiting period is a shocking limitation to SSDI Applicants have undergone clinical and vocational evaluation and have been deemed unable to engage in substantial gainful employment due to a clinically verifiable health condition Clearly in need of health insurance coverage, as well as benefit checks The wait period is at the top of many advocates agenda for Medicare reform

36 Decoupling health insurance and disability insurance TWWIIA and other RTW programs don t fully address the perceived risks to health insurance and financial stability Medicare for all could be pricey, but Medicare for all workers with disabilities could eliminate a major barrier to workforce participation and reduce one big incentive for enrolling in SSDI

37 Disabled workers are an obvious target for disease management Integration of primary care, specialty care, and rehabilitation could slow the progression of chronic conditions and associated costs Given the lengthy period of participation, disabled workers in DM programs are more likely to show a return on investment

38 For more information Jae Kennedy, Ph.D., Associate Professor Department of Health Policy and Administration School of Pharmacy, Washington State University Academic Center, Suite 411, PO Box 1495 Spokane, WA Telephone: (509) Fax: (509)

White Paper. Medicare Part D Improves the Economic Well-Being of Low Income Seniors

White Paper. Medicare Part D Improves the Economic Well-Being of Low Income Seniors White Paper Medicare Part D Improves the Economic Well-Being of Low Income Seniors Kathleen Foley, PhD Barbara H. Johnson, MA February 2012 Table of Contents Executive Summary....................... 1

More information

INSIGHT on the Issues

INSIGHT on the Issues INSIGHT on the Issues AARP Public Policy Institute Medicare Beneficiaries Out-of-Pocket for Health Care Claire Noel-Miller, PhD AARP Public Policy Institute Medicare beneficiaries spent a median of $3,138

More information

Health Economics Program

Health Economics Program Health Economics Program Issue Brief 2006-05 August 2006 Medicare Supplemental Coverage and Prescription Drug Use, 2004 Medicare is a federal health insurance program that provides coverage for the elderly

More information

Medicare Beneficiaries Out-of-Pocket Spending for Health Care

Medicare Beneficiaries Out-of-Pocket Spending for Health Care Insight on the Issues OCTOBER 2015 Beneficiaries Out-of-Pocket Spending for Health Care Claire Noel-Miller, MPA, PhD AARP Public Policy Institute Half of all beneficiaries in the fee-for-service program

More information

Medicare Supplemental Coverage in Minnesota

Medicare Supplemental Coverage in Minnesota Medicare Supplemental Coverage in Minnesota December 2002 h ealth e conomics p rogram Health Policy and Systems Compliance Division Minnesota Department of Health Medicare Supplemental Coverage in Minnesota

More information

2015 Medicare Low-Income Subsidy (LIS), or Extra Help

2015 Medicare Low-Income Subsidy (LIS), or Extra Help 2015 Medicare Low-Income Subsidy (LIS), or Extra Help Extra Help with Prescription Drug Costs Medicare LIS Overview Patient Eligibility and Application Process How LIS Affects Patient Responsibility for

More information

Chartpack. August 2008

Chartpack. August 2008 Chartpack Examining Sources of Coverage Among Medicare Beneficiaries: Supplemental Insurance, Medicare Advantage, and Prescription Drug Coverage Findings from the Medicare Current Beneficiary Survey, 2006

More information

The Health Insurance Marketplace in Iowa: The consumer perspective

The Health Insurance Marketplace in Iowa: The consumer perspective The Health Insurance in Iowa: The consumer perspective Final report to the Iowa Dept. of Public Health Peter Damiano* Suzanne Bentler* Daniel Shane* University of Iowa Public Policy Center* and College

More information

Crossing the Doughnut Hole: The Effects of the Medicare Drug Coverage Gap for Patients who Require High-cost Medications

Crossing the Doughnut Hole: The Effects of the Medicare Drug Coverage Gap for Patients who Require High-cost Medications Crossing the Doughnut Hole: The Effects of the Medicare Drug Coverage Gap for Patients who Require High-cost Medications AcademyHealth Annual Research Meeting June 29, 2009 Dominick Esposito 1, Margaret

More information

Dual Eligibility in Pennsylvania: What Happens When I Am Newly Eligible for Medicare and Medicaid?

Dual Eligibility in Pennsylvania: What Happens When I Am Newly Eligible for Medicare and Medicaid? Dual Eligibility in Pennsylvania: What Happens When I Am Newly Eligible for Medicare and Medicaid? Each month through our Helpline, PHLP talks to individuals (or to their family members, advocates or providers)

More information

By Christina Crain, MSW. Director of Programs

By Christina Crain, MSW. Director of Programs By Christina Crain, MSW Director of Programs What we ll cover Medicare Eligibility Medicaid Eligibility Medicare Parts A, B, C and D New Improvements to Medicare under ACA The Medicare Savings Programs

More information

Medicare Part D: 2010. Presented by: Howard Houghton Virginia Insurance Counseling & Assistance Program (VICAP)

Medicare Part D: 2010. Presented by: Howard Houghton Virginia Insurance Counseling & Assistance Program (VICAP) Medicare Part D: 2010 Presented by: Howard Houghton Virginia Insurance Counseling & Assistance Program (VICAP) 1 The Basics Medicare Part D is available to all Medicare beneficiaries regardless of their

More information

Medigap Insurance 54110-0306

Medigap Insurance 54110-0306 Medigap Insurance Overview A summary of the insurance policies to supplement and fill gaps in Medicare coverage. How to be a smart shopper for Medigap insurance Medigap policies Medigap and Medicare prescription

More information

Dual Eligible and Low-Income Medicare Beneficiaries and Part D

Dual Eligible and Low-Income Medicare Beneficiaries and Part D Dual Eligible and Low-Income Medicare Beneficiaries and Part D Presentation to National Medicaid Congress by Andy Schneider, Senior Advisor June 5, 2006 What is the Experience of Dual Eligible and Low-Income

More information

How To Answer A Test For A Welfare Check (For Seniors)

How To Answer A Test For A Welfare Check (For Seniors) Start Making the Most of Your Money! Answer 23 simple questions and you will get a personal report with tips on money management and budgeting, staying healthy, and protecting your financial information.

More information

Geneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population

Geneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population Geneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population November 18, 2013 Diana Dennett EVP, Global Issues and Counsel America s Health Insurance Plans (AHIP) America

More information

Retiree Considerations Medicare 101. June 26, 2012

Retiree Considerations Medicare 101. June 26, 2012 Retiree Considerations Medicare 101 June 26, 2012 Agenda Goal: Present information regarding Medicare and related products to assist you in evaluating options Key Topics: Eligibility Rules Enrollment Rules

More information

MEDICARE PART D THE BASICS

MEDICARE PART D THE BASICS THE BASICS Participation is voluntary. The income level and assets of beneficiaries determine the level of prescription assistance they will receive. Beneficiaries with incomes over 150% of the Federal

More information

Near-Elderly Adults, Ages 55-64: Health Insurance Coverage, Cost, and Access

Near-Elderly Adults, Ages 55-64: Health Insurance Coverage, Cost, and Access Near-Elderly Adults, Ages 55-64: Health Insurance Coverage, Cost, and Access Estimates From the Medical Expenditure Panel Survey, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research

More information

Low Income Subsidy / Extra Help and Enrollment Assistance

Low Income Subsidy / Extra Help and Enrollment Assistance Low Income Subsidy / Extra Help and Enrollment Assistance Objectives After actively participating in this session, agents will: Identify the value of assisting LISeligible consumers. Identify features

More information

UPDATED: NOVEMBER 2009 344.1 RESOURCES THIRD PARTY RESOURCES

UPDATED: NOVEMBER 2009 344.1 RESOURCES THIRD PARTY RESOURCES UPDATED: NOVEMBER 2009 344.1 NOTE: Enrollment in Medicare is a condition of eligibility for Medicaid. Beginning in 2006, persons entitled to Part A and/or enrolled in Part B are eligible for the prescription

More information

Lee County Central Point of Coordination Application Return Application Requested By: HIPPA Yes NO. Date of Application: / / Phone: #( )- -

Lee County Central Point of Coordination Application Return Application Requested By: HIPPA Yes NO. Date of Application: / / Phone: #( )- - Lee County Central Point of Coordination Application Return Application Requested By:_ HIPPA Yes NO Date of Application: / /Phone: #()-- Name of Applicant: Last First M.I. Current Address: City State Zip

More information

MEDICARE 101 A Webinar presented by Keenan & Associates and Kaiser Permanente

MEDICARE 101 A Webinar presented by Keenan & Associates and Kaiser Permanente MEDICARE 101 A Webinar presented by Keenan & Associates and Kaiser Permanente Sylvia Weathers Service Consultant Keenan & Associates Nancy C. Voltero Retiree Programs Consultant Kaiser Permanente License

More information

Medicare Advantage Election Form

Medicare Advantage Election Form Serving select counties Medicare Advantage Election Form Serving select counties Serving select counties Already a Blue Cross of Idaho Care Plus Medicare member? Please check the box below: o I have a

More information

Merrile Sing. Agency for Healthcare Research and Quality Working Paper No. 08011. December 2008

Merrile Sing. Agency for Healthcare Research and Quality Working Paper No. 08011. December 2008 Benchmarking Medicare Managed Care Plan Enrollment Estimates from the Medical Expenditure Panel Survey and Administrative Enrollment Files from the Centers for Medicare & Medicaid Services Merrile Sing

More information

Prescription Drug Coverage for Medicare Beneficiaries: A Summary of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003

Prescription Drug Coverage for Medicare Beneficiaries: A Summary of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Prescription Drug Coverage for Medicare Beneficiaries: A Summary of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 Prepared by Health Policy Alternatives, Inc. for The Henry

More information

Medicare Economics. Part A (Hospital Insurance) Funding

Medicare Economics. Part A (Hospital Insurance) Funding Medicare Economics Medicare expenditures are a substantial part of the federal budget $556 billion, or 15 percent in 2012. They also comprise 3.7 percent of the country s gross domestic product (GDP),

More information

Medicare Prescription Drug Benefit Progress Report:

Medicare Prescription Drug Benefit Progress Report: Chartpack Medicare Prescription Drug Benefit Progress Report: Findings from the Kaiser/Commonwealth/Tufts-New England Medical Center 2006 National Survey of Seniors and Prescription Drugs August 2007 Methodology

More information

Financial Planning. Patient Education Guide to Your Kidney/Pancreas Transplant Page 18-1. For a kidney/pancreas transplant.

Financial Planning. Patient Education Guide to Your Kidney/Pancreas Transplant Page 18-1. For a kidney/pancreas transplant. Patient Education Page 18-1 For a kidney/pancreas transplant Kidney and pancreas transplants are expensive. Planning your finances, both your income and insurance, will be a key part of planning for transplant.

More information

medicaid and schip 8% Defense Discretionary 19% medicare 12% Other Mandatory Spending 13% Interest on the debt 7%

medicaid and schip 8% Defense Discretionary 19% medicare 12% Other Mandatory Spending 13% Interest on the debt 7% Social Security 21% Defense Discretionary 19% medicare 12% Other Mandatory Spending 13% Nondefense discretionary Spending 20% medicaid and schip 8% Interest on the debt 7% Prepared by: Juliette Cubanski

More information

Health Insurance Reform at a Glance Implementation Timeline

Health Insurance Reform at a Glance Implementation Timeline Health Insurance Reform at a Glance Implementation Timeline 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access

More information

Work Incentives For Individuals Receiving SSDI or SSI Payments

Work Incentives For Individuals Receiving SSDI or SSI Payments Work Incentives For Individuals Receiving SSDI or SSI Payments SSDI Work Incentives * Continuation of Benefits While in a Rehabilitation Program * Continuation of Medicare Coverage * Exemption of Scholarships

More information

Medicare Part D Frequently Asked Questions: Eligibility & Enrollment

Medicare Part D Frequently Asked Questions: Eligibility & Enrollment Medicare Part D Frequently Asked Questions: Eligibility & Enrollment This list of Frequently Asked Questions regarding eligibility and enrollment issues in the new Medicare Part D prescription drug benefit

More information

If I have a psychiatric disability. Will Health Reform Help Me?

If I have a psychiatric disability. Will Health Reform Help Me? If I have a psychiatric disability Will Health Reform Help Me? For consumers of mental health services, a review of the bills passed by Congress in 2009 This paper was written by Chris Koyanagi, policy

More information

Medicare Basics: Frequently Asked Questions

Medicare Basics: Frequently Asked Questions TIP SHEET Information Partners Can Use on: Medicare Basics: Frequently Asked Questions As of October 2006 What is Medicare? Medicare is health insurance for people age 65 or older, under age 65 with certain

More information

Prescription drugs are a critical component of health care. Because of the role of drugs in treating conditions, it is important that Medicare ensures that its beneficiaries have access to appropriate

More information

AN OVERVIEW OF THE MEDICARE PROGRAM AND MEDICARE BENEFICIARIES COSTS AND SERVICE USE

AN OVERVIEW OF THE MEDICARE PROGRAM AND MEDICARE BENEFICIARIES COSTS AND SERVICE USE AN OVERVIEW OF THE MEDICARE PROGRAM AND MEDICARE BENEFICIARIES COSTS AND SERVICE USE Statement of Juliette Cubanski, Ph.D. Associate Director, Program on Medicare Policy The Henry J. Kaiser Family Foundation

More information

Strengthening Community Health Centers. Provides funds to build new and expand existing community health centers. Effective Fiscal Year 2011.

Strengthening Community Health Centers. Provides funds to build new and expand existing community health centers. Effective Fiscal Year 2011. Implementation Timeline Reflecting the Affordable Care Act 2010 Access to Insurance for Uninsured Americans with a Pre-Existing Condition. Provides uninsured Americans with pre-existing conditions access

More information

Presented by: Teresa R. Banda Benefits Counselor Lead Specialist Health Information, Counseling and Advocacy Program Bexar Area Agency on Aging Alamo

Presented by: Teresa R. Banda Benefits Counselor Lead Specialist Health Information, Counseling and Advocacy Program Bexar Area Agency on Aging Alamo Presented by: Teresa R. Banda Benefits Counselor Lead Specialist Health Information, Counseling and Advocacy Program Bexar Area Agency on Aging Alamo Area Council of Governments San Antonio, Texas Types

More information

Medicare Benefits. As of 2012, approximately 50 million people were Medicare beneficiaries.

Medicare Benefits. As of 2012, approximately 50 million people were Medicare beneficiaries. Medicare Benefits Medicare is the federal health insurance program for people age 65 and older, and those of all ages with certain disabilities, End-Stage Renal Disease (ESRD), or Lou Gehrig s disease

More information

Presented by Bradford & Barthel, LLP Sherri M. Dozier, Director of Client Development and Relations Large Loss Department Specialist

Presented by Bradford & Barthel, LLP Sherri M. Dozier, Director of Client Development and Relations Large Loss Department Specialist Presented by Bradford & Barthel, LLP Sherri M. Dozier, Director of Client Development and Relations Large Loss Department Specialist Approximately 12.4% of Gross Wages (F.I.C.A) pay for Social Security.

More information

Appendix C: Online Health Care Poll

Appendix C: Online Health Care Poll Appendix C: Online Health Care Poll Internet Poll through May 14, 2006 (10,512 responses) 1. How much do you agree or disagree with the following statement about health insurance coverage and public policy

More information

Medicare: An Overview

Medicare: An Overview Medicare: An Overview Presented by Elaine Wong Eakin Project Manager This special regional educational effort is supported by funding provided by the California HealthCare Foundation Our Focus is dedicated

More information

Risk Adjustment: Implications for Community Health Centers

Risk Adjustment: Implications for Community Health Centers Risk Adjustment: Implications for Community Health Centers Todd Gilmer, PhD Division of Health Policy Department of Family and Preventive Medicine University of California, San Diego Overview Program and

More information

Health Insurance Coverage in Nebraska Kelly Shaw-Sutherland and Jim P. Stimpson

Health Insurance Coverage in Nebraska Kelly Shaw-Sutherland and Jim P. Stimpson Health Insurance Coverage in Nebraska Kelly Shaw-Sutherland and Jim P. Stimpson S U M M A R Y 217,100 Nebraskans lack health insurance. Nebraska s uninsured rate for the population younger than 65 years

More information

Care needs for dual-eligible beneficiaries

Care needs for dual-eligible beneficiaries C h a p t e r6 Care needs for dual-eligible beneficiaries C H A P T E R 6 Care needs for dual-eligible beneficiaries Chapter summary In this chapter Dual-eligible beneficiaries are eligible for both Medicare

More information

Contents. What s your current coverage? 13 What are my choices? 14 What to do and when to do it 16 Frequently asked questions 18 Glossary 21

Contents. What s your current coverage? 13 What are my choices? 14 What to do and when to do it 16 Frequently asked questions 18 Glossary 21 Show-Me Guide Introduction to Part D: Medicare s New Prescription Drug Coverage An educational resource developed and published by UnitedHealth Group Contents What are the big ideas? 2 Is a Part D plan

More information

Chapter 8: Just in Case Additional Material

Chapter 8: Just in Case Additional Material Chapter 8: Just in Case Additional Material Here I go into detail about Medicare, Medicare Advantage (MA) plans, and Medigap plans. What about Medicare? Medicare is a federal health insurance program for

More information

Medicare s Limited Income Newly Eligible Transition (NET) Program. Four Steps for Pharmacy Providers

Medicare s Limited Income Newly Eligible Transition (NET) Program. Four Steps for Pharmacy Providers Medicare s Limited Income Newly Eligible Transition (NET) Program Four Steps for Pharmacy Providers The Limited Income NET Program (or LI NET) is designed to eliminate any gaps in coverage for low-income

More information

Ten Things Your Clients Wish You Knew About Medicare A CLE presentation for the CBA Elder Law Section

Ten Things Your Clients Wish You Knew About Medicare A CLE presentation for the CBA Elder Law Section 1 Ten Things Your Clients Wish You Knew About Medicare A CLE presentation for the CBA Elder Law Section Alice Ierley, Esq. Brown & Ierley, LLC alice@brownandierley.com 303-835-7001 Higher income clients:

More information

Supplemental Security Income (SSI) and Social Security Insurance. September 12, 2015 Andrew Hardwick Social Security Administration

Supplemental Security Income (SSI) and Social Security Insurance. September 12, 2015 Andrew Hardwick Social Security Administration Supplemental Security Income (SSI) and Social Security Insurance September 12, 2015 Andrew Hardwick Social Security Administration 1 How is SSI Different from Social Security? SSI not based on work Limited

More information

THE FUTURE OF EMPLOYER BASED HEALTH INSURANCE FOLLOWING HEALTH REFORM

THE FUTURE OF EMPLOYER BASED HEALTH INSURANCE FOLLOWING HEALTH REFORM THE FUTURE OF EMPLOYER BASED HEALTH INSURANCE FOLLOWING HEALTH REFORM National Congress on Health Insurance Reform Washington, D.C., January 20, 2011 Elise Gould, PhD Health Policy Research Director Economic

More information

Policy Options to Improve the Performance of Low Income Subsidy Programs for Medicare Beneficiaries

Policy Options to Improve the Performance of Low Income Subsidy Programs for Medicare Beneficiaries Policy Options to Improve the Performance of Low Income Subsidy Programs for Medicare Beneficiaries January 2012 Stephen Zuckerman, Baoping Shang, Timothy Waidmann Introduction One of the principal goals

More information

PUBLIC BENEFITS. What are disability benefits? How is disability determined for SSDI and SSI?

PUBLIC BENEFITS. What are disability benefits? How is disability determined for SSDI and SSI? PUBLIC BENEFITS Public benefits are government programs that are set up to help people who need health care, cash assistance, food stamps, housing assistance, and other programs. Determining which programs

More information

CHAPTER M20 EXTRA HELP - MEDICARE PART D LOW-INCOME SUBSIDY

CHAPTER M20 EXTRA HELP - MEDICARE PART D LOW-INCOME SUBSIDY CHAPTER M20 EXTRA HELP - MEDICARE PART D LOW-INCOME SUBSIDY Virginia DSS, Volume XIII M20 Changes Changed With Effective Date Pages Changed TN #96 10/1/11 Table of Contents pages 1, 2 Pages 3-18 and Appendices

More information

Health Insurance and Financing of care for seniors : An Overview"

Health Insurance and Financing of care for seniors : An Overview Health Insurance and Financing of care for seniors : An Overview" Peter C. Damiano! Director, Public Policy Center! University of Iowa! Senior College! September 30, 2011! Today s topics! Principles of

More information

Making Sense of Medicare

Making Sense of Medicare Making Sense of Medicare Stephanie M. Turnbull Manager, Member Benefits 1 Highlights Medicare Eligibility Types of Medicare Coverage Medicare Part A Medicare Part B Medicare Part C Medicare Part D Medicare

More information

2014 Medicare Part D Low-Income Subsidy (LIS) Income and Resource Standards

2014 Medicare Part D Low-Income Subsidy (LIS) Income and Resource Standards DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244-1850 MEDICARE ENROLLMENT & APPEALS GROUP DATE: February 21, 2014 TO: FROM: SUBJECT:

More information

HEALTH INSURANCE OPTIONS FOR PEOPLE ON MEDICARE DUE TO DISABILITY

HEALTH INSURANCE OPTIONS FOR PEOPLE ON MEDICARE DUE TO DISABILITY HEALTH INSURANCE OPTIONS FOR PEOPLE ON MEDICARE DUE TO DISABILITY io n a He Pro gram Seniors SHIIP lth at Ins urance Inform North Carolina Department of Insurance Seniors Health Insurance Information Program

More information

Medicare At A Glance. State Health Insurance Assistance Program (SHIP)

Medicare At A Glance. State Health Insurance Assistance Program (SHIP) 2015 Medicare At A Glance Indiana 2015 State Health Insurance Assistance Program (SHIP) Who runs the Medicare Program? The Centers for Medicare & Medicaid Services (CMS) is the Federal agency that runs

More information

Welcome to: Medicare and Social Security 101. Presented by: WGA s Retiree Solutions Team and WGA s Compliance Practice

Welcome to: Medicare and Social Security 101. Presented by: WGA s Retiree Solutions Team and WGA s Compliance Practice Welcome to: Medicare and Social Security 101 Presented by: WGA s Retiree Solutions Team and WGA s Compliance Practice Introducing the webcast presenters: Alyssa Martin, Speaker Vice President Member of

More information

Access to Health Services

Access to Health Services Ah Access to Health Services Access to Health Services HP 2020 Goal Improve access to comprehensive, quality health care services. HP 2020 Objectives Increase the proportion of persons with a usual primary

More information

KAISER/COMMONWEALTH FUND 1997 SURVEY OF MEDICARE BENEFICIARIES Cathy Schoen, Patricia Neuman, Michelle Kitchman, Karen Davis, and Diane Rowland

KAISER/COMMONWEALTH FUND 1997 SURVEY OF MEDICARE BENEFICIARIES Cathy Schoen, Patricia Neuman, Michelle Kitchman, Karen Davis, and Diane Rowland KAISER/COMMONWEALTH FUND 1997 SURVEY OF MEDICARE BENEFICIARIES Cathy Schoen, Patricia Neuman, Michelle Kitchman, Karen Davis, and Diane Rowland December 1998 EXECUTIVE SUMMARY Central to the debate on

More information

What is the Low Income Subsidy? Ginger Rogers Medicare Part D Disability Drug Benefit Helpline Disability Rights Wisconsin

What is the Low Income Subsidy? Ginger Rogers Medicare Part D Disability Drug Benefit Helpline Disability Rights Wisconsin What is the Low Income Subsidy? Ginger Rogers Medicare Part D Disability Drug Benefit Helpline Disability Rights Wisconsin 1 What is the Low Income Subsidy? Also known as LIS or Extra Help Medicare beneficiaries

More information

Medicare. What you need to know. Choose the plan that s right for you GNHH2ZTHH_15

Medicare. What you need to know. Choose the plan that s right for you GNHH2ZTHH_15 Medicare What you need to know Choose the plan that s right for you GNHH2ZTHH_15 Choosing a Medicare plan is a lot like buying a car. There are lots of options to consider. And what s right for you may

More information

Medicare Supplement Insurance Approved Policies 2011

Medicare Supplement Insurance Approved Policies 2011 Medicare Supplement Insurance Approved Policies 2011 For more information on health insurance call: MEDIGAP HELPLINE 1-800-242-1060 This is a statewide toll-free number set up by the Wisconsin Board on

More information

Policy Forum. Understanding the Effects of Medicare Prescription Drug Insurance. About the Authors. By Robert Kaestner and Kelsey McCoy

Policy Forum. Understanding the Effects of Medicare Prescription Drug Insurance. About the Authors. By Robert Kaestner and Kelsey McCoy Policy Forum Volume 23, Issue 1 October 2010 Understanding the Effects of Medicare Prescription Drug Insurance By Robert Kaestner and Kelsey McCoy The Medicare Modernization The size and potential significance

More information

Medicare- Medicaid Enrollee State Profile

Medicare- Medicaid Enrollee State Profile Medicare- Medicaid Enrollee State Profile North Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6 Spending...

More information

Quality Ratings of Medicare Advantage Plans, 2011

Quality Ratings of Medicare Advantage Plans, 2011 Issue Brief Quality Ratings of Medicare Advantage Plans, 2011 February 2011 This information was reprinted with permission from the Henry J. Kaiser Family Foundation. The Kaiser Family Foundation is a

More information

Information provided by NYS Civil Service Medicare for Disability Retirees - September 2007

Information provided by NYS Civil Service Medicare for Disability Retirees - September 2007 Information provided by NYS Civil Service Medicare for Disability Retirees - September 2007 For employees of New York State agencies who are awarded a Disability Retirement Disability Retirees Must Enroll

More information

National Findings on Access to Health Care and Service Use for Non-elderly Adults Enrolled in Medicaid

National Findings on Access to Health Care and Service Use for Non-elderly Adults Enrolled in Medicaid National Findings on Access to Health Care and Service Use for Non-elderly Adults Enrolled in Medicaid By Sharon K. Long Karen Stockley Elaine Grimm Christine Coyer Urban Institute MACPAC Contractor Report

More information

What You Need to Know About SSDI and Medicare

What You Need to Know About SSDI and Medicare 1 What You Need to Know About SSDI and Medicare Tai Venuti, MPH Adrienne Muralidharan April 18, 2012 Welcome 2 Today we ll cover: History of SSDI SSDI process Evaluating spinal/musculoskeletal claims Awards

More information

MEDICARE: You ve earned It. Make the most of it.

MEDICARE: You ve earned It. Make the most of it. Cigna Medicare Services MEDICARE: You ve earned It. Make the most of it. A simple guide filled with useful information on Medicare, health and wellness and more. Section 1 MEDICARE. PLAIN AND SIMPLE. Section

More information

While Medicare is most popularly

While Medicare is most popularly MONITORING MEDICARE+CHOICE OPERATIONALInsights May 2001, Number 2 Medicare s Less Visible Population: Disabled Beneficiaries under Age 65 While Medicare is most popularly known as a program for people

More information

Medicare- Medicaid Enrollee State Profile

Medicare- Medicaid Enrollee State Profile Medicare- Medicaid Enrollee State Profile Montana Centers for Medicare & Medicaid Services Introduction... 1 At a Glance... 1 Eligibility... 2 Demographics... 3 Chronic Conditions... 4 Utilization... 6

More information

Th e c u r r e n t c o n gr e s s i o n a l d e ba t e on extending

Th e c u r r e n t c o n gr e s s i o n a l d e ba t e on extending Socioeconomic Differences In Medicare Supplemental Coverage Adding prescription drug coverage to Medicare could put a financial squeeze on lower-income beneficiaries. by Nadereh Pourat, Thomas Rice, Gerald

More information

Medicare Resource Guide

Medicare Resource Guide Medicare Resource Guide Patient Name Dear Patient, Please take the time to read the following sections of this brochure as noted by your healthcare provider. These different components of Medicare deal

More information

Agenda. Medicare Overview Medicare Part B Drug Coverage Medicare Part D: How to Find and Compare Medicare Part D Plans Summary Provider Contacts

Agenda. Medicare Overview Medicare Part B Drug Coverage Medicare Part D: How to Find and Compare Medicare Part D Plans Summary Provider Contacts 2 Medicare Part D Agenda Medicare Overview Medicare Part B Drug Coverage Medicare Part D: Background Benefits of Medicare Part D Enrollment Coverage Specialty Medications Part D Costs How to Find and Compare

More information

Medicare Part D & Ryan White HIV/AIDS Program As of November 2008

Medicare Part D & Ryan White HIV/AIDS Program As of November 2008 Medicare Part D & Ryan White HIV/AIDS Program As of November 2008 The below discussion can guide Ryan White HIV/AIDS programs in understanding implications of the Medicare Part D prescription drug benefit

More information

Last name First name Middle initial Social Security number (required)

Last name First name Middle initial Social Security number (required) Alaska Medicare Supplement Enrollment Application for Plans A, F, High Deductible F and N 2550 Denali St., Suite 1404 Anchorage, AK 99503 1-888-669-2583 Fax: 907-258-1619 ou are eligible to apply for a

More information

Medicare Cost Sharing and Supplemental Coverage

Medicare Cost Sharing and Supplemental Coverage Medicare Cost Sharing and Supplemental Coverage Topics to be Discussed Medicare costs to beneficiaries Review Medicare premiums and cost sharing Background on Medicare beneficiary income Current role of

More information

Maryland Medicaid Program

Maryland Medicaid Program Maryland Medicaid Program Maryland s Pharmacy Discount Waiver Tuesday, November 19, 2002 Debbie I. Chang Deputy Secretary for Health Care Financing Maryland Department of Health and Mental Hygiene Overview

More information

Increasing participation in the Medicare savings programs and the low-income drug subsidy. Joan Sokolovsky and Hannah Neprash November 8, 2007

Increasing participation in the Medicare savings programs and the low-income drug subsidy. Joan Sokolovsky and Hannah Neprash November 8, 2007 Increasing participation in the Medicare savings programs and the low-income drug subsidy Joan Sokolovsky and Hannah Neprash November 8, 2007 Key findings Medicare beneficiaries typically have lower incomes

More information

Enrollment Application for Medicare Supplement

Enrollment Application for Medicare Supplement Group Health Options, Inc. PO Box 34803 Seattle, WA 98124-1803 PLAN CHOICE rplan A rplan F rplan K rplan N Enrollment Application for Medicare Supplement PLEASE PRINT Answer all questions completely and

More information

Medicare Explained (For the rest of us!) A plain English version

Medicare Explained (For the rest of us!) A plain English version Produced by & Not affiliated with any Government Agency A Brief History of Medicare Medicare is a national social insurance program, administered by the U.S. federal government since 1965, that guarantees

More information

Enrollment Application for Medicare Supplement

Enrollment Application for Medicare Supplement Page 1 of 6 PO Box 34803 Seattle, WA 98124-1803 SECTION 1 PLAN CHOICE rplan A (2010 STANDARDIZED) rplan F (2010 STANDARDIZED) rplan K rplan N PLEASE PRINT Answer all questions completely and accurately

More information

This glossary provides simple and straightforward definitions of key terms that are part of the health reform law.

This glossary provides simple and straightforward definitions of key terms that are part of the health reform law. This glossary provides simple and straightforward definitions of key terms that are part of the health reform law. A Affordable Care Act Also known as the ACA. A law that creates new options for people

More information

Financial assistance for low-income Medicare beneficiaries

Financial assistance for low-income Medicare beneficiaries Financial assistance for low-income Medicare beneficiaries C h a p t e r4 C H A P T E R 4 Financial assistance for low-income Medicare beneficiaries Chapter summary In this chapter Medicare Savings Programs

More information

Massachusetts Bulletin for People with Medicare January 2016

Massachusetts Bulletin for People with Medicare January 2016 The Commonwealth of Massachusetts Executive Office of Elder Affairs One Ashburton Place, 5th Floor Boston, Massachusetts 02108 CHARLES D. BAKER Governor KARYN E. POLITO Lieutenant Governor Tel: (617) 727-7750

More information

Planning for Health Care in Retirement

Planning for Health Care in Retirement Planning for Health Care in Retirement 1 Agenda The Retirement Income Challenge Understanding Health Care Creating a Plan to Address Health Care Costs 3 The Retirement Income Challenge 4 The Retirement

More information

Retiree prescription drug program: time to move to an Employer Group Waiver Plan (EGWP)?

Retiree prescription drug program: time to move to an Employer Group Waiver Plan (EGWP)? Retiree prescription drug program: time to move to an Employer Group Waiver Plan (EGWP)? Gail Levenson and Rich Stover Today s areas of focus Overview of Medicare Part D plan Impact of health care reform

More information

P.O. Box 91120, MS 295 Seattle, WA 98111-9220 1-800-752-6663 Fax: 425-918-5278

P.O. Box 91120, MS 295 Seattle, WA 98111-9220 1-800-752-6663 Fax: 425-918-5278 Washington Medicare Supplement Enrollment Application for Plans A, F, High Deductible F and N P.O. Box 91120, MS 295 Seattle, WA 98111-9220 1-800-752-6663 Fax: 425-918-5278 ou are eligible to apply for

More information

Programs. Summary of State Programs and Laws Highlighted in Faces of Maryland s Newly Insured. Medical Assistance for Families (SB 6)

Programs. Summary of State Programs and Laws Highlighted in Faces of Maryland s Newly Insured. Medical Assistance for Families (SB 6) Programs Summary of State Programs and Laws Highlighted in Faces of Maryland s Newly Insured Medical Assistance for Families (SB 6) Medical Assistance for Families provides full health care insurance to

More information

Impact of Part D Coverage Gap on Adherence to Diabetes Medications Feng Zeng, Ph.D.

Impact of Part D Coverage Gap on Adherence to Diabetes Medications Feng Zeng, Ph.D. Impact of Part D Coverage Gap on Adherence to Diabetes Medications Feng Zeng, Ph.D. Good morning. Welcome to my presentation. So today I m going to talk about the impact of coverage gap reforms on adherence

More information

Prescription Drug Benefits Under Part D of the Medicare Modernization Act The Genie s Out of the Bottle

Prescription Drug Benefits Under Part D of the Medicare Modernization Act The Genie s Out of the Bottle ISSUE BRIEF VOL. 5, NO. 10, 2005 This ongoing series provides information on how to develop programs to educate Medicare beneficiaries and their families. Additional information about this and other projects

More information

Treatment. Race. Adults. Ethnicity. Services. Racial/Ethnic Differences in Mental Health Service Use among Adults. Inpatient Services.

Treatment. Race. Adults. Ethnicity. Services. Racial/Ethnic Differences in Mental Health Service Use among Adults. Inpatient Services. CHAPTER 1 Introduction Racial/Ethnic Differences in Mental Health Service Use among Adults Treatment Ethnicity Outpatient Services Mental Health Adults Mental Health Care Prevalence Inpatient Services

More information

Chart 11-1. Number of dialysis facilities is growing, and share of for-profit and freestanding dialysis providers is increasing

Chart 11-1. Number of dialysis facilities is growing, and share of for-profit and freestanding dialysis providers is increasing 11 0 Chart 11-1. Number of dialysis facilities is growing, and share of for-profit and freestanding dialysis providers is increasing Average annual percent change 2014 2009 2014 2013 2014 Total number

More information

Introducing OneExchange.

Introducing OneExchange. RETIREE BENEFITS Introducing OneExchange. OneExchange provides you with plan advice and enrollment assistance to choose Medicare supplemental healthcare and prescription drug coverage that s right for

More information

OFFICE OF FINANCIAL MANAGEMENT. 2012 Washington State Primary Care Nurse Practitioner Survey Data Report

OFFICE OF FINANCIAL MANAGEMENT. 2012 Washington State Primary Care Nurse Practitioner Survey Data Report OFFICE OF FINANCIAL MANAGEMENT 2012 Washington State Primary Care Nurse Practitioner Survey Data Report August 2012 Table of Contents Introduction... 1 Select Results from the Survey... 1 About the Survey...

More information