The Medicare Prescription

Size: px
Start display at page:

Download "The Medicare Prescription"

Transcription

1 COVERING HEALTH ISSUES, 2006 Chapter : Medicare Prescription Drug Program The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ( Medicare Modernization Act or MMA) became law in December Among other provisions, the MMA created the Part D drug benefit, which became available to Medicare beneficiaries on January 1, Before the MMA, Medicare covered no outpatient drugs, an omission that created an increasingly large hole in the program s benefits.1 Prior to passage of the MMA, Medicare did cover certain physicianadministered drugs under Part B.2 Passage of the MMA came after extended debate in which policymakers were sharply divided over the design of the drug benefit, its structure and its cost particularly whether it could be restricted to the $400 billion, 10- year budget established by the Bush Administration.3 On May 1, 2006, the initial enrollment period ended. 4 Some 22. million beneficiaries (out of 43 million overall) enrolled in either stand-alone Part D plans or in drug plans affiliated with Medicare Advantage plans. Most of these beneficiaries were automatically enrolled, either because of their status as dual eligibles (participants in both Medicare and Medicaid) or as current enrollees in Medicare Advantage plans. 6 By the Administration s numbers, an additional 1.8 million beneficiaries have coverage as good as Part D. 7 Instead of offering the benefit itself, Medicare relies on private drug plans that compete among themselves. The benefit is available either from stand-alone private prescription drug plans (PDPs) or drug plans sponsored by Medicare Advantage organizations for those who get their overall benefits from these private health plans. 8 These affiliated drug plans are known as MA-PDs. (For more on Medicare Advantage plans, See Chapter 4, Medicare ). These organizations are at risk for the cost of the benefit although the government shares some of the risk. 9 The general outlines of the standard benefit are established by law, though plans have the option of modifying the benefit design. Most plans are using cost management tools (e.g., formularies and prior authorization) to leverage their buying power to negotiate price discounts and thus manage drug costs and to encourage appropriate utilization. 10 The success of the Medicare drug benefit may be judged by a number of factors, only a few of which will be known in the short term. Furthermore, this program is may KEY FACTS As of June 2006, 22. million beneficiaries were enrolled in stand-alone Part D plans or Medicare Advantage drug plans. a Another 1.8 million retained current coverage as good as Part D through former or current employers or the VA. b In 2006, beneficiaries had more than 1,400 stand-alone drug plan options offered by about 6 different organizations. c Most plans offered benefits with either no deductible or a reduced deductible, but only 1 percent of plans provided any benefits in the coverage gap. d On what drugs to cover, organizations offering plans on a national or near-national basis usually covered the top ten generic drugs on their formularies, but only about half covered all 10 of the most prescribed brand-name drugs. e About 6.6 million beneficiaries with both Medicaid and Medicare coverage were shifted from Medicaid coverage and were auto-enrolled into Medicare plans. f Most employers took the available federal subsidy to retain their retiree coverage, allowing retirees to avoid the disruption of shifting to a Part D plan. But only about half of these employers indicated they are likely to do so in g For story ideas on the Medicare prescription drug program, see page 70. A list of experts and websites also begins on page

2 COVERING HEALTH ISSUES, 2006 CHAPTER Premium Program Deductible before initial coverage begins Shape of the Standard Benefit in 2006 Total Drug Spending Amount Paid by Beneficiary Under Standard Benefit Average of $24 per month Up to $20 $20 None Amount Paid by Low-Income Beneficiary None for eligible plan During initial coverage period $20 to $2,20 2% of cost $1 to $ (varies by type of drug, income, Medicaid status) In the coverage gap $2,20 to $,100 Pay full cost No coverage gap Once catastrophic coverage begins Over $,100 Greater of %, $2 (generic), $ (brand) No cost sharing above $3,600 in out-of-pocket costs Note: Excludes those eligible for partial subsidies. Most amounts are indexed and will be higher in Source: Medicare Modernization Act of 2003 (www.hhs.gov/news/press/2006pres/ html) and calculations by Jack Hoadley, Georgetown University (www.cmwf.org/usr_doc/hoadley_medicaresnewadventure_911.pdf) undergo administrative and potentially legislative changes in its early years, making it a moving target. This chapter assesses the Part D benefit at this early stage, including a look ahead at the prospects for THE SHAPE OF MEDICARE PART D Medicare Part D relies on private drug plans competing in 39 regions to make the benefit available to beneficiaries covered under traditional Medicare. MA organizations are required to offer at least one plan with a qualified drug benefit to enrollees in each area they serve. MA enrollees, if they want a drug benefit, must get it from their MA plan. 11 The benefit has a complex design shaped by a combination of political and budget factors. Under the standard benefit,* beneficiaries are subject to an initial deductible ($20 in 2006) and then must pay 2 percent of drug costs up to an initial coverage limit ($2,20 in 2006). Above the initial coverage limit, beneficiaries are responsible for paying the entire cost of their drugs until they reach $3,600 in out-of-pocket costs, equivalent in 2006 to $,100 in total drug costs under the standard benefit. This coverage gap is often referred to as the doughnut hole. After reaching the threshold for out-of-pocket spending, catastrophic coverage kicks in with only modest cost-sharing, generally percent of the cost of the drug. 12 (See table, Shape of the Standard Benefit in ) Plans may substitute their own benefit design for this standard benefit but it must be actuarially equivalent (i.e., covers the same amount of drug costs on average). Substitute coverage may, for example, replace percentage coinsurance with flat copayments or eliminate the deductible. Plans also may enhance their coverage by adopting a more generous benefit structure. For example, a plan can choose to pay some of a beneficiary's drug costs in the coverage gap. 13 Beneficiary premiums and not federal dollars must cover the cost of the value of enhanced coverage. 14 Beneficiaries pay a premium to the drug plan they select. In 2006 the average premium, excluding retiree coverage, is less than $24. 1 The drug benefit - unlike other parts of the Medicare program - varies according to income. Beneficiaries with incomes below 13 percent of the federal poverty level ($13,230 for a single person and $17,820 for a couple in 2006) are eligible for a subsidy if they also have assets below a specified level ($6,000 for an individual and $9,000 for a couple in 2006). Once enrolled, they typically face no premiums and only minimal out-of-pocket costs. Those with Medicaid coverage do not have to meet the federal asset test, * The Medicare Modernization Act (MMA) defines a "standard" prescription drug benefit. Plans are free to modify the actual benefits they offer as long as benefits are actuarially equivalent to the standard benefit outlined under MMA. 64

3 CHAPTER COVERING HEALTH ISSUES, 2006 RANGE OF PREMIUMS FOR ALL STAND-ALONE PRESCRIPTION DRUGS PLANS, 2006 Number of Plans 3% 30% 2% 20% 1% 10% % 0% 6% Under $20 22% $20 to $30 32% $30 to $40 Source: Hoadley, Jack (2006). Medicare s New Adventure: The Part D Drug Benefit. The Commonwealth Fund, March, p. 13. Retrieved on July 12, (http://www.cmwf.org/usr_doc/hoadley_medicaresnewadventure_911.pdf). although some states apply their own asset test. Beneficiaries with incomes between 13 and 10 percent of the federal poverty level and with somewhat higher assets may receive partial subsidies. 16 In exchange for taking over from the states coverage of drugs for Medicaid beneficiaries, the federal government recoups a share of the cost from the states. 17 States will now be required to send monthly payments to the federal government based on estimates of how much the state would have had to pay through its Medicaid program if it were not for the Medicare prescription drug benefit. 18 Known as the "clawback", these payments have been challenged (unsuccessfully, as of September 2006) by states in court for a variety of technical and policy reasons. 19 Many states maintain that clawback costs will exceed their previous Medicaid costs, since many had taken effective steps to manage their costs. 20 PLANS IN THE PART D MARKET 23% $40 to $0 Monthly Premium 11% $0 to $60 Approximately 6 different organizations offered PDPs in Ten organizations offered plans in all 39 regions covering the states. 21 Four other organizations offered plans in most regions, while others (especially locally based insurers) participated in a smaller set of regions. Most organizations, mainly large insurance % Over $60 companies and pharmacy benefit management chose to offer three plan options in each region, thus guaranteeing that beneficiaries across the country have a large array of options. 22 Nationally, more than 1,400 plan options were available through Part D in In most regions, beneficiaries faced between 40 and 4 plan options. 23 In the first year, two organizations dominated the market nationally, controlling nearly half the stand-alone PDP market and about one-third of the MA-PD market, according to partial data released by CMS. 24 United HealthCare (including its merger partner, PacifiCare) has the largest share, due in part to its affiliation with AARP, while Humana obtained the second largest share, probably as a result of its aggressive strategy of offering lowpremium plans. No other organization topped 10 percent of national enrollment in the PDP market. United/PacifiCare, Humana, and Kaiser Permanente have the strongest enrollment numbers in the MA market. 2 Monthly premiums across all stand-alone prescription drug plans range from $1.87 to $ (See chart, Range of Premiums for All Stand-Alone Prescription Drug Plans. ) 26 Some plans are available at no premium charge to enrollees who are eligible for the low-income subsidy. 27,28 In order for the subsidy to be applicable, plans must be priced below a regional benchmark that is defined as the average of plan premiums, including MA premiums but excluding the value of enhanced benefits. 28 Benchmarks in 2006 ranged from $23.2 a month in California to $36.39 in Mississippi. On average, subsidy-eligible beneficiaries have between five and 14 options. 29 Drug plans have taken full advantage of the flexibility allowed by law to vary their benefit designs and formularies. A majority of plans chose to lower or eliminate the standard deductible, substitute flat copayments for coinsurance (e.g., $2 for a one-month supply instead of 2 percent of the cost), and adopt tiered cost-sharing where the beneficiary pays different amounts for different types of drugs (See chart, Cost- Sharing Designs for Stand-Alone Prescription Drug Plans ). 6

4 COVERING HEALTH ISSUES, 2006 CHAPTER The most common approach was to use three tiers with different copayment amounts for generic drugs, preferred brand-name drugs and nonpreferred brand-name drugs. Sometimes there is a separate tier for specialty drugs (e.g., biotechnology products or injectable drugs). Relatively few plans chose to fill in the doughnut hole at all, and most that did cover only generic drugs in this gap. 30 Median copayment levels for 2006 are about $ for generic drugs, $2 for preferred brand-name drugs, and $3 for non-preferred drugs. 31 But there is substantial variation among plans. Several have no copayments for generic drugs, while others charge as much as $1. Copayments typically range from about $1 to $40 for preferred brand drugs and from about $40 to $72.0 for non-preferred drugs. 32 The MMA limits plan flexibility around formularies and other cost management approaches by requiring that plan bids be rejected if the proposed design and benefits are likely to substantially discourage enrollment by certain part D eligible individuals. 33. This aims to protect beneficiaries by ensuring that formularies are not overly restrictive and that commonly needed drugs are available. 34 A plan must cover at least two drugs in each therapeutic class and most or all drugs in certain designated classes (e.g., drugs used to treat mental health conditions and HIV/AIDS). 3 Beneficiaries may request exceptions and appeal most situations where coverage of a drug is denied. 36 The competing drug plans made significantly different decisions about their formularies. The national and nearnational plans covered between 64 percent and 97 percent of a sample of 12 drugs. While nearly all these plans covered the ten most commonly prescribed generic drugs, only about half the plans covered the top ten brand-name drugs (See table, Number and Percentage of Plans Covering Top 10 Brand-Name and Generic Drugs ). Plans sometimes omitted drugs with therapeutically similar competitors, for example, covering Lipitor but not Zocor as a treatment for high cholesterol. 37 When a drug is not listed on the formulary, beneficiaries must pay for the drug out of pocket, switch to an alternative or request an exception. 38 Placement on different tiers can also mean COST-SHARING DESIGNS FOR STAND-ALONE PRESCRIPTION DRUG PLANS, 2006 Tiered Cost Sharing 2% Coinsurance Source: MedPAC (2006). "Report to Congress: Increasing the Value of Medicare." Table 7-2. (www.medpac.gov/publications/congressional_reports/jun06_ch07.pdf) substantially different costs for the beneficiary. An enrollee could pay from $1 to $62 for Norvasc (a common drug for high blood pressure), $1 to $100 for Namenda (for Alzheimer s disease) or even $20 to $1,276 for Enbrel (for rheumatoid arthritis), depending on the plan selected. 39 RELATIONSHIP OF PART D TO EXISTING COVERAGE The role of Medicare Part D differs substantially depending on a beneficiary s situation. Some people have chosen to stay with their previous source of drug coverage. For others, Medicare Part D provides coverage not previously available or replaces their current source of coverage. Most beneficiaries with coverage through former employers were able to retain it in 2006 and avoid the disruption of moving into Part D. 40 As an incentive for employers to continue offering retiree drug coverage at least equivalent to Part D (referred to as creditable coverage ), Medicare pays a tax-free subsidy equal to 28 percent of allowable drug costs between $20 and $,000. Although four of every five large employers reported that they would accept the subsidy and continue to provide benefits in 2006, only about half indicated they are likely to do so in About 6.6 million dually eligible beneficiaries who had been receiving drug coverage from Medicaid were required to switch to Part D plans. 42 Dually eligible beneficiaries were automatically enrolled for the low-income subsidy and were randomly autoenrolled in a Part D plan with an option of switching to a different plan

5 CHAPTER COVERING HEALTH ISSUES, 2006 Medicaid beneficiaries, if enrolled in eligible Medicare drug plans, do not pay premiums or deductibles, and do not face a coverage gap. Although some beneficiaries had no copayments under Medicaid, they generally now face copayments of between $1 and $ (depending on their income level and whether a drug is generic or brand). 44 Some may also find that drugs they take are not on their Part D plan s formulary. CMS required Part D plans to establish transition plans to accommodate, at least temporarily, beneficiaries in this situation. 4 Most beneficiaries who were enrolled in MA plans in 200 took the option of receiving Part D coverage from their plan. Nearly 40 percent of MA plans offered drug coverage in 2006 without an added premium and about two-thirds provided enhanced drug coverage. 46 In recent years many MA plans had reduced the scope of their drug coverage so most beneficiaries enrolled in MA plans should have seen improvements to their previous drug coverage. 47 Most beneficiaries with privately purchased supplemental insurance, called Medigap, were expected to switch into Part D plans. No new Medigap policies with drug coverage can be sold, although those with such coverage have the option of retaining it. Medigap policies have high premiums for relatively thin benefits and do not qualify as creditable coverage. As a result, policyholders should have better coverage at a lower price by switching to Part D plans. 48 In some states, beneficiaries have had coverage available through state pharmacy assistance programs. Typically, these state-funded programs provided coverage to beneficiaries with incomes below a certain threshold but not low enough to make them eligible for Medicaid. Most larger state programs continue to be available, though modified to wrap around Part D. Beneficiaries eligible for these state pharmacy assistance programs typically have maintained coverage at least as generous as they had previously, while the states save money because Medicare now pays a portion of the drug costs. 49,0 EDUCATION, MARKETING, AND ENROLLMENT Medicare faced a great challenge in educating beneficiaries about the new benefit. One incentive to enroll is the penalty for late enrollment, which discourages people from deferring enrollment until Number and Percentage of Plans Covering Top 10 Brand-Name and Generic Drugs, 2006 Top 10 Brand-Name and Generic Drugs All Top 10 Brands 18 1% All Top 10 Generics 32 91% Note: The analysis is based on coverage of 12 drugs from Medicare.gov Drug Plan Finder for 3 different stand-alone Medicare Prescription Drug Plans offered by 14 sponsor organizations, representing 1,222 of the 1,429 plans nationwide. Source: Hoadley, Jack et al. (2006) (www.kff.org/medicare/upload/7489.pdf) they have substantial drug costs. Beneficiaries who sign up after the end of the initial open enrollment season without creditable coverage from another source will pay a larger premium (increased by 1 percent of the national average premium for each month not enrolled) for the duration of their participation in the program. 1 Such a beneficiary deciding in July 2006 to enroll must wait for the November open season to choose a plan effective in January 2007; in addition, this beneficiary will pay a 7 percent premium surcharge (probably about $2 per month in 2007). 2 Confusion about the drug benefit has been a major implementation concern. About 40 percent of beneficiaries reportedly found the process of researching a plan selection to be difficult. CMS ran an extensive information campaign that included mailings, flyers, advertising, a toll-free telephone line (1-800-Medicare), and website (www.medicare.gov). Yet only one-fifth of surveyed beneficiaries reported that either they or someone helping them used the toll-free line, and only 11 percent used the website. Only 6 percent of surveyed respondents reported using a counselor. 3 Despite considerable confusion along the way, CMS reported enrollment of 22. million beneficiaries in the prescription drug plan as of June 11, Over half of these were dually eligible beneficiaries assigned to plans or beneficiaries adding Part D coverage to existing Medicare Advantage coverage (See table, Enrollment in Part D and Other Sources of Drug Coverage, June ) 4 67

6 COVERING HEALTH ISSUES, 2006 CHAPTER Enrollment in Part D and Other Sources of Drug Coverage, June 2006 Category of Beneficiaries Enrollment (millions)** Drug Coverage from Medicare Plans - Standalone PDPs Dual Eligibles in PDPs Medicare Advantage Plans (MA-PDs)* 6.0 TOTAL ENROLLMENT IN PART D PLANS 22. Subsidized Drug Coverage from Former Employer 6.9 TOTAL PART D-RELATED COVERAGE 29.4 Other Sources of Creditable Coverage - Federal Retiree Coverage (FEHB, TRICARE) 3. - Federal Benefits (VA, Indian Health Service) Active Workers with Medicare Secondary Payer Other (Unsubsidized Retiree Coverage, SPAPs) 0.7 TOTAL BENEFICIARIES WITH CREDITABLE DRUG COVERAGE 38.2 TOTAL MEDICARE BENEFICIARIES ELIGIBLE FOR DRUG COVERAGE 42.6 * About 00,000 dual eligibles are enrolled in MA-PDs and are listed in this category. ** Numbers do not sum because of rounding. Source: Estimates based on CMS numbers (Mark McClellan, Centers for Medicare and Medicaid Services, testimony before the House Committee on Ways and Means, June 14, (http://waysandmeans.house.gov/hearings.asp?formmode=view&id=4992) As of June 2006, 1.8 million beneficiaries had applied and qualified for the low-income subsidy (in addition to dual eligibles and others who were automatically deemed eligible). According to CMS estimates, another 3.3 million have not applied despite being eligible. CMS has committed to ongoing outreach to these individuals. Some 2.3 million applicants were rejected as a result of excess income, assets, or both. 6 MONITORING IMPLEMENTATION It is too early to evaluate the overall success of Medicare Part D, which will be measured in the court of public opinion by enrollment numbers and the general satisfaction of beneficiaries. In the meantime, Congress may decide to make mid-course corrections or more fundamental changes to the program s design. Beneficiaries, although sometimes frustrated by the enrollment process and the early transition, generally have been satisfied with the benefit itself. 7 Whether they will remain so as they hit the coverage gap or face decisions about whether to switch plans in future open enrollment periods is unknown. Several measures beyond enrollment should be examined as indicators of success. One is the overall cost of the program a matter of debate prior to its inception. In 2003, CBO estimated its cost at $394 billion over 10 years while in 2004 the Health and Human Services Office of the Actuary priced the program at $34 billion. 8 In 200, the Administration released an estimate pricing the program at $720 billion between 2006 and 201. Part of the reason for the discrepancy between the 68

7 CHAPTER COVERING HEALTH ISSUES, 2006 earlier and later figures is that the earlier numbers included in their 10-year estimates initial start up years before seniors were fully using the new benefit. Later estimates consider a 10-year span after the program has been fully implemented. 9 The Bush Administration in mid-2006 reported that lower-thanexpected plan premiums and decisions by beneficiaries to enroll in the lowest-premium plans have reduced total estimated costs by nearly $180 billion (or 20 percent of the most recent administration estimate - $926 billion for the period ). 60 As plans report their actual first-year results, low costs more generally may signify that plans have negotiated low prices and managed drug utilization successfully, but can also result from low enrollment or the failure of beneficiaries to fill needed prescriptions. Policy makers will undoubtedly look at indicators of quality, such as whether beneficiaries receive needed drugs and whether their use of services is inappropriately reduced. PROSPECTS FOR 2007 AND BEYOND In the short term, Congress may consider making changes to the late-enrollment penalty 61 or address the concerns of some pharmacies that they are not being paid on a timely basis. 62 Advocates are urging Congress to consider more transition protections for dual eligibles, a first-year need that could be repeated if changes to plan premiums force many low-income beneficiaries to be assigned to new plans, or to eliminate the asset test for eligibility for the lowincome subsidy). 63 Some lawmakers may also push for stronger guidelines for formulary adequacy, or steps to reduce beneficiary confusion through greater standardization of plans benefits and procedures. 64 In addition, some members of Congress want to grant the Secretary negotiating authority over drug prices, 6 or reduce the coverage gap. 66 The projected cost of the Medicare Part D benefit was a major political issue surrounding enactment of the MMA, and actual costs will have a huge impact on the benefit s future. Some fiscal conservatives have already proposed repealing Part D because of its high costs, 67 while others have revived prior proposals to restrict it to low-income beneficiaries. 68 On the other side of the political spectrum, policy leaders may push proposals to integrate the drug benefit into the broader Medicare package 69 or to create a government plan option. 70 On November 1, 2006, beneficiaries will once again be able to enroll in Part D or switch plans (effective January 1, 2007). 71 In advance of that date, several questions will be answered: Will the same plans be offered? Will premiums go higher? Will plan formularies become more restrictive? The 2006 open season will include some new enrollees and some who switch to different plans. Both CMS and the plans should be in a better position to avoid the initial problems faced in January 2006, when some beneficiaries could not get their prescriptions filled at the correct price. Some experts believe that significant market consolidation might wait until 2008, after plans have been able to see a full year s claims experience and after some of the initial financial protections begin to phase out. 72 It remains to be seen what impact such consolidation would have on access to prescription drug coverage, quality of coverage and costs for beneficiaries. Even sooner than the end of 2006, new problems could arise as more beneficiaries hit the coverage gap and may be startled when they are billed full price for a prescription they have been getting for a $1 copayment. Similarly, beneficiaries who are prescribed new drugs may run into denials of coverage for the first time if the drug is off formulary or requires prior authorization. CONCLUSION Policymakers will have at least some indicators of Medicare Part D s success within the first year of the program, and beneficiaries reactions to the benefit could play an important role in the 2006 congressional elections. Other signs of success or failure will only be available after a full year, when various types of data can be collected and made available to Congress and the public. As is true for many complex public policy issues, political decisions may have to be made more quickly than data can be collected and analyzed. One thing is certain: Medicare Part D will continue to receive considerable attention from researchers, journalists, beneficiaries, and policymakers. 69

8 COVERING HEALTH ISSUES, 2006 CHAPTER STORY IDEAS When new plan offerings are announced, beneficiaries face an open season for the year to come. What organizations are leaving the program in your area and why? For organizations that are staying in the program, are they modifying their plan offerings? How many dual eligibles (enrolled in both Medicare and Medicaid) will have to change plans for 2007? Are premiums lower or higher, and by how much? How many beneficiaries in general will need to switch to new plans? Does your state have a state pharmacy assistance program (SPAP) in 2006? How many enrollees are getting coverage through it? How smooth has coordination been between the SPAP and the Part D benefit? Are there any new issues facing these programs or are further program changes expected in 2007? Are beneficiaries still having problems getting access to needed drugs? To what extent have beneficiaries needed to request exceptions or request prior authorization? How hard has this process been for beneficiaries? For pharmacists and physicians? How are beneficiaries handling their costs as they reach the coverage gap? Does the gap come as a surprise, or were they prepared for it? Are they cutting back on needed medications? Plans report quarterly to the government on such topics as call center performance, generic drug dispensing rates, use of the exceptions and appeals processes, etc. Are those figures being made available? How do plans in your area compare on these measures? What implications does this have for educating beneficiaries during the next open enrollment season? What has been the experience of counselors those who are part of the state counseling ( SHIP ) program, members of the ABC coalition, or others in working with beneficiaries? What lessons can they offer for future years? What challenges have they faced? What resources do they have available? States now pay directly for lesser amounts of drugs through Medicaid, because Medicare now finances drugs for those enrolled in both programs. Has this affected the state s bargaining power with drug companies for the drugs they still buy? Is the state making its clawback payment to the federal government, to compensate for its lowered drug costs? Does your state consider the payment to be the fair amount? EXPERTS AND WEBSITES Analysts/Advocates Antos, Joseph, Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute, 202/ Benoff, Marc, Director and Practice Leader, IMS Health, 610/ Biles, Brian, Professor, Department of Health Policy, George Washington University, 202/ Carino, Tanisha, Director, Center on Evidence- Based Medicine, Avalere Health, 202/ Cauchi, Richard, Senior Policy Specialist, Health Program, National Conference of State Legislatures, 303/ Claxton, Gary, Vice President/Director, Health Care Marketplace Project, Kaiser Family Foundation, 202/ Evans, Richard, Senior Analyst, Bernstein Investment Research and Management, 212/ Feder, Judy, Professor and Dean, Public Policy Institute, Georgetown University, 202/ Findlay, Steve, Managing Editor, Consumer Reports Best Buy Drugs, Consumers Union, 202/ Firman, James, President and CEO, National Council on Aging, 202/ Frank, Richard, Margaret T. Morris Professor of Health Economics, Harvard Medical School, Harvard University, 617/ Fronstin, Paul, Senior Research Associate, Employee Benefit Research Institute, 202/ Gottlich, Vicki, Senior Policy Attorney, Center for Medicare Advocacy, 202/ x103 70

9 CHAPTER COVERING HEALTH ISSUES, 2006 Guterman, Stuart, Senior Program Director, Program on Medicare's Future, The Commonwealth Fund, 202/ Hash, Michael, Principal, Health Policy Alternatives, 202/ Hayes, Robert, President, Medicare Rights Center, 212/ x1 Hoadley, Jack, Research Professor, Health Policy Institute, Georgetown University, 202/ Hutchinson, Bernice, Director, Family Caregiver Support Project, National Association of State Units on Aging, 202/ Jennings, Chris, President, Jennings Policy Strategies, 202/ Kennelly, Barbara, President and CEO, National Committee to Preserve Social Security and Medicare, 202/ Lambrew, Jeanne, Associate Professor of Health Policy, George Washington University, 202/ Laszewski, Robert, President, Health Policy and Strategy Associates, 703/ Levitt, Larry, Vice President, Kaiser Family Foundation, 60/ Matheis, Cheryl, Director of Health Strategies, AARP, 202/ McManus, John, President, The McManus Group, 202/ Mendelson, Dan, Founder and President, Avalere Health, 202/ Moffit, Robert, Director, Center for Health Policy Studies, The Heritage Foundation, 202/ Moon, Marilyn, Vice President and Director of the Health Program, American Institutes for Research, 202/ Morrisey, Patrick, Partner, Sidley Austin Brown & Wood, 202/ Neuman, Tricia, Director, Medicare Policy Project, Kaiser Family Foundation, 202/ Pollack, Ron, Executive Director, Families USA, 202/ Raetzman, Susan, Associate Director, Public Policy Institute, AARP, 202/ Reinhard, Susan, Professor and Co-Director, Center for State Health Policy, Rutgers University, 732/ Roherty, Martha, Director of Health Policy, Policy and Government Affairs, National Association of State Medicaid Directors, 202/ Rosen, Dean, Principal, Mehlman, Vogel, Castagnetti, Inc., 202/ Rother, John, Director of Policy and Strategy, AARP, 202/ Rowland, Diane, Executive Vice President, Kaiser Family Foundation, 202/ Salisbury, Dallas, President and CEO, Employee Benefit Research Institute, 202/ Salo, Matt, Director, Health & Human Services Committee, National Governors Association, 202/ Scala, Steve, Senior Pharmaceuticals Analyst, SG Cowen & Co., 617/ Scala-Foley, Marisa, Associate Director, Access to Benefits Coalition, 202/ Shearer, Gail, Director, Health Policy Analysis, Consumers Union, 202/ Snedden, Tom, Director of the PACE Program, Pennsylvania Department of Aging, 717/ Stuart, Bruce, Professor and Executive Director of the Peter Lamy Center on Drug Therapy and Aging, University of Maryland, 410/ Vachon, R. Alexander, President, Hamilton PPB, 202/ Weil, Alan, Executive Director, National Academy for State Health Policy, 202/ Wilensky, Gail, Senior Fellow, Project Hope, 301/ Wilson, Joy Johnson, Federal Affairs Counsel, National Conference of State Legislatures, 202/ Government Bailey, Gary, Deputy Director, Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, 410/ Block, Abby, Director, Center for Beneficiary Choices, Centers for Medicare and Medicaid Services, 202/ Bradley, Tom, Chief Health Cost Estimates Unit, Congressional Budget Office, 202/ Disman, Beatrice, Regional Commissioner, New York Region, Social Security, 212/

10 COVERING HEALTH ISSUES, 2006 CHAPTER Fishman, Linda, Director, Office of Legislation, Centers for Medicare and Medicaid Services, 202/ King, Kathleen, Director, Healthcare, Government Accountability Office, 202/12-14 Steinwald, Bruce, Director, Health Care, Economic and Payment Issues, Government Accountability Office, 202/ Vogelsong, Jack, Statewide SCHIP Coordinator, Pennsylvania Department of Aging, 717/ Stakeholders Atkins, Lawrence, Executive Director, Public Policy and Reimbursement, Schering-Plough, 202/ Barrueta, Anthony, Senior Counsel for Governmental Relations, Kaiser Permanente, 10/ Blando, Phil, Vice President, Public Affairs, Pharmaceutical Care Management Association, 202/ Buto, Kathleen, Vice President for Health Policy, Government Affairs, Johnson & Johnson, 202/ Coster, John, Vice President of Policy and Programs, National Association of Chain Drug Stores, 703/ Fowler, Elizabeth, Vice President, Public Policy and External Affairs, Wellpoint, 202/ Fox, Alissa, Vice President, Legislative and Regulatory Policy, Blue Cross Blue Shield Association, 202/ Gallagher, Joan, Senior Vice President of Corporate Communications, Caremark Rx, Inc., Ignagni, Karen, President and CEO, America's Health Insurance Plans, 202/ Jaeger, Kathleen, President and CEO, Generic Pharmaceutical Association, 703/ Lindsay, Mark, Director, Public Communications and Strategy, UnitedHealth Group, 92/ Manasse, Jr., Henri, Executive Vice President and Chief Executive Officer, American Society of Health-System Pharmacists, 301/ Mihalski, Ed, Director, Federal Affairs, Eli Lilly, 202/ Smith, Ann, Senior Director of Public Affairs, Medco Health Solutions, Spatz, Ian, Vice President, Public Policy, Merck & Company, Inc., 202/ Websites AARP - Medicare RX AARP Drug Benefit Calculator Access to Benefits Coalition Aetna Alliance of Community Health Plans American Institutes for Research American Society of Health-System Pharmacists American Society on Aging - Medicare Avalere Health BenefitsCheckUpRx (NCOA) Blue Cross Blue Shield Association Center for Medicare Advocacy Center on Budget and Policy Priorities Centers for Medicare and Medicaid Services CMS Resources for Partners The Commonwealth Fund Congressional Budget Office Consumer Reports Best Buy Drugs Consumers Union 72

11 CHAPTER COVERING HEALTH ISSUES, 2006 Employee Benefit Research Institute Families USA- Medicare Drug Coverage Center Generic Pharmaceutical Association George Washington University Department of Health Policy Georgetown University Public Policy Institute Government Accountability Office Harvard Medical School Department of Health Care Policy Health Policy and Strategy Associates The Heritage Foundation Humana - Medicare IMS Health Jennings Policy Strategies Kaiser Family Foundation Kaiser Family Foundation - Medicare Rx Drug Benefit Kaiser Family Foundation Drug Benefit Calculator Kaiser Foundation Health Plan Inc. The Lewin Group, Drug Calculator Medco Health Solutions Medicare Rights Center Medicare Rx Connect Medicare Rx Education Network Medicare Rx Outreach & Education Project Medicare Today Medicare.gov - U.S. Government Site for People with Medicare Merck & Company, Inc. National Academy for State Health Policy National Association of Chain Drug Stores National Association of State Medicaid Directors National Association of State Units on Aging National Committee to Preserve Social Security and Medicare National Conference of State Legislatures, Health Program National Council on Aging National Governors Association Pennsylvania Department of Aging Pharmaceutical Care Management Association Pharmaceutical Research and Manufacturers of America (PhRMA) Project HOPE Robert Wood Johnson Foundation Rutgers Center for State Health Policy Social Security Administration 73

12 COVERING HEALTH ISSUES, 2006 CHAPTER U.S. Pharmacopeia UnitedHealth Group Wellpoint Health Networks, Inc. ENDNOTES a U.S. Department of Health and Human Services (2006). Over 38 Million People With Medicare Now Receiving Prescription Drug Coverage. Press release, June 14. (http://www.hhs.gov/news/press/2006pres/ html). Retrieved on July 12, b Kaiser Family Foundation (2006). Medicare: Prescription Drug Coverage Among Medicare Beneficiaries. Data Update, June. (http://www.kff.org/medicare/upload/743.pdf). Retrieved on July 7, c Hoadley, Jack (2006). Medicare s New Adventure: The Part D Drug Benefit. The Commonwealth Fund, March, p (http://www.cmwf.org/usr_doc/hoadley_medicaresnewadventure_911.pdf). Retrieved on June 30, d MedPAC (2006). Report to the Congress: Increasing the Value of Medicare. June, p (http://www.medpac.gov/publications/congressional_reports/jun06_ch07.pdf). Retrieved on June 30, e f g Hoadley, Jack et al. (2006). An In-Depth Examination of Formularies and Other Features of Medicare Drug Plans. Kaiser Family Foundation, April, p. 6. (http://www.kff.org/medicare/upload/7489.pdf). Retrieved on June 30, Kaiser Family Foundation (2006). Medicare: Prescription Drug Coverage Among Medicare Beneficiaries. Data Update, June. (http://www.kff.org/medicare/upload/743.pdf). Retrieved on July 7, Hewitt Associates (200). Prospects for Retiree Health Benefits as Medicare Prescription Drug Coverage Begins: Findings from the Kaiser/Hewitt 200 Survey on Retiree Health Benefits. Kaiser Family Foundation, December, p (http://www.kff.org/medicare/upload/7439.pdf). Retrieved on July 12, Dept. of Health and Human Services (2003). Report to the President: Prescription Drug Coverage, Spending, Utilization, and Prices. April, Executive Summary. (http://aspe.hhs.gov/health/reports/drugstudy/exec.htm). Retrieved on June 30, MedPAC (2003). Report to the Congress: Variation and Innovation in Medicare. June, p. 10. (http://www.medpac.gov/publications/congressional_reports/june03_ch9.pdf). Retrieved on June 30, Washington Drug Letter (2004). CBO Repeats Cost Estimate of Medicare Drug Law. Washington Business Information, July 26. (http://www.fdanews.com/wdl/36_29/fda/ html). Retrieved on July 7, Dept. of Health and Human Services (2006). Over 38 Million People With Medicare Now Receiving Prescription Drug Coverage. Press release, June 14. Kaiser Family Foundation (2006). Medicare: Prescription Drug Coverage Among Medicare Beneficiaries. Data Update, June. (http://www.kff.org/medicare/upload/743.pdf). Retrieved on July 7, Dept. of Health and Human Services (2006). Over 38 Million People With Medicare now Receiving Prescription Drug Coverage. Press release, June 14. (http://www.hhs.gov/news/press/2006pres/ html). Retrieved on July, McClellan, Mark (2006). Testimony before the House Committee on Ways and Means, June 14. (http://waysandmeans.house.gov/hearings.asp?formmode=view&id=4992). Retrieved on June 30, 2006; Kaiser Family Foundation (2006). Medicare: Prescription Drug Coverage Among Medicare Beneficiaries. Data Update, June. (http://www.kff.org/medicare/upload/743.pdf). Retrieved on July 7, Kaiser Family Foundation (2006). Medicare: The Medicare Prescription Drug Benefit. Fact Sheet, June. (http://www.kff.org/medicare/upload/ pdf). Retrieved on July 7, CBO (2004). A Detailed Description of CBO s Cost Estimate for the Medicare Prescription Drug Benefit. July. (http://www.cbo.gov/showdoc.cfm?index=668&sequence=0). Retrieved on July, Hoadley, Jack (200). The Effect of Formularies and Other Cost Management Tools on Access to Medications: An Analysis of the MMA and the Final Rule. March, p. 2,. (http://www.kff.org/medicare/7160.cfm). Retrieved on July 7, Hoadley, Jack (2006). Medicare s New Adventure: The Part D Drug Benefit. The Commonwealth Fund, March, p. 4, 11. (http://www.cmwf.org/usr_doc/hoadley_medicaresnewadventure_911.pdf). Retrieved on July 12, 2006; Adelberg, Mike (200). Medicare Part D Plan Training: Marketing Guidelines Overview. Presentation at the CMS Medicare Part D Marketing Guideline Training Conference, June 3, 200. (http://www.cms.hhs.gov/prescriptiondrugcovcontra/downloads/mktgtrng_ pdf). Retrieved on August 1,

13 CHAPTER COVERING HEALTH ISSUES, Kaiser Family Foundation (2006). Medicare: The Medicare Prescription Drug Benefit. Fact Sheet, June. (http://www.kff.org/medicare/upload/ pdf). Retrieved on July 7, 2006; CMS (2006). Find a Medicare Prescription Drug Plan. June. (http://www.medicare.gov/mpdpf/shared/static/resources.asp?dest=nav%7chome%7cresources%7cresources). Retrieved on July 7, 2006; In 2007, the benefit amounts will increase according to various indexing rules in the MMA. The 2007 deductible will be $26; the initial coverage limit will be $2,400, and the out-of-pocket limit will be $3,80 (equivalent to $41.2 under the standard benefit). In addition, some of the copayment amounts are indexed, so that copayments for catastrophic coverage are the greater of percent of the cost of the drug or $2.1 (generics) or $.3 (brands), and copayments for low-income beneficiaries can go as high as $.3. See: CMS (2006). Medicare Part D Benefit Parameters for Standard Benefit: Annual Adjustments for May. (http://www.cms.hhs.gov/medicareadvtgspecratestats/downloads/2007_part_d_parameter_update.pdf). Retrieved on June 30, Hoadley, Jack (2006). Medicare s New Adventure: The Part D Drug Benefit. The Commonwealth Fund, March, p., 13. (http://www.cmwf.org/usr_doc/hoadley_medicaresnewadventure_911.pdf). Retrieved on July 12, MedPAC (2006). Report to Congress: Increasing the Value of Medicare. June, 12. (http://www.medpac.gov/publications/congressional_reports/jun06_entirereport.pdf). Retrieved on July 24, Dept. of Health and Human Services (2006). Over 38 Million People With Medicare now Receiving Prescription Drug Coverage. Press release, June 14. (http://www.hhs.gov/news/press/2006pres/ html). Retrieved on July, Hoadley, Jack (2006). Medicare s New Adventure: The Part D Drug Benefit. The Commonwealth Fund, March, p.. (http://www.cmwf.org/usr_doc/hoadley_medicaresnewadventure_911.pdf). Retrieved on July 12, 2006; Dept. of Health and Human Services (2006). Prior HHS Poverty Guidelines and Federal Register References. (http://aspe.hhs.gov/poverty/figuresfed-reg.shtml). Retrieved on July 6, Revised health spending data have reduced the estimated amounts that states will pay by about 10 percent. See: Kaiser Commission on Medicaid and the Uninsured (2006). An Update on the Clawback: Revised Health Spending Data Change State Financial Obligations for the New Medicare Drug Benefit. March, p. 1. (http://www.kff.org/medicaid/upload/7481.pdf). Retrieved on June 30, Schneider, Andy (2004). The Clawback : State Financing of Medicare Drug Coverage. Kaiser Commission on Medicaid and the Uninsured, June, p. 1. (http://www.kff.org/medicaid/upload/the-clawback-state-financing-of-medicare-drug-coverage.pdf). Retrieved on June 30, Freking, Kevin (2006). States Considering Medicare Options after Rejection from Supreme Court. Boston Globe, June 19. (http://www.boston.com/news/local/new_hampshire/articles/2006/06/19/states_considering_medicare_options_after_rejection_fro m_supreme_court/). Retrieved on July 24, 2006; State and Local Government Law Prof Blog (2006). States Seek Redress on Medicare Clawback. March 10. (http://lawprofessors.typepad.com/statelocal/2006/03/states_seek_red.html). Retrieved on July 12, Schneider, Andy (2004). The Clawback : State Financing of Medicare Drug Coverage. Kaiser Commission on Medicaid and the Uninsured, June, p. 6. (http://www.kff.org/medicaid/upload/the-clawback-state-financing-of-medicare-drug-coverage.pdf). Retrieved on June 30, There are five regions for the territories. Of the national plans, only United Healthcare offers plans in all five territories. See Hoadley, Jack (2006). Medicare s New Adventure: The Part D Drug Benefit. The Commonwealth Fund, March, p. 6, 21. (http://www.cmwf.org/usr_doc/hoadley_medicaresnewadventure_911.pdf). Retrieved on July 12, CMS has requested that organizations offer only two plan options in 2007 unless one of the options covers drugs in the coverage gap as an enhanced benefit. See: CMS (2006). CMS Commitment to Continuous Quality Improvement Drives Requirements and Expectations for 2007 Prescription Drug Plans. Press release, April 3. (http://www.cms.hhs.gov/apps/media/press/release.asp?counter=1826). Retrieved on August 1, Beneficiaries in Alaska and Hawaii had 27 and 29 options, respectively. See Hoadley, Jack (2006). Medicare s New Adventure: The Part D Drug Benefit. The Commonwealth Fund, March, p. 7. (http://www.cmwf.org/usr_doc/hoadley_medicaresnewadventure_911.pdf). Retrieved on July 12, The data released by CMS as of this writing do not report on plans with low enrollment. In addition, they do not include enrollment numbers for the individual plan options offered by an organization. For CMS raw data see: 2 Pear, Robert (2006). In Scramble for New Medicare Business, a Few Insurers Grab the Most. The New York Times, April 29. (http://www.nytimes.com/2006/04/29/washington/29medicare.html?ex= &en=709a91c9bd6a061&ei=088&partner=r ssnyt&emc=rss). Retrieved on July 24, For CMS raw data see: 7

14 COVERING HEALTH ISSUES, 2006 CHAPTER 26 CMS (200). Top PDP Plans by Number Enrolled (v ) [Excel, zip, KB]. November. (http://www.cms.hhs.gov/prescriptiondrugcovgenin/02_enrollmentdata.asp). Retrieved on July 24, 2006; MedPAC (2006). Report to Congress: Increasing the Value of Medicare. June, 17. (http://www.medpac.gov/publications/congressional_reports/jun06_entirereport.pdf). Retrieved on July 24, These qualifying plans cannot offer enhanced benefits. If they do, beneficiaries must pay for the value of the enhanced benefit even if the premium is lower than the benchmark. See: MedPAC (2006). Report to Congress: Increasing the Value of Medicare. June, 12. (http://www.medpac.gov/publications/congressional_reports/jun06_entirereport.pdf). Retrieved on July 24, Note that this is not specifically stated in the source; however, it is the implication since beneficiaries are always required to pay extra for enhanced benefits. 28 MedPAC (2006). Report to Congress: Increasing the Value of Medicare. June, 12. CMS announced on June 8, 2006, that it would not use enrollment weights to calculate average premiums for the 2007 benchmarks. This will lead to higher benchmarks and mean that more plans will be available at a zero premium for beneficiaries who qualify for the low-income subsidy. See: CMS (2006). Medicare Demonstration to Transition Enrollment of Low Income Subsidy Beneficiaries. Letter to Part D Plan Sponsors and MA Organizations, June 8. (http://www.cms.hhs.gov/states/downloads/transitiondemoforlis.pdf). Retrieved on July 24, Hoadley, Jack (2006). Medicare s New Adventure: The Part D Drug Benefit. The Commonwealth Fund Commission on a High Performance Health System, March 2006, p (http://www.cmwf.org/usr_doc/hoadley_medicaresnewadventure_911.pdf). Retrieved on July 12, Also, data on which plans are available without a premium for subsidy-eligible beneficiaries can be found at Data on benchmarks can be found at 30 MedPAC (2006). "Report to the Congress: Increasing the Value of Medicare." June, p. 1, 16, 19. (http://www.medpac.gov/publications/congressional_reports/jun06_ch07.pdf) and Hoadley, Jack et al. (2006). "An In-Depth Examination of Formularies and Other Features of Medicare Drug Plans." Kaiser Family Foundation, April, p (http://www.kff.org/medicare/upload/7489.pdf). 31 Figures cited are for plans with a three-tier structure (with or without a specialty tier) and for those not offering enhanced benefits. 32 Hoadley, Jack et al. (2006). An In-Depth Examination of Formularies and Other Features of Medicare Drug Plans. Kaiser Family Foundation, April, p (http://www.kff.org/medicare/upload/7489.pdf). Retrieved on July 28, SSA 1860D-11(e)(2)(D)(i) (2006). Compilation of the Social Security Laws. Social Security Online, June. (http://www.ssa.gov/op_home/ssact/title18/1860d11.htm). Retrieved on July 28, Hoadley, Jack (200). The Effect of Formularies and Other Cost Management Tools on Access to Medications: An Analysis of the MMA and the Final Rule. Kaiser Family Foundation, March, p (http://www.kff.org/medicare/upload/the-effect-of- Formularies-and-Other-Cost-Management-Tools-on-Access-to-Medications-An-Analysis-of-the-MMA-and-the-Final-Rule-Issue- Brief.pdf). Retrieved on June 30, Hoadley, Jack et al. (2006). An In-Depth Examination of Formularies and Other Features of Medicare Drug Plans. Kaiser Family Foundation, April, p. 1, 7. (http://www.kff.org/medicare/upload/7489.pdf). Retrieved on June 30, 2006; Hoadley, Jack (2006). Medicare s New Adventure: The Part D Drug Benefit. The Commonwealth Fund Commission on a High Performance Health System, March 2006, p (http://www.cmwf.org/usr_doc/hoadley_medicaresnewadventure_911.pdf). Retrieved on July 12, Hoadley, Jack (2006). Medicare s New Adventure: The Part D Drug Benefit. The Commonwealth Fund Commission on a High Performance Health System, March 2006, p. 10. (http://www.cmwf.org/usr_doc/hoadley_medicaresnewadventure_911.pdf). Retrieved on July 12, Hoadley, Jack et al. (2006). An In-Depth Examination of Formularies and Other Features of Medicare Drug Plans. Kaiser Family Foundation, April, p. 6. (http://www.kff.org/medicare/upload/7489.pdf). Retrieved on June 30, Hoadley, Jack (200). The Effect of Formularies and Other Cost Management Tools on Access to Medications: An Analysis of the MMA and the Final Rule. Kaiser Family Foundation, March, p. 3. (http://www.kff.org/medicare/upload/the-effect-of-formularies-and-other- Cost-Management-Tools-on-Access-to-Medications-An-Analysis-of-the-MMA-and-the-Final-Rule-Issue-Brief.pdf).Retrieved June 30, Hoadley, Jack et al. (2006). An In-Depth Examination of Formularies and Other Features of Medicare Drug Plans. Kaiser Family Foundation, April, p. ii. (http://www.kff.org/medicare/upload/7489.pdf). Retrieved on June 30, McClellan, Mark (2006). Testimony before the House Committee on Ways and Means. June 14. (http://waysandmeans.house.gov/hearings.asp?formmode=view&id=4992). Retrieved on July 3, Similarly, beneficiaries receiving drug coverage through the Veterans Administration or Tricare have been able to maintain their current coverage. 76

15 CHAPTER COVERING HEALTH ISSUES, Hoadley, Jack (2006). Medicare s New Adventure: The Part D Drug Benefit. The Commonwealth Fund Commission on a High Performance Health System, March 2006, p. 11. (http://www.cmwf.org/usr_doc/hoadley_medicaresnewadventure_911.pdf). Retrieved on July 12, ; Hinden, Stan (200). Medicare s Part D as Plan B. Washington Post, November 13. (http://www.washingtonpost.com/wp-dyn/content/article/200/11/12/ar html). Retrieved on August 1, Kaiser Family Foundation (2006). Medicare: Prescription Drug Coverage Among Medicare Beneficiaries. Data Update, June. (http://www.kff.org/medicare/upload/743.pdf). Retrieved on July 7, Hoadley, Jack (2006). Medicare s New Adventure: The Part D Drug Benefit. The Commonwealth Fund Commission on a High Performance Health System, March 2006, p. 12. (http://www.cmwf.org/usr_doc/hoadley_medicaresnewadventure_911.pdf). Retrieved on July 12, I deleted this number because I could not find it anywhere only as an uncited footnote in Medicare s Adventure. 44 Kaiser Family Foundation (2006). Low-Income Assistance Under the Medicare Drug Benefit. Medicare Fact Sheet, May. (http://www.kff.org/medicare/upload/7327.pdf). Retrieved on July 31, CMS (200). Ensuring an Effective Transition of Dual Eligibles from Medicaid to Medicare Part D. Press release, December 1. (http://www.cms.hhs.gov/apps/media/press/release.asp?counter=1736). Retrieved on July 31, MedPAC (2006). Report to the Congress: Increasing the Value of Medicare. June 2006, p 146 (http://www.medpac.gov/publications/congressional_reports/jun06_ch07.pdf). Retrieved on June 30, Hoadley, Jack (2006). Medicare s New Adventure: The Part D Drug Benefit. The Commonwealth Fund Commission on a High Performance Health System, March 2006, p. 12. (http://www.cmwf.org/usr_doc/hoadley_medicaresnewadventure_911.pdf). Retrieved on July 12, CMS estimates that about 1.2 million beneficiaries are new enrollees in Medicare. It is likely that some beneficiaries also dropped their MA enrollment because they could get drug coverage from a stand-alone PDP. See: McClellan, Mark (2006). Testimony before the House Committee on Ways and Means. June 14. (http://waysandmeans.house.gov/hearings.asp?formmode=view&id=4992). Retrieved on July 3, CMS (2006). Do You Have a Medigap Policy with Prescription Drug Coverage? May. (http://www.medicare.gov/publications/pubs/pdf/11113.pdf). Retrieved on July 31, Williams, Claudia, et al (200). State Pharmacy Assistance Programs at a Crossroads: How Will They Respond to the Medicare Drug Benefit? AcademyHealth, July 200, p. 1, 8. (http://www.hcfo.net/pdf/brief070.pdf). Retrieved on July 3, In some states, beneficiaries have the option of continuing to receive creditable coverage from an SPAP. A forthcoming paper will highlight final state decisions in this area. 0 National Conference of State Legislatures (2006). State Pharmaceutical Assistance Programs in 2006: Helping to Make Medicare Part D Easier and More Affordable. July. (http://www.ncsl.org/programs/health/spapcoordination.htm). Retrieved on July 31, Individuals who first become eligible for Medicare after December 31, 200, have until three months after their date of eligibility to enroll before they are subject to a late enrollment penalty. Also, CMS has indicated that beneficiaries eligible for the lowincome subsidy can enroll without penalty during See: Center for Medicare Advocacy (2006). Coping with the Medicare Part D Enrollment Deadline. CMA Weekly Alert, May 11. (http://www.medicareadvocacy.org/partd_06_0.11.enrollmentdeadline.htm). Retrieved on July 31, 2006; AARP (2006). What You Need to Know: The New Medicare Prescription Drug Coverage. (http://www.aarp.org/health/medicare/drug_coverage/medicarepdf7.html). Retrieved on July 31, MedPAC (2006). Report to the Congress: Increasing the Value of Medicare. June 2006, p 186. (http://www.medpac.gov/publications/congressional_reports/jun06_ch08.pdf). Retrieved July 3, 2006; CalMedicare.org (200). Medicare Prescription Drug Coverage Overview. December. (http://www.calmedicare.org/drugs/mpdc/overview.html). Retrieved on July 31, MedPAC (2006). Report to the Congress: Increasing the Value of Medicare. June 2006, p 183, 18, 189, 192. (http://www.medpac.gov/publications/congressional_reports/jun06_ch08.pdf). Retrieved July 3, McClellan, Mark (2006). Testimony before the House Committee on Ways and Means. June 14. (http://waysandmeans.house.gov/hearings.asp?formmode=view&id=4992). Retrieved on July 3, McClellan, Mark (2006). Testimony before the House Committee on Ways and Means. June 14. (http://waysandmeans.house.gov/hearings.asp?formmode=view&id=4992). Retrieved on July 3, These numbers do not include individuals estimated to be eligible for the low-income subsidy, but who have other sources of creditable coverage. 6 Kaiser Family Foundation (2006). Medicare: Prescription Drug Coverage Among Medicare Beneficiaries. Data Update, June. (http://www.kff.org/medicare/upload/743.pdf). Retrieved on July 7,

16 COVERING HEALTH ISSUES, 2006 CHAPTER 7 Medicare Rx Education Network (2006). Survey Assesses New Medicare Drug Program. Press release, April 3. (http://www.medicarerxeducation.org/survey/survey_pr_04_03_06.htm). Retrieved on July 12, Washington Drug Letter (2004). CBO Repeats Cost Estimate of Medicare Drug Law. Washington Business Information, July 26. (http://www.fdanews.com/wdl/36_29/fda/ html). Retrieved on July 7, 2006; Holtz-Eakin, Douglas (2004). Comparison of CBO and Administration Estimates of the Effect of H.R. 1 on Direct Spending, Letter to Jim Nussle. February 2. (http://www.cbo.gov/ftpdocs/49xx/doc499/ombdrugltr.pdf) Retrieved on July 3, Various factors account for the difference between the two estimates. 9 Ceci Connolly and Mike Allen, Washington Post, Medicare Drug Benefit May Cost $1.2 Trillion, p. A1. (www.washingtonpost.com/wp-dyn/articles/a feb8.html) 60 McClellan, Mark (2006). Testimony before the House Committee on Ways and Means. June 14. (http://waysandmeans.house.gov/hearings.asp?formmode=view&id=4992). Retrieved on July 3, 2006; CMS (2006). Drug Benefit Enrollment Up, Costs Down from Competition and Beneficiary Choices: Lower Costs Support Low Income Beneficiary Options and Strong Competition. Press release, June 8. (http://www.cms.hhs.gov/apps/media/press/release.asp?counter=1876). Retrieved on July 12, Congresswoman Nancy Johnson (2006). AARP Endorses Johnson Bill Waiving Medicare Late Fee: Bipartisan Bill Introduced in U.S. House with 26 Cosponsors. Press release, May 18. (http://www.house.gov/nancyjohnson/medicarelatefeebill.pdf). Retrieved on July 31, 2006; Senator Chuck Grassley (2006). Senators Announce Bipartisan Bill to Allow Penalty-Free Enrollment in New Prescription Drug Plan. Press release, May 16. (http://grassley.senate.gov/index.cfm?fuseaction=pressreleases.detail&pressrelease_id=063&month=&year=2006). Retrieved on July 31, Committee on Finance (2006). Senators Introduce Bills to Simplify Medicare Drug Benefit, Improve Pharmacy Access and Information. Press release, April 27. (http://www.senate.gov/~finance/press/bpress/200press/prb pdf). Retrieved on July 31, Novelli, William (2006). AARP s Policy Priorities for Annual Pre-State of the Union Press Briefing, January 27. (http://www.aarp.org/issues/2006_presotu.html.). Retrieved on July 31, 2006); Ron Pollack (2006). Testimony before the House Committee on Ways and Means. Families USA, June 14. (http://www.familiesusa.org/assets/docs/families-w-m-testimony- 2006June14FINAL.doc). Retrieved on July 31, Committee on Finance (2006). Senators Introduce Bills to Simplify Medicare Drug Benefit, Improve Pharmacy Access and Information. Press release, April 27. (http://www.senate.gov/~finance/press/bpress/200press/prb pdf). Retrieved on July 31, A largely symbolic amendment sponsored by Sen. Olympia Snowe to the fiscal year 2007 budget resolution to provide the Secretary with negotiating authority passed with 4 votes in the Senate on March 16, See: Senator Olympia J. Snowe (2006). Snowe-Wyden Measure to Allow HHS Secretary to Negotiate for Prescription Drugs Passes Major Hurdle. Press release, March 16. (http://snowe.senate.gov/public/index.cfm?fuseaction=pressroom.pressreleases&contentrecord_id=c6de e4-b92e-caaa14864be&Region_id=&Issue_id). Retrieved on July 31, Democratic Policy Committee (2006). The Medicare Drug Benefit s Donut Hole Threatens Financial and Health Security of Vulnerable Seniors. July. (http://democrats.senate.gov/dpc/dpc-new.cfm?doc_name=fs ). Retrieved on July 31, Cannon, Michael (2004). Repeal Medicare Drug Entitlement. Cato Institute, May. (http://www.cato.org/pub_display.php?pub_id=2662). Retrieved on July 31, Moffitt, Robert E. (2006). Medicare in Issues 2006: The Candidate s Briefing Book. Heritage Foundation. (http://www.heritage.org/research/features/issues/pdfs/medicare.pdf). Retrieved on July 31, Hayes, Robert (2006). Implementation of Medicare Part D Prescription Drug Benefit. Testimony before the U.S. House Committee on Ways and Means. June 14. (http://www.medicarerights.org/testimony21.html). Retrieved on August 1, Burgess, Michael (2006). Try Standardized Health Coverage. Global Action on Aging, May 14. (http://www.globalaging.org/health/us/2006/tryit.htm) Retrieved August 2, AARP (2006). Key Medicare Dates. (http://www.aarp.org/health/medicare/drug_coverage/key_medicare_dates_that_could_ affect_you.html). Retrieved on July 12, Arnold, Christine and Douglas Simpson (2006). 11th Annual Wall Street Comes to Washington Conference. Testimony before the 11th Annual Wall Street Comes to Washington Conference. June 21. (http://www.hschange.org/content/84/). Plans are protected by risk-sharing provisions that are loosened starting in In 2006 and 2007, plans are only at full risk for spending within 2. percent of a target amount. The government shares in the gains or losses outside that corridor. As of 2008, the full-risk corridor is set at percent above or below the target amount. 78

The Medicare Drug Benefit (Part D)

The Medicare Drug Benefit (Part D) THE BASICS The Medicare Drug Benefit (Part D) The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit for Medicare

More information

State Pharmacy Assistance Programs vs. Medicare Prescription Drug Plans:

State Pharmacy Assistance Programs vs. Medicare Prescription Drug Plans: State Pharmacy Assistance Programs vs. Medicare Prescription Drug Plans: How Do They Contain Rising Costs? By Sarah Goodell, Jack Hoadley, Ellen O Brien, and Claudia Williams* October 2005 This policy

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

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

Basic Reimbursement - Medicare Part D Specifics

Basic Reimbursement - Medicare Part D Specifics Basic Reimbursement - Medicare Part D Specifics 60889-R8-V1 (c) 2012 Amgen Inc. All rights reserved 2 This information is provided for your background education and is not intended to serve as guidance

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

Medicare Part D Open Enrollment for 2012: Increasing Plan Complexity Highlights Need for Careful Evaluation

Medicare Part D Open Enrollment for 2012: Increasing Plan Complexity Highlights Need for Careful Evaluation Fact Sheet Medicare Part D Open Enrollment for 202: Increasing Plan Complexity Highlights Need for Careful Evaluation Leigh Purvis, MPA, and N. Lee Rucker, MSPH AARP Public Policy Institute Medicare beneficiaries

More information

Medicare Part D Prescription Drug Coverage

Medicare Part D Prescription Drug Coverage Medicare Part D Prescription Drug Coverage Part 3 Version 6.0 September 25, 2012 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and

More information

Significance of the Coverage Gap Under Medicare Part D

Significance of the Coverage Gap Under Medicare Part D June 8, 2006 Significance of the Coverage Gap Under Medicare Part D The gap in coverage between spending levels of $2,250 and $3,600 in true out-of-pocket spending is one of the most discussed aspects

More information

Part D payment system

Part D payment system Part D payment system paymentbasics Revised: October 204 This document does not reflect proposed legislation or regulatory actions. 425 I Street, NW Suite 70 Washington, DC 2000 ph: 202-220-3700 fax: 202-220-3759

More information

PRIVATE MEDICARE DRUG PLANS: HIGH EXPENSES AND LOW REBATES INCREASE THE COSTS OF MEDICARE DRUG COVERAGE

PRIVATE MEDICARE DRUG PLANS: HIGH EXPENSES AND LOW REBATES INCREASE THE COSTS OF MEDICARE DRUG COVERAGE UNITED STATES HOUSE OF REPRESENTATIVES COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM MAJORITY STAFF OCTOBER 2007 PRIVATE MEDICARE DRUG PLANS: HIGH EXPENSES AND LOW REBATES INCREASE THE COSTS OF MEDICARE

More information

THE A,B,C,D S OF MEDICARE

THE A,B,C,D S OF MEDICARE THE A,B,C,D S OF MEDICARE An important resource for understanding your healthcare in retirement What you need to know for 2014 How Medicare works What Medicare covers How much Medicare costs INTRODUCTION

More information

MEDICARE PART D PRESCRIPTION DRUG COVERAGE 2016

MEDICARE PART D PRESCRIPTION DRUG COVERAGE 2016 PO Box 350 Willimantic, Connecticut 06226 (860)456-7790 (800)262-4414 1025 Connecticut Ave, NW Suite 709 Washington, DC 20036 (202)293-5760 MEDICARE PART D PRESCRIPTION DRUG COVERAGE 2016 Se habla español

More information

Waste and inefficiency in the Bush Medicare prescription drug plan: Allowing Medicare to negotiate lower prices could save $30 billion a year

Waste and inefficiency in the Bush Medicare prescription drug plan: Allowing Medicare to negotiate lower prices could save $30 billion a year Waste and inefficiency in the Bush Medicare prescription drug plan: Allowing Medicare to negotiate lower prices could save $30 billion a year By Roger Hickey & Jeff Cruz In cooperation with Dean Baker,

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

Medicare Part D Open Enrollment for 2014: Popular Plans Continue to Evolve

Medicare Part D Open Enrollment for 2014: Popular Plans Continue to Evolve Fact Sheet Medicare Part D Open Enrollment for 2014: Popular Plans Continue to Evolve By Leigh Purvis AARP Public Policy Institute AARP Public Policy Institute Premiums for many popular stand-alone 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

BENEFITS OF PROPOSED DEMOCRATIC MEDICARE DRUG PROGRAM REFORMS IN NEW YORK S 14TH CONGRESSIONAL DISTRICT

BENEFITS OF PROPOSED DEMOCRATIC MEDICARE DRUG PROGRAM REFORMS IN NEW YORK S 14TH CONGRESSIONAL DISTRICT UNITED STATES HOUSE OF REPRESENTATIVES COMMITTEE ON GOVERNMENT REFORM MINORITY STAFF SPECIAL INVESTIGATIONS DIVISION OCTOBER 2006 BENEFITS OF PROPOSED DEMOCRATIC MEDICARE DRUG PROGRAM REFORMS IN NEW YORK

More information

Status report on Part D

Status report on Part D C h a p t e r14 Status report on Part D C H A P T E R 14 Status report on Part D Chapter summary In this chapter Each year the Commission provides a status report on the Medicare prescription drug benefit

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

What s New with Medicare in 2015

What s New with Medicare in 2015 November 2014 What s New with Medicare in 2015 Audio Portion: 1-866-740-1260 Web Portion: www.readytalk.com Code: 4796976 1 What we ll cover today 2015 Medicare cost sharing Part D in 2015 What s the big

More information

CALIFORNIA. By the numbers: Medicare Part D. Medicare Part D is working well for beneficiaries and taxpayers And it s getting better.

CALIFORNIA. By the numbers: Medicare Part D. Medicare Part D is working well for beneficiaries and taxpayers And it s getting better. CALIFORNIA By the numbers: Medicare Part D 3,687,561 Medicare Part D beneficiaries in California 1,638,344 278 Beneficiaries enrolled in Medicare Advantage prescription drug plans in 2015 1 Number of Medicare

More information

GAO MEDICARE PART D. Prescription Drug Plan Sponsor Call Center Responses Were Prompt, but Not Consistently Accurate and Complete

GAO MEDICARE PART D. Prescription Drug Plan Sponsor Call Center Responses Were Prompt, but Not Consistently Accurate and Complete GAO United States Government Accountability Office Report to Congressional Requesters June 2006 MEDICARE PART D Prescription Drug Plan Sponsor Call Center Responses Were Prompt, but Not Consistently Accurate

More information

Medicare Part D Prescription Drug Coverage

Medicare Part D Prescription Drug Coverage Medicare Part D Prescription Drug Coverage Part 3 Version 7.1 August 1, 2013 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and international

More information

Medicare Part D Prescription Drug Coverage

Medicare Part D Prescription Drug Coverage Medicare Part D Prescription Drug Coverage Part 3 Version 9.0 June 22, 2015 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and international

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

Assessing Medicare Part D Ten Years After Enactment. Statement of Jack Hoadley, Ph.D.

Assessing Medicare Part D Ten Years After Enactment. Statement of Jack Hoadley, Ph.D. Assessing Medicare Part D Ten Years After Enactment Statement of Jack Hoadley, Ph.D. Research Professor Health Policy Institute, Georgetown University Before the Senate Special Committee on Aging May 22,

More information

Summary of Benefits. (PDP), Blue MedicareRx Plus SM. (PDP) and Blue MedicareRx Premier SM

Summary of Benefits. (PDP), Blue MedicareRx Plus SM. (PDP) and Blue MedicareRx Premier SM Summary of Benefits for SM, Plus SM and Premier SM Available in Maine and New Hampshire A -approved Part D sponsor. Anthem Insurance Companies, Inc. (AICI) is the legal entity who has contracted with the

More information

THE MEDICARE PART D LOW-INCOME SUBSIDY PROGRAM Experience to Date and Policy Issues for Consideration

THE MEDICARE PART D LOW-INCOME SUBSIDY PROGRAM Experience to Date and Policy Issues for Consideration THE MEDICARE DRUG BENEFIT THE MEDICARE PART D LOW-INCOME SUBSIDY PROGRAM Experience to Date and Policy Issues for Consideration Prepared By Laura Summer Georgetown University Jack Hoadley Georgetown University

More information

Issue Brief. Medicare Part D: Simplifying the Program and Improving the Value of Information for Beneficiaries

Issue Brief. Medicare Part D: Simplifying the Program and Improving the Value of Information for Beneficiaries MAY 2008 Issue Brief Medicare Part D: Simplifying the Program and Improving the Value of Information for Beneficiaries JACK HOADLEY HEALTH POLICY INSTITUTE, GEORGETOWN UNIVERSITY For more information about

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

November 4, 2010. Honorable Paul Ryan Ranking Member Committee on the Budget U.S. House of Representatives Washington, DC 20515.

November 4, 2010. Honorable Paul Ryan Ranking Member Committee on the Budget U.S. House of Representatives Washington, DC 20515. CONGRESSIONAL BUDGET OFFICE U.S. Congress Washington, DC 20515 Douglas W. Elmendorf, Director November 4, 2010 Honorable Paul Ryan Ranking Member Committee on the Budget U.S. House of Representatives Washington,

More information

Medicare Part D. MMA establishes a standard Part D drug benefit, which consists of four components or phases.

Medicare Part D. MMA establishes a standard Part D drug benefit, which consists of four components or phases. Medicare Part D The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) added voluntary prescription drug coverage to Medicare, the federal health insurance program for seniors

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

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: A First Look at Plan Offerings in 2016

Medicare Part D: A First Look at Plan Offerings in 2016 Medicare Part D: A First Look at Plan Offerings in 2016 During the Medicare open enrollment period, which runs from October 15 to December 7 each year, beneficiaries have the opportunity to enroll in a

More information

An Important Message on Medicare Prescription Drug Plans Coming to the U.S. Virgin Islands in 2006

An Important Message on Medicare Prescription Drug Plans Coming to the U.S. Virgin Islands in 2006 An Important Message on Medicare Prescription Drug Plans Coming to the U.S. Virgin Islands in 2006 What are Medicare Prescription Drug Plans? Beginning January 1, 2006, Medicare Prescription Drug Plans

More information

The Changing Face of Employer-Sponsored Retiree Prescription Benefits. Long-term strategies for a rapidly evolving market

The Changing Face of Employer-Sponsored Retiree Prescription Benefits. Long-term strategies for a rapidly evolving market The Changing Face of Employer-Sponsored Retiree Prescription Benefits Long-term strategies for a rapidly evolving market February 2015 Executive Summary The past decade has seen fundamental changes in

More information

The Role of Beneficiary-Centered Assignment for

The Role of Beneficiary-Centered Assignment for Jack Hoadley Laura Summer Jennifer Thompson Georgetown University Elizabeth Hargrave Katie Merrell NORC at the The Role of Beneficiary-Centered Assignment for Medicare Part D University of Chicago A study

More information

Medicare Mental Health Coverage

Medicare Mental Health Coverage Medicare Mental Health Coverage ISSUE BRIEF VOL. 4, NO. 3, 2003 This ongoing series provides information on how to develop programs to educate Medicare beneficiaries and their families. Additional information

More information

Medicare Advantage 2014 Spotlight: Plan Availability And Premiums

Medicare Advantage 2014 Spotlight: Plan Availability And Premiums December 2013 Issue Brief Medicare Advantage 2014 Spotlight: Plan Availability And Premiums Marsha Gold, Gretchen Jacobson, Anthony Damico, and Tricia Neuman Under the current Medicare program, beneficiaries

More information

Medicare Part D Prescription Drug Plans: The Marketplace in 2013 and Key Trends, 2006-2013

Medicare Part D Prescription Drug Plans: The Marketplace in 2013 and Key Trends, 2006-2013 December 2013 Issue Brief Medicare Part D Prescription Drug Plans: The Marketplace in 2013 and Key Trends, 2006-2013 Jack Hoadley and Laura Summer, Georgetown University Elizabeth Hargrave, NORC at the

More information

Medicare Part D Amounts Will Increase in 2016

Medicare Part D Amounts Will Increase in 2016 April 9, 2015 Medicare Part D Amounts Will Increase in 2016 The Medicare Modernization Act (MMA) requires the Centers for Medicare & Medicaid Services (CMS) to announce each year the Medicare Part D standard

More information

Medicare Coverage Gap Discount Program to Provide Economic Relief to Medicare Part D Enrollees by Closing the Donut Hole

Medicare Coverage Gap Discount Program to Provide Economic Relief to Medicare Part D Enrollees by Closing the Donut Hole Medicare Coverage Gap Discount Program to Provide Economic Relief to Medicare Part D Enrollees by Closing the Donut Hole By Cynthia S. Marietta, J.D., LL.M. (Health Law) csmarie@central.uh.edu Introduction

More information

1Will my Medicare Part D plan be

1Will my Medicare Part D plan be 2014 Medicare Prescription Drug Annual Open Enrollment Questions & Answers The Annual Open Enrollment for Medicare prescription drug (Part D) is October 15, 2013 December 7, 2013. Certain people with Medicare

More information

Medicare doesn t have to be complicated. This guide is provided to help you better understand Medicare and how a Medicare Advantage plan may offer

Medicare doesn t have to be complicated. This guide is provided to help you better understand Medicare and how a Medicare Advantage plan may offer clarity YOUR GUIDE TO MEDicare AdvantaGE Medicare doesn t have to be complicated. This guide is provided to help you better understand Medicare and how a Medicare Advantage plan may offer the coverage

More information

Issue Brief: Medicare Drug Discount Card. May 2004

Issue Brief: Medicare Drug Discount Card. May 2004 Issue Brief: Medicare Drug Discount Card May 2004 Oregon Health Policy and Research If you would like additional copies of this report, or if you need this material in an alternate format, please call

More information

Insurance Trust for Delta Retirees 2013 Prescription Drug Plan (PDP)

Insurance Trust for Delta Retirees 2013 Prescription Drug Plan (PDP) Your Plan Explained Insurance Trust for Delta Retirees 2013 Prescription Drug Plan (PDP) UnitedHealthcare MedicareRx for Groups (PDP) Y0066_PDP_896487_000 What is Medicare Part D? Medicare Part D is a

More information

Annual Notice of Changes for 2015

Annual Notice of Changes for 2015 Express Scripts Medicare (PDP) for Consolidated Associations of Railroad Employees (CARE) Annual Notice of Changes for 2015 You are currently enrolled as a member of Express Scripts Medicare (PDP). The

More information

Annual Notice of Changes for 2015

Annual Notice of Changes for 2015 BlueRx (PDP) Local Government Health Insurance Plan (LGHIP) Prescription Drug Coverage for Medicare Members offered by Blue Cross and Blue Shield of Alabama Annual Notice of Changes for 2015 You are currently

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

Essentials Rx 15 (HMO) Plan offered by PacificSource Medicare. Annual Notice of Changes for 2014

Essentials Rx 15 (HMO) Plan offered by PacificSource Medicare. Annual Notice of Changes for 2014 Essentials Rx 15 (HMO) Plan offered by PacificSource Medicare Annual Notice of Changes for 2014 You are currently enrolled as a member of Essentials Rx 15 (HMO) Plan. Next year, there will be some changes

More information

Improving Medicare Part D. Shinobu Suzuki and Rachel Schmidt March 3, 2016

Improving Medicare Part D. Shinobu Suzuki and Rachel Schmidt March 3, 2016 Improving Medicare Part D Shinobu Suzuki and Rachel Schmidt March 3, 2016 Future challenges require changes to Part D s original structure Designed to encourage broad participation by plans and beneficiaries

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

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

Choosing a Medicare Part D Plan: Are Medicare Beneficiaries Choosing Low-Cost Plans?

Choosing a Medicare Part D Plan: Are Medicare Beneficiaries Choosing Low-Cost Plans? THE MEDICARE DRUG BENEFIT Choosing a Medicare Part D Plan: Are Medicare Beneficiaries Choosing Low-Cost Plans? Prepared By: Jonathan Gruber MIT For: The Henry J. Kaiser Family Foundation March 2009 This

More information

On the next page are answers to some important questions that can help you during the Annual Open Enrollment.

On the next page are answers to some important questions that can help you during the Annual Open Enrollment. QA 2015 Medicare Prescription Drug Annual Open Enrollment The Annual Open Enrollment for Medicare prescription drug coverage (Part D) is October 15, 2014 December 7, 2014. Certain people with Medicare

More information

New Medicare Prescription Drug Coverage: An Overview for Pharmacies in Oregon

New Medicare Prescription Drug Coverage: An Overview for Pharmacies in Oregon New Medicare Prescription Drug Coverage: An Overview for Pharmacies in Oregon Note: All material in this manual is intended for people with Medicare who live in Oregon. It is not indicative of what classes

More information

Guide to Choosing a Medicare Prescription Drug Plan in Connecticut

Guide to Choosing a Medicare Prescription Drug Plan in Connecticut Medicare Prescription Drug - Choosing the Plan that s Right for You! Guide to Choosing a Medicare Prescription Drug Plan in Connecticut Medicare Prescription Drug, also called Part D or Medicare Rx, is

More information

Prescription Drug Coverage. Presented by: Medigap Part D & Prescription Drug Helpline Board on Aging & Long Term Care A Wisconsin SHIP

Prescription Drug Coverage. Presented by: Medigap Part D & Prescription Drug Helpline Board on Aging & Long Term Care A Wisconsin SHIP Prescription Drug Coverage Presented by: Medigap Part D & Prescription Drug Helpline Board on Aging & Long Term Care A Wisconsin SHIP Medicare Part A Prescription Drug Coverage Part A generally pays for

More information

Medicare. Prescription Drug Plan Guide. Simple steps to help you choose the right prescription drug coverage

Medicare. Prescription Drug Plan Guide. Simple steps to help you choose the right prescription drug coverage Medicare Prescription Drug Plan Guide An educational resource developed by Simple steps to help you choose the right prescription drug coverage and published by Rite Aid Corporation. Rite Aid pharmacists

More information

Medicare Prescription Drug Benefit

Medicare Prescription Drug Benefit Medicare Prescription Drug Benefit Karen Tritz Overview Overview of new Medicare Prescription Drug Benefit The Timing and Process Implications for Working People with Disabilities Overview of Medicare

More information

Annual Notice of Changes for 2015

Annual Notice of Changes for 2015 Prescription Blue SM PDP, Option B, offered by Blue Cross Blue Shield of Michigan Annual Notice of Changes for 2015 You are currently enrolled as a member of Prescription Blue Option B. Next year, there

More information

Faculty Alabama State Health Insurance Assistance Program and Medicare 101

Faculty Alabama State Health Insurance Assistance Program and Medicare 101 Faculty Alabama State Health Insurance Assistance Program and Medicare 101 Susan Segrest Community Based Services Division Chief Central Alabama Aging Consortium A Training on Basic Medicare and the Alabama

More information

The Medicare Prescription Drug Proposals and Health Insurance Risk

The Medicare Prescription Drug Proposals and Health Insurance Risk NHPF Issue Brief No.793 / September 4, 2003 The Medicare Prescription Drug Proposals and Health Insurance Risk Dawn M. Gencarelli, Senior Research Associate OVERVIEW In order to facilitate a better understanding

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

Annual Notice of Changes for 2015

Annual Notice of Changes for 2015 Kaiser Permanente Senior Advantage Essential Plus plan (HMO) offered by Kaiser Foundation Health Plan, Inc., Hawaii Region Annual Notice of Changes for 2015 You are currently enrolled as a member of Kaiser

More information

This is the official U.S. government Medicare handbook. What s important in 2015 (page 12) What Medicare covers (page 35)

This is the official U.S. government Medicare handbook. What s important in 2015 (page 12) What Medicare covers (page 35) 2015 This is the official U.S. government Medicare handbook. What s important in 2015 (page 12) What Medicare covers (page 35) CENTERS FOR MEDICARE & MEDICAID SERVICES Section 7 Get Information about Prescription

More information

Summary of benefits. 2009 idaho, utah. Health Net orange prescription drug plan

Summary of benefits. 2009 idaho, utah. Health Net orange prescription drug plan Health Net orange prescription drug plan Summary of benefits 2009 idaho, utah Benefits effective January 1, 2009 (S5678-064) PDP Option 1 (S5678-063) PDP Value Option 2 Section I INTRODUCTION TO SUMMARY

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

Prescription Drugs. Inside this Brief. Background Brief on

Prescription Drugs. Inside this Brief. Background Brief on Background Brief on Prescription Drugs Prepared by: Rick Berkobien Inside this Brief November 2006 Spending for Prescription Drugs Medicare and Prescription Drugs Drug Costs in Other Countries and the

More information

Annual Notice of Changes for 2014

Annual Notice of Changes for 2014 True Blue Rx Option Il (HMO) offered by Blue Cross of Idaho Health Service, Inc. (Blue Cross of Idaho) Annual Notice of Changes for 2014 You are currently enrolled as a member of True Blue Rx Option Il

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

Your Questions Answered

Your Questions Answered Your Questions Answered 1. GENERAL 1.1 What is happening to my retiree medical and prescription drug benefits for Medicare-eligible participants as of January 1, 2015? Effective December 31, 2014, CIGNA

More information

Kansas Health Policy Forums

Kansas Health Policy Forums Forum Brief 2004 Kansas Health Policy Forums The Medicare Reform Act: What Are the Consequences for Kansas? Thursday, March 18, 2004 Noon 2:30 Lunch provided 212 SW Eighth Avenue, Topeka, KS Lower Level

More information

State Pharmacy Assistance Programs at a Crossroads:

State Pharmacy Assistance Programs at a Crossroads: State Pharmacy Assistance Programs at a Crossroads: How Will They Respond to the Medicare Drug Benefit? By Claudia Williams, Sarah Goodell, Jack Hoadley, Ellen O Brien, and Matt Kanter* July 2005 This

More information

Pharmacy Outreach Program The University of Rhode Island College of Pharmacy

Pharmacy Outreach Program The University of Rhode Island College of Pharmacy Pharmacy Outreach Program The University of Rhode Island College of Pharmacy Updated October 2014 Medicare provides health insurance for Aged 65 years or older Aged 65 years or less with certain disabilities

More information

Choosing a Medicare prescription drug plan.

Choosing a Medicare prescription drug plan. Choosing a Medicare prescription drug plan. Medicare Made Clear TM Get Answers Series Look inside to: Learn about Part D prescription drug coverage options Find out what you need to know about the Part

More information

Annual Notice of Changes for 2016

Annual Notice of Changes for 2016 Healthy Advantage Plus HMO offered by Molina Healthcare of Utah Annual Notice of Changes for 2016 You are currently enrolled as a member of Healthy Advantage Plus HMO. Next year, there will be some changes

More information

GAO MEDICARE PART D. Opportunities Exist for Improving Information Sent to Enrollees and Scheduling the Annual Election Period

GAO MEDICARE PART D. Opportunities Exist for Improving Information Sent to Enrollees and Scheduling the Annual Election Period GAO United States Government Accountability Office Report to the Chairman, Committee on Energy and Commerce, House of Representatives December 2008 MEDICARE PART D Opportunities Exist for Improving Information

More information

Medicare (History and Financing)

Medicare (History and Financing) Medicare (History and Financing) Note: Please pay attention to dates on slides and data; CMS has discontinued the publication of some valuable figures and these are occasionally referenced for prior years.

More information

3How do I know what changes my plan is

3How do I know what changes my plan is 2012 Medicare Prescription Drug Annual Open Enrollment Questions & Answers The Annual Open Enrollment for Medicare prescription drug (Part D) is October 15, 2011 December 7, 2011. The Open Enrollment Period

More information

Testimony on: Medicare Part D and Dual Eligibles. presented to: Senate Committee on Ways and Means

Testimony on: Medicare Part D and Dual Eligibles. presented to: Senate Committee on Ways and Means ROBERT M. DAY, DIRECTOR DIVISION OF HEALTH POLICY AND FINANCE KATHLEEN SEBELIUS, GOVERNOR Testimony on: presented to: Senate Committee on Ways and Means by: Scott Brunner Division of Health Policy and

More information

Medicare Open Enrollment

Medicare Open Enrollment Medicare Open Enrollment For Coverage in 2015 1-800-MEDICARE www.medicare.gov Module Summary This module will provide the following information: Medicare Part A and B basic costs Medicare Advantage Plan

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

Revolution or Evolution: What s Happening Next for MedAdv and Prescription Drug Plans

Revolution or Evolution: What s Happening Next for MedAdv and Prescription Drug Plans Revolution or Evolution: What s Happening Next for MedAdv and Prescription Drug Plans Issues & Trends in Medicare Supplement Insurance 2012 Conference Presented by: T. Scott Bentley, FSA, MAAA Consulting

More information

Thank you for choosing Emeriti. Open Enrollment. In This Issue. Dear Retiree,

Thank you for choosing Emeriti. Open Enrollment. In This Issue. Dear Retiree, RETIREE NEWSLETTER MESSAGE FROM THE PRESIDENT FALL 2015 In This Issue President s Message 2016 Insurance Plans Medicare Updates Health Care Reform Update Default Options For 2016 Insurance Billing Information

More information

ANNUAL NOTICE OF CHANGES FOR 2016

ANNUAL NOTICE OF CHANGES FOR 2016 Cigna-HealthSpring Preferred (HMO) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2016 You are currently enrolled as a member of Cigna-HealthSpring Preferred (HMO). Next year, there will be

More information

Office of the Actuary

Office of the Actuary DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop N3-01-21 Baltimore, Maryland 21244-1850 Office of the Actuary DATE: March 25, 2008 FROM:

More information

Things to think about when you compare Medicare drug coverage

Things to think about when you compare Medicare drug coverage Things to think about when you compare Medicare drug coverage Revised September 2015 There are 2 ways to get Medicare prescription drug coverage. You can join a Medicare Prescription Drug Plan and keep

More information

PDP. Ask. Learn. Understand your Medicare. With a little help from HAP. hap.org/medicare. (800) 868-3153 or TTY/TDD (800) 649-3777

PDP. Ask. Learn. Understand your Medicare. With a little help from HAP. hap.org/medicare. (800) 868-3153 or TTY/TDD (800) 649-3777 Alliance Medicare Rx (pdp) Prospective members: If you have questions, or for full information about our benefits, enrollment periods or plan network, call a licensed HAP Medicare Sales Representative

More information

Status report on Part D

Status report on Part D C h a p t e r15 Status report on Part D C H A P T E R 15 Status report on Part D Chapter summary In this chapter Each year the Commission provides a status report on Part D to: provide information on

More information

EFFECT OF THE PART D COVERAGE GAP ON MEDICARE BENEFICIARIES WITHOUT FINANCIAL ASSISTANCE IN 2006

EFFECT OF THE PART D COVERAGE GAP ON MEDICARE BENEFICIARIES WITHOUT FINANCIAL ASSISTANCE IN 2006 Department of Health and Human Services OFFICE OF INSPECTOR GENERAL EFFECT OF THE PART D COVERAGE GAP ON MEDICARE BENEFICIARIES WITHOUT FINANCIAL ASSISTANCE IN 2006 Daniel R. Levinson Inspector General

More information

MEDICARE PART D. Types of Part D Plans: PDP and MAPD. Help with your Prescription Drug Costs

MEDICARE PART D. Types of Part D Plans: PDP and MAPD. Help with your Prescription Drug Costs MEDICARE PART D PRESCRIPTION DRUG 2015 Part D Plan Costs COVERAGE Types of Part D Plans: PDP and MAPD Help with your Prescription Drug Costs Need information about Medicare drug plans? Call the Center

More information

Savings Needed for Health Expenses for People Eligible for Medicare: Some Rare Good News, p. 2

Savings Needed for Health Expenses for People Eligible for Medicare: Some Rare Good News, p. 2 October 2012 Vol. 33, No. 10 Savings Needed for Health Expenses for People Eligible for Medicare: Some Rare Good News, p. 2 A T A G L A N C E Savings Needed for Health Expenses for People Eligible for

More information

Prescription Drug Plan (PDP)

Prescription Drug Plan (PDP) Prescription Drug Plan (PDP) Blue Shield of California Medicare Rx Plan (PDP) Evidence of Coverage Effective January 1, 2015 Blue Shield of California is a PDP with a Medicare contract. Enrollment in Blue

More information

The Future of Rural Health: The MMA As a Change Agent

The Future of Rural Health: The MMA As a Change Agent The Future of Rural Health: The MMA As a Change Agent Keith J. Mueller, Ph.D. Professor and Director RUPRI University of Nebraska Medical Center Prepared for Presentation at the All Programs Meeting of

More information