Presentation is loading. Please wait.

Presentation is loading. Please wait.

The Perils and Promise of Medicare Part D Marc Steinberg, Families USA Making Public Programs Work for Communities of Color January 25, 2006 ** Washington,

Similar presentations


Presentation on theme: "The Perils and Promise of Medicare Part D Marc Steinberg, Families USA Making Public Programs Work for Communities of Color January 25, 2006 ** Washington,"— Presentation transcript:

1 The Perils and Promise of Medicare Part D Marc Steinberg, Families USA Making Public Programs Work for Communities of Color January 25, 2006 ** Washington, DC (202)

2 Medicare Modernization Act of 2003 (MMA) Biggest changes in Medicares history Biggest changes to Medicaid in a generation or more Major philosophical change in delivery of public coverage Dangers, opportunities for beneficiaries, especially minorities

3 Medicare Beneficiaries by Race/Ethnicity, 2002 source: Kaiser, Million Total Beneficiaries White, non-Hispanic79% Black, non-Hispanic9% Hispanic7% Asian2% Other2%

4 Medicare Benefits Part A – hospital coverage Part B – outpatient coverage Part C – managed care (Medicare Advantage) Option for beneficiaries – varies by region About 15% of all beneficiaries enrolled 2005 Received big subsidies under 2003 law No outpatient Rx coverage prior to 2006

5 Part D: Prescription Drugs 2003 MMA added Medicare Part D Rx Benefit Benefit delivered by private plans ONLY Basic benefit with lots of variation Substantial cost-sharing for most beneficiaries Subsidy for low-income beneficiaries Formularies and utilization management Pharmacy Network Voluntary, opt-in enrollment Open to anyone with Part A or Part B Penalties for late enrollment

6 Overall concerns Huge number of plans (often 40+ in a region) Overwhelming number of variables to consider Troubled enrollment systems Intersection with other retiree coverage Substantial penalties for late enrollment Culturally appropriate outreach is new challenge for Medicare

7 Low-Income Provisions MMA includes substantial assistance for low-income beneficiaries Premiums and co-payments heavily subsidized Limited choice of plans Enrollment automatic for dual eligibles and some others

8 Dual Eligibles: Medicares Neediest 6.2 Million Full Dual Eligibles Qualify for Medicare based on age or disability Qualify for Medicaid based on income Poorer and sicker than average beneficiaries 60% live below poverty 71% have a functional limitation (vs. 45% of non- duals) Medicaid covered Rx prior to January 1, 2006

9 Dual and non-dual beneficiaries by race/ethnicity, 2002 source: MedPAC, 2005 Race/EthnicityNon-dual eligiblesDual eligibles White, non- Hispanic 84%55% Black, non- Hispanic 7%22% Hispanic6%15% Other3%8%

10 Changes from Medicaid for dual eligibles Higher co-pays in about half the states; indexed to inflation Co-pays not automatically waived Formularies with utilization management Duals can change plans monthly Some drugs not covered under Part D More restrictive appeals

11 Automatic enrollment of dual eligibles Automatically assigned to low-cost standard plan in region Random assignment for those who do not choose Right to change plans at any time Those in Medicare Advantage (MA) assigned to that MA-PD Plans should provide all current meds during initial transition

12 Non-dual Low-Income Coverage (Extra Help) Subsidy ASubsidy B Income 135% FPL150% FPL Assets $7,500 individual $12,000 couple $11,500 individual $23,000 couple Copays $2 generic / $ 5 non-generic in 2006 (indexed) 15% coinsurance to catastrophic maximum Premiums Avg. basic premium covered Sliding scale

13 Concerns for non-dual low- income beneficiaries Enrollment voluntary – must sign up Exception: Medicare savings programs beneficiaries Enrollment is 2-step process Must apply and get subsidy (Extra Help) AND choose Part D plan Major outreach needed – Social Security Administration is lead agency

14 Where we are so far Confusion Complexity of plans Initial new enrollment about 3.6 million as of 1/13/06 Chaotic transition for dual eligibles Conflict with retiree coverage Enrollment or subsidy info lost Transitional benefits limited Many states have filled gaps Slow enrollment for Extra Help About 1 million out of 5.5 – 7 million eligible have enrolled

15 Conclusion: Agenda for improvement Short term: make it work Correct enrollment for all low-income Deliver transitional benefits Standardize exceptions and appeals Long term: fix the program Liberalize / drop asset test for subsidy Allow Medicare to negotiate directly for lower prices and richer benefit

16 Dual eligible coverage Status/ Income2006 Co-payments In InstitutionsNone Income up to 100% FPL $1 generics/ $3 non-generics Income over 100% FPL $2 generics/ $5 non-generics Premiums: Avg. basic premium in region covered No copays after total drug costs reach $5,100 (in 2006)

17 Part D Basic Benefit Total CostsYou Pay Medicare Pays Premium (avg.)$32.20/mo.100%0% Deductible$0-$250100%0% Initial Coverage$251-$2,25025%75% Coverage Gap$2,251-$5,100100%0% CatastrophicAbove $5,1005%95%


Download ppt "The Perils and Promise of Medicare Part D Marc Steinberg, Families USA Making Public Programs Work for Communities of Color January 25, 2006 ** Washington,"

Similar presentations


Ads by Google