Medicare: Low Income Issues
From Families USA:
Welcome to the Medicare Prescription Drug Benefit for 2012 is an updated illustration that reflects improvements made by the Affordable Care Act that will lessen the amount enrollees will pay when they fall into the "doughnut hole." (Updated February 2012)
The Medicare Drug Benefit: How Much Will You Pay? presents tables that detail the basic benefit, as well as the low-income benefit for those who are and aren't enrolled in Medicaid. (Updated February 2012)
Health Hazard: How the House Republican Budget Resolution Would Dramatically Change Medicare looks at the impact of the proposal, which would turn Medicare into a voucher program, re-open the "doughnut hole," and raise the eligibility age for Medicare. (May 2011)
A Guide for State Advocates: State Demonstrations to Integrate Medicare and Medicaid explains the requirements for demonstrations, discusses possible models of integration, and provides guidance to advocates on how to get involved in the planning process. (April 2011) To see links to states' initial proposals, click here.
Helping People with Medicare discusses how health reform will help make Medicare more affordable for seniors and people with disabilities, improve health care quality for enrollees, and make the program more financially secure. (June 2010)
Making the Medicare Improvements for Patients and Providers Act (MIPPA) Work: How States Can Help People with Medicare examines how this legislation improves the Medicare Savings Programs and the Part D Low-Income Subsidy, making Medicare more affordable for low-income beneficiaries. It includes tips for advocates. (February 2010)
Help for People with Medicare discusses how the health reform legislation that is before Congress will help make Medicare more affordable for seniors and people with disabilities, as well as help make the program more financially secure. (August 2009)
Key Priorities to Help Low-Income Medicare Beneficiaries discusses three actions Congress should take to improve the Medicare Savings Programs (MSPs) and the Part D Low-Income Subsidy (LIS) as part of health reform. (May 2009)
Medicare: Helping Low-Income Seniors and People with Disabilities examines the high out-of-pocket costs Medicare beneficiaries face and how health reform should improve existing programs that help them afford these costs. (May 2009)
Medicare Improvements for Patients and Providers Act of 2008: Addressing Racial and Ethnic Health Disparities discusses how the Medicare Improvements for Patients and Providers Act (MIPPA) addresses health disparities within the Medicare population. MIPPA provisions to address these issues include: improved data collection for measuring and evaluating health disparities, outreach to the previously uninsured, and compliance with cultural competency standards. (November 2008)
Congress Delivers Help to People with Medicare: An Overview of the Medicare Improvements for Patients and Providers Act discusses the positive changes the Medicare Improvements for Patients and Providers Act (MIPPA) makes to Medicare. These changes include the improvement of Medicare health care benefits, the creation of policies that reduce racial and ethnic disparities among beneficiaries, and the reining in of inefficient private Medicare Advantage Plans. (October 2008)
Buyer Beware: Higher Costs, More Confusion for the 2008 Part D Enrollment Season discusses several reasons why Part D enrollees, especially those with low incomes, should carefully examine their plans to see if the plans will continue to suit their needs. These reasons include rising premiums, the widening "doughnut hole," and other changes in coverage. (November 2007)
The CHAMP Act's Medicare Provisions Offer Real Help to Seniors and People with Disabilities discusses how this bill, passed by the House of Representatives on August 1, would level the playing field between traditional Medicare and private Medicare Advantage plans, improve benefits for beneficiaries, particularly for those with low incomes, and protect Medicare consumers. (September 2007)
Coverage through the "Doughnut Hole" Grows Scarcer in 2007 examines what will happen next year to stand-alone drug plans that provide meaningful doughnut hole coverage—plans that provide doughnut hole coverage of both the generic and non-generic drugs that most seniors need. (November 2006)
Press Release: Key Medicare Drug Issues Lie Ahead after the End of the First Enrollment Period (May 12, 2006)
Statement: Bush Administration Playing "Fast and Loose" with New Medicare Enrollment Numbers (May 10, 2006)
Medicare Drug Program Fails to Reach Low-Income Seniors documents the slow pace of enrollment in Medicare Part D and, particularly, the program's failure to reach those most in need—the low-income seniors and people with disabilities who are entitled to special subsidies. (May 2006)
On April 1, 2006, Medicare beneficiaries lose the protection of extended transition benefits. April Fools for Medicare Part D Beneficiaries? Transitional Benefits End April 1 explains what this means for beneficiaries and what they can do about it. (March 29, 2006)
Expectations Shrinking for Medicare Part D Enrollment assesses the first two months of enrollment in the new drug benefit. The report shows that: 1) enrollment so far is lagging well behind last year's projections; 2) most of those counted as covered already had drug coverage; and 3) low-income beneficiaries are being left behind. | Press Release (February 2006)
Press Release: Less than 18 Percent of Low-Income Seniors Approved for New Medicare Drug Subsidies (January 6, 2006)
Press Release: Only One Out of Nine Low-Income Seniors Approved for New Medicare Drug Subsidies (December 5, 2005)
Getting the Best Price: Lessons Learned from the Medicare Discount Card Program Families USA examined how well the Medicare discount card program did in negotiating lower drug prices for those in Medicare. We found that, for the 50 drugs most frequently prescribed to seniors, the lowest Medicare discount card price was almost always much higher than the lowest price negotiated by one large government purchaser, the Department of Veterans Affairs (VA). | Press Release | Charts (September 2005)
Gearing Up Series--The Holes in Part D: Gaps in the New Medicare Drug Benefit (Part 1 of 2) This brief discusses the three major kinds of gaps associated with the Part D benefit: 1) the financial gap beneficiaries will face; 2) the drug coverage gap; and 3) the enrollment gap. (July 2005)
Gearing Up Series--Filling the Holes in Part D: The Essential Role of State Pharmacy Assistance Programs (Part 2 of 2) This brief examines the key decisions states will have to make when determining how their Pharmacy Assistance Programs can provide wraparound coverage and explains the special role of these programs under the Medicare drug law. It also discusses how these programs can help with enrollment. (July 2005)
Trouble Brewing? New Medicare Drug Law Puts Low-Income People at Risk The Medicare Modernization Act (MMA) was touted as a program that would help all Medicare enrollees, particularly the neediest, obtain prescription drug coverage. Now there is evidence that a flaw in the MMA will cause serious harm to many of the most vulnerable elderly and people with disabilities. | Press Release (July 2005)
Approximately Half of Americans in Medicare Are at Risk of Losing Coverage When the New Law Is Implemented This careful analysis of the new Medicare law and proposed regulations for the law shows that the new program will be more than a disappointment--half of America's Medicare beneficiaries are at risk of being worse off then they are today. (October 20, 2004)
Statement: Data Hidden in 2004 Medicare Trustees' Report Show Huge Harm to Seniors by New Drug Law (September 14, 2004)
Gearing Up: States Face the New Medicare Law Is Your State Ready for 2006? An Introduction to What the New Medicare Part D Prescription Drug Benefit Means for Medicaid (September 2004)
Statement: Sharp Contrast between Presidential Rhetoric and Reality of Medicare Drug Discount Card Program (June 14, 2004)
Testimony of Families USA Executive Director Ron Pollack on the Medicare Prescription Drug Discount Card before the Subcommittee on Health, Committee on Energy and Commerce, U.S. House of Representatives (May 20, 2004)
Statement: Medicare Drug Discount Card Fails To Make Drug Costs Affordable for Seniors (April 29, 2004)
Q&A: Understanding the New Medicare Prescription Drug Benefit | en Español (Spring 2004)
Release: Cronkite Video Helps Launch National Senior Education Campaign about New Medicare Law (February 25, 2004)
The New Medicare Prescription Drug Discount Card: A Very Flawed Program (December 19, 2003)
Statement: Medicare Legislation Will Be A Deep Disappointment For America's Seniors (November 25, 2003)
Statement: Medicare Proposal Denies Much-Needed Help To 2.8 Million Lowest-Income Seniors (November 20, 2003)
Statement: New Proposal Provides Too Little Help For Poor Seniors, Too Much Harm to Traditional Medicare (November 17, 2003)
Statement: Medicare Conference Committee May Cause Significant Harm To Poorest Seniors (November 12, 2003)
The House Medicare Drug Bill's Doughnut Hole: A Chasm for Low-Income Beneficiaries? discusses the large gap in drug coverage low-income Medicare beneficiaries would experience under the House Medicare drug bill. (September 26, 2003)
Private Plans: A Bad Choice for Medicare discusses the role of private plans in Medicare up to this point. According to the piece, the evidence so far indicates that, for seniors and people with disabilities, particularly those living in rural areas, the traditional Medicare program works better than private plans. (September 26, 2003)
Prescription Drug Cost-Sharing and Low-Income People: Five Good Reasons to Keep It Minimal makes the point that prescription drugs aren't the only health expenses Medicare beneficiaries must pay for out of pocket. It goes on to assert that any final Medicare prescription drug bill should not raise cost-sharing amounts above the limits in the current Senate and House bills. (September 12, 2003)
More Red Tape for the Poor? Dual Eligibles in the Medicare Rx Bill describes the potential problems that the Senate's Medicare prescription drug bill, which would not cover dual eligibles (low-income people who are eligible for both Medicare and Medicaid), could create for such beneficiaries and for Medicare and state Medicaid programs. (September 3, 2003)
What's in the House and Senate Medicare Prescription Drug Bills? (July 17, 2003)
Who are Medicare's Low-Income Beneficiaries? (July 14, 2003)
Low-Income Prescription Drug Benefit: Key Differences between House and Senate Medicare Bills (July 10, 2003)
Low-Income Medicare Beneficiaries Are Most in Need of Prescription Drug Coverage (June 17, 2003)
The Impact of Medicare Reform on Low-Income Beneficiaries discusses the recommendations for Medicare reform included in the Breaux-Thomas proposal stemming from the National Bipartisan Commission on the Future of Medicare. According to the report, these recommendations are likely to have a particularly profound effect on one out of four low-income Medicare beneficiaries. (March 1999)
Medicare Buy-In is a brochure that explains this program and its benefits to low-income Medicare beneficiaries. It also provides state contacts for further information. (January 1999)
Shortchanged: Billions Withheld From Medicare Beneficiaries: This report reveals how millions of Americans who are eligible for the Medicare Buy-In program are not receiving these critical benefits. | Press Release | Statement (in response to President Clinton's July 6th press conference) (July 1998)
From AARP:
FYI: The Cost of Prescription Drugs: Who Needs Help? This issue brief presents data on out-of-pocket spending on prescription drugs by poor and low-income beneficiaries, as well as by beneficiaries with modest incomes, such as those with incomes between 175% and 250% of the federal poverty level. It also shows differences in out-of-pocket drug spending between beneficiaries with and without drug coverage.
From the Access to Benefits Coalition and the National Council on Aging:
The Department of Health and Human Services has estimated that at least 75 percent of the Medicare beneficiaries who do not have any prescription drug coverage are eligible for the Low-Income Subsidy. The Next Steps: Strategies to Improve the Medicare Part D Low-Income Subsidy identifies recommended legislative, administrative, and regulatory reforms that should be made to the Low-Income Subsidy to improve access to the program for seniors and people with disabilities with limited means. (January 2007)
From the Alliance for Health Reform:
Integrating Care for Dual Eligibles: What Do Consumers Want? answers the following questions related to the 9 million people who are eligible for both Medicare and Medicaid: How do the two programs coordinate payment and care? What do consumers think about fee-for-service and special needs plans? And what can policy makers learn about program design from the attitudes of consumers? (December 2011)
From Avalere Health:
Low-Income Medicare Beneficiaries Will Have Fewer Part D Options in 2009 reports that the number of free-standing plans available for low-income beneficiaries who qualify for the low-income subsidy will decrease from about 500 this year to 308 in 2009. Approximately 1.3 million individuals will be automatically reassigned to new drug plans by the end of this year due to marketplace changes, continuing the trend of reassignment that has increased every year since the program began. (October 2008)
From the Center for Studying Health System Change:
Access to Prescription Drugs for Medicare Beneficiaries finds that the introduction of the Medicare prescription drug program in 2006 did little to close longstanding gaps in drug accessibility between white and African American seniors, healthier and sicker beneficiaries, and lower-income and higher-income beneficiaries. For example, in 2007, three times as many African American beneficiaries went without a prescribed medication as white beneficiaries. (March 2009)
More Nonelderly Americans Face Problems Affording Prescription Drugs finds that the proportion of children and working-age Americans who went without a prescription drug because of cost concerns reached 13.9 percent in 2007, up from 10.3 percent in 2003. Nearly one in four working-age adults with Medicaid or other state insurance reported having difficulties affording prescription drugs, while nearly three in 10 working-age Medicare beneficiaries reported having such problems. (January 2009)
Living on the Edge: Health Care Expenses Strain Family Budgets reports that the financial pressures faced by families due to medical bills increase sharply when out-of-pocket spending for medical care exceeds 2.5 percent of family income. Low-income families and people in poor health experience financial pressures at even lower levels of spending, largely because they have already accumulated large medical debts that they are unable to pay off. Almost all families that had problems paying medical bills reported putting off or going without medical care to avoid additional expenses. (December 2008)
From the Center on Budget and Policy Priorities:
Moving “Dual Eligibles” into Mandatory Managed Care and Capping Their Federal Funding Would Risk Significant Harm to Poor Seniors and People with Disabilities stresses the importance of carefully assessing managed care for dual eligibles in order to learn how best to coordinate care for this population and what roles Medicare and Medicaid should play. (October 2012)
About 1.7 Million Medicare Beneficiaries in Rural America Would Be Denied Medicare Prescription Drug Benefits under the Senate Prescription Drug Bill explains that these beneficiaries would not be covered under the Senate's bill because they are "dual eligibles"-low-income people who are eligible for both Medicare and Medicaid-that the Senate bill doesn't cover. Dual eligibles are more likely to live in rural areas than typical Americans, so this exclusion would disproportionately affect rural beneficiaries. This would represent the first time that a group of Medicare beneficiaries would be excluded from a Medicare benefit. (September 2003)
From The Commonwealth Fund:
Health Insurance and Health Care Access before and after SSDI Entry sheds new light on the experiences of people with disabilities and raises the question of why many people who are eligible for Medicare are denied coverage when they are perhaps most in need of it. While the cost of eliminating the waiting period seems high, it represents only a small percentage increase in Medicare spending, and it could help states reduce their spending on public coverage programs. (May 2009)
The Continuing Cost of Privatization: Extra Payments to Medicare Advantage Plans Jump to $11.4 Billion in 2009 concludes that payments to MA plans in 2009 are projected to be 13 percent greater than the corresponding costs in traditional Medicare—an average of $1,138 per MA plan enrollee. If these beneficiaries were enrolled in traditional Medicare instead, more than $150 billion could be saved over 10 years, which could be used to finance improved benefits for the low-income elderly and disabled or for expanding health coverage. (May 2009)
Medicare Part D: How Do Vulnerable Beneficiaries Fare? surveyed counselors, attorneys, program managers, and health professionals about steps that could make Medicare Part D work better for the most vulnerable beneficiaries. For some enrollees, particularly those who must transition from Medicaid to Medicare drug coverage, the new program can be confusing or disruptive and result in delays in getting drugs. The report also suggests certain policy and procedural changes that could enhance program performance. (May 2008)
The Medicare prescription drug program has improved access to needed medications for millions of Americans. However, an estimated 3.3 million of the 13.2 million beneficiaries eligible for the low-income subsidy are not receiving that help. Improving the Medicare Part D Program for the Most Vulnerable Beneficiaries argues that administrators must find better ways to reach out to these beneficiaries, simplify the enrollment process, and provide hands-on assistance in navigating that process. (May 2007)
Medicare Beneficiary Out-of-Pocket Costs: Are Medicare Advantage Plans a Better Deal? finds that, although costs for beneficiaries in good or fair health are lower in most Medicare plans when compared to fee-for-service-Medicare, beneficiaries in poor health have the potential to pay much more in annual out-of-pocket costs. (May 2006)
The Role of the Asset Test in Targeting Benefits for Medicare Savings Programs finds that less than half of those who meet income requirements also meet asset limits for eligibility, meaning that a substantial proportion of low-income people are unable to get help from the programs because of their assets. The report focuses on the methods used by some of the 21 states that have modified their asset tests to ease enrollment for low-income beneficiaries. (October 2002)
Medicare Beneficiaries: A Population at Risk: a large majority of Medicare beneficiaries struggle with low incomes or health problems according to this report. (January , 1999)
From Health Affairs:
The Vast Majority of Medicare Part D Beneficiaries Still Don’t Choose the Cheapest Plans that Meet Their Medication Needs finds that Medicare enrollees tend to overprotect themselves with plans that include features they don’t need. Therefore, seniors need more targeted government assistance to choose the plan that is right for them. (October 2012)
Putting Limits on ‘Medigap’ explains how Medigap works and explores the arguments for and against changing its coverage options. Some have proposed that people with comprehensive Medigap plans should pay more for Medicare Part B premiums, while others recommend putting limits on what Medigap covers. (September 2011)
Lessons Learned: Who Didn’t Enroll in Medicare Drug Coverage in 2006, and Why? reveals that only 63 percent of eligible seniors and 69 percent of low-income seniors enrolled in Medicare Part D in 2006. Many eligible seniors reported that premiums were too expensive, enrollment was too difficult, and information about enrollment was hard to find. The findings emphasize the need to improve enrollment policies and procedures. (June 2010) Subscription Required
How Much “Skin in the Game” Do Medicare Beneficiaries Have? The Increasing Financial Burden of Health Care Spending examines the financial burden among beneficiaries between 1997 and 2003. Results suggest that sustained increases in out-of-pocket spending could make health care less affordable for all but the highest-income beneficiaries. (November 2007)
Access to Cancer Drugs in Medicare Part D: Formulary Placement and Beneficiary Cost-Sharing in 2006 found that Part D greatly expanded Medicare beneficiaries’ access to cancer treatments. An analysis of nearly 3,000 Part D plans found that virtually all plans cover generic cancer drugs and the majority of brand-name drugs. Copayments for cancer drugs are relatively low, but prior-authorization requirements may limit access to some brand-name treatments. A subscription is necessary to view the full article. (September 2006)
From Health Affairs and the Robert Wood Johnson Foundation:
Care for Dual Eligibles describes efforts by the Medicare-Medicaid Coordination Office, which was created by the Affordable Care Act, to integrate the two programs. It also discusses how this integration should be structured and how likely it is to lower costs. (June 2012)
From The Health Care Financing Administration (HCFA):
www.medicare.gov is the website of new Prescription Drug Assistance Program that helps consumers get information on programs providing prescription drug assistance to individuals in need. Other new online resources include a directory of physicians serving Medicare beneficiaries, a complete Spanish language version of the Medicare Health Plan Compare site, and enhancements to Nursing Home Compare.
From the Journal of the American Medical Association:
Cost-Related Medication Nonadherence and Spending on Basic Needs Following Implementation of Medicare Part D presents an analysis of data from a government survey of 24,234 Medicare beneficiaries in 2004, 2005, and 2006. The percentage of seniors who said they skipped medications because of cost declined after Part D took effect in January 2006. However, the sickest beneficiaries still skip prescriptions because they cannot afford them. (April 2008)
Health of Previously Uninsured Adults after Acquiring Medicare Coverage strengthens the argument that health coverage improves the health of adults who had previously been uninsured. Medicare improved the general health, mobility, and agility of patients 65 years and up, particularly those with cardiovascular disease or diabetes. (December 2007)
From the Journal of Women, Politics and Policy:
Health Coverage and Expenses: Impact on Older Women’s Economic Well-Being explores gender-based differences in health and long-term care use, spending patterns, and the financial burden of out-of-pocket expenses among Medicare beneficiaries. The study reveals that women’s health care expenses were higher than men’s, and older women had an even greater overall financial burden with less income at their disposal. It concludes that controlling health spending and developing options to help finance long-term care for Medicare enrollees are key to improving the economic security of older women. (August 2009)
From the Kaiser Commission on Medicaid and the Uninsured:
State Demonstrations to Integrate Care and Align Financing for Dual Eligible Beneficiaries: A Review of the 26 Proposals Submitted to CMS examines the contents of the proposals in the areas of target population, implementation date, enrollment, financing, benefits, beneficiary protections, stakeholder engagement, and evaluation. It includes a chart summarizing the features of each proposal. (October 2012)
The Diversity of Dual Eligibles: An Examination of Services and Spending for People Eligible for Both Medicaid and Medicare discusses the characteristics, health status, and spending for dual eligibles, all of which have implications for efforts to integrate benefits and align financing for this group. (April 2012)
A Profile of Medicaid Managed Care Programs in 2010: Findings from a 50-State Survey provides a comprehensive look at these programs, documenting their diversity; examining how states monitor quality; and exploring efforts to improve care, including managed long-term care and initiatives targeted at dual eligibles. (September 2011)
Proposed Models to Integrate Medicare and Medicaid Benefits for Dual Eligibles: A Look at the 15 State Design Contracts Funded by CMS summarizes states’ preliminary proposals to better coordinate care for people who are enrolled in both programs. The 15 states are as follows: CA, CO, CT, MA, MI, MN, NC, NY, OK, OR, SC, TN, VT, WA, WI. (August 2011)
Where Does the Burden Lie?: Medicaid and Medicare Spending for Dual Eligible Beneficiaries fills in gaps in information about dual eligibles by analyzing their demographic and health characteristics, as well as their patterns of service utilization and spending under both Medicare and Medicaid. These seniors are generally low-income, in poor health, and have considerable health care needs, making them one of the most costly populations to be covered by public insurance. (April 2009)
Dual Eligibles: Medicaid Enrollment and Spending for Medicare Beneficiaries in 2005 provides the latest data on the total Medicaid enrollment and spending attributable to dual eligibles, with state-level estimates available in interactive tables and maps. The brief finds that dual eligibles comprise 18 percent of the Medicaid population but account for 46 percent of Medicaid spending. (February 2009)
Rethinking Medicaid’s Financing Role for Medicare Enrollees examines coverage of the nearly 9 million dual eligibles, the low-income elderly, and people with disabilities who are enrolled in both Medicare and Medicaid. The brief explores the national and state impacts of shifting the financing of selected services for dual eligibles from Medicaid to Medicare, including having the federal government pick up the full cost of Medicare premiums, cost-sharing, gaps in Medicare-covered services, and long-term care services. (February 2009)
From the Kaiser Family Foundation:
Seniors’ Knowledge and Experience with Medicare’s Open Enrollment Period and Choosing a Plan finds that nearly one-quarter of seniors are unaware of this annual opportunity to review and change their Medicare coverage. An even greater proportion of seniors with low incomes, limited educations, functional impairments, and poor health status do not know about open enrollment. (October 2012)
Medigap Reform: Setting the Context provides national and state-level data on Medigap enrollment and premiums. Categories of data include the percentage of Medicare beneficiaries with a Medigap policy, the percentage of enrollees in plans with first dollar coverage, and the costs of monthly premiums. (September 2011)
The Innovation Center: How Much Can It Improve Quality and Reduce Costs–and How Quickly? presents a panel discussion of questions related to the new Center for Medicare and Medicaid Innovation. The center will test new health care payment and service delivery models that can potentially enhance quality and reduce health care costs. The panel covers the center’s early projects, how likely it will be to achieve its goals, and how the center plans to administer its $10 billion budget. (July 2011)
Caring for People Covered by Both Medicare and Medicaid: A Primer on Dually Eligible Beneficiaries discusses the characteristics and needs of this population, how Medicaid and Medicare coordinate payment and care, and how the health reform law will improve coordination and delivery of services for dual eligibles. (June 2011)
The Social Security COLA and Medicare Part B Premium: Questions, Answers, and Issues explains the relationship between the Social Security cost of living adjustment (COLA) and Medicare Part B premiums and how those who are covered by both programs will be affected. (December 2010)
Medicare’s Role for Women examines the demographics of women who rely on Medicare, including their health status and income levels. It also looks at the benefits and cost-sharing requirements of Medicare and the prevalence of other types of coverage, such as job-based insurance or Medigap. For women, who are disproportionately low-income and who have more chronic conditions than men, Medicare is a particularly critical source of retirement security. (June 2009)
Health Care on a Budget: An Analysis of Spending by Medicare Households reports that in 2006, out-of-pocket healthcare spending accounted for 14.1 percent of all expenditures for Medicare households and that one in four households devoted more than one-quarter of total household expenditures to health care. This group includes a disproportionate share of Medicare households that are low- and middle-income, that have older members, and that live in rural areas. (February 2009)
Examining Sources of Coverage among Medicare Beneficiaries: Supplemental Insurance, Medicare Advantage, and Prescription Drug Coverage -- Findings from the Medicare Current Beneficiary Survey, 2006 provides the first detailed look at the characteristics of beneficiaries with various sources of drug coverage in the first year of the Medicare Part D drug benefit. The chart pack compares the characteristics of Medicare beneficiaries enrolled in Medicare Advantage plans to beneficiaries in traditional fee-for-service Medicare. It also examines drug coverage and enrollment in the low-income subsidy among beneficiaries with low incomes. (August 2008)
Medicare Prescription Drug Plans in 2008 and Key Changes Since 2006: Summary of Findings covers topics ranging from premiums and the coverage gap to benefit design, cost-sharing, and the availability of plans for those who receive the low-income subsidy. The analysis found little change in Part D plans since 2006, but it concluded that increases in cost-sharing and utilization management restrictions may keep some beneficiaries from obtaining the drugs they need. (April 2008)
Medicare Prescription Drug Benefit includes the latest information and data about Medicare Part D, including 2008 plan information and the most recent enrollment data. (November 2007)
The Medicare Prescription Drug Benefit provides the latest information and data about the Medicare Part D program. These data include a breakdown of the standard benefit, updates on additional low-income assistance, and the latest 2006 enrollment data. (November 2006)
Early Experiences of Medicare Beneficiaries in Prescription Drug Plans: Insights from Medicare State Health Insurance Assistance Program (SHIP) Directors explores early experiences with the Part D drug benefit based on the observations of SHIP directors who work closely with Medicare beneficiaries and CMS. SHIP directors reported problems and concerns relating to enrollment, premium payments, dual eligibles, authorization requirements, data system errors, and the “doughnut hole.” (August 2006)
The Stability of Medicaid Coverage for Low-Income Dually Eligible Medicare Beneficiaries examines the health coverage of the 7 million Americans who rely on Medicaid to fill the gaps in their Medicare coverage. The analysis focuses on the rates of gain and loss of Medicaid coverage, among other topics. (May 2006)
Medicare Drug Plans: Experiences of Dual Enrollees and Other Low-Income Beneficiaries is a forum in which experts discussed how well Part D has done in providing low-income subsidies to seniors and beneficiaries with disabilities, as well as dual eligibles. The following materials were released in conjunction with the forum (May 18, 2006):
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Transitions 2006 is a video that shows the experiences of three dual eligibles whose drug coverage shifted from Medicaid to Medicare.
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Talking about Medicare: Your Guide to Understanding the Program is designed to help beneficiaries and their families think through basic health care issues. It also provides information on how the Part D drug program works, how to choose a drug plan that meets beneficiary needs, and how low-income enrollees can get additional help with drug costs. (April 2006)
Low-income assistance is one key feature of the Medicare prescription drug bills passed by the House and Senate. State-Level Poverty Data for the Medicare Populationincludes tables that present national and state-level data on the number of Medicare beneficiaries who may be eligible for additional assistance based on the income eligibility thresholds specified in the House and Senate bills (135 percent, 150 percent, and 160 percent of the federal poverty level). (July 2003)
From Lake Research Partners and the California Endowment:
Experiences with Medicare Part D: Stories from Low-Income, Ethnically Diverse and Medically Needy Californians examines early experiences with Medicare Part D through in-depth interviews with 35 "vulnerable" Medicare beneficiaries. This is the first of several sets of interviews that will track beneficiary experiences through the first year of Part D operations. The report focuses on choosing and enrolling in Part D plans, as well as using the new prescription drug coverage. (June 2006)
From Mathematica Policy Research:
Helping Eligible Medicare Beneficiaries Access Medicaid: Lessons from SCHIP reports on a study that used recent experiences in promoting enrollment of low-income children in SCHIP to examine barriers to Medicaid enrollment for eligible Medicare beneficiaries. One of the main barriers cited is that dual-eligible Medicare beneficiaries often do not know about Medicaid or do not think they are eligible for it. The piece also reviews steps that may help remove these barriers. (September 2002)
From the National Academy of Social Insurance:
Improving the Medicare Savings Programs details the findings of an independent panel tasked with developing strategies for enrolling more low-income seniors and people with disabilities in the Medicare Savings Programs (MSPs). It finds that the problem could largely be ameliorated by providing additional federal funding. That funding can then be used to increase participation through options such as using the information gathered by Social Security to facilitate enrollment in MSPs, or simplifying and liberalizing the eligibility rules to provide greater uniformity between the MSPs and the low-income Part D subsidy. (June 2006)
From The National Senior Citizens Law Center:
Improving the Qualified Medicare Benefit Program for Dual Eligibles explains the Qualified Medicare Beneficiary (QMB) program and focuses on four problem areas that prevent people from fully using their Medicare benefits. It recommends methods for improvement and proposes a comprehensive redesign of the QMB program. (November 2011)
Medicaid Division of Assets and Income Rules for Long-Term Care -- Spousal Impoverishment (April 1999)
Medicaid Buy-In Programs for Low-Income Medicare Beneficiaries:Some low-income Medicare beneficiaries are entitled to have their Medicare premiums paid for by the Medicaid program. This report gives details. (April 1999)
From The New England Journal of Medicine:
Effect of Cost Sharing on Screening Mammography in Medicare Health Plans examines the rates at which women with cost-sharing in their Medicare managed care plans get mammograms. The data show that even relatively small copayments were associated with significantly lower mammography rates. (January 2008)
From the New York State Health Foundation:
Integrating Care for Dual Eligibles in New York: Issues and Options outlines the challenges involved in navigating Medicare and Medicaid that are faced by people who are eligible for both programs, their families, health care providers, and those who operate the programs. It examines national and state-level data on the characteristics of dual eligibles, their care needs, and the cost of care, as well as options for developing integrated care programs. (February 2012)
From The Robert Wood Johnson Foundation:
Disparities in Health and Health Care among Medicare Beneficiaries highlights the importance of understanding health care within local context, and of efforts to explore and address the underlying causes of disparities within and across regions. The study’s major findings include: the rate of leg amputation is four times greater for blacks than for whites; and, for evidence-based services such as screening mammography and testing for diabetes, disparities across states and regions are substantially greater than the differences by race. (June 2008)
From the Social Security Administration:
Low-income Medicare beneficiaries can apply for Extra Help with their Medicare Part D costs (also known as the Low-Income Subsidy) through their state's Medicaid offices or through the Social Security Administration's Web site.
From the Urban Institute:
Policy Options to Improve the Performance of Low Income Subsidy Programs for Medicare Beneficiaries considers options for better aligning low-income subsidies with the Affordable Care Act, such as extending financial assistance to enrollees with incomes up to 300 percent of the federal poverty level. Currently, Medicare offers financial assistance only to people with incomes up to 150 percent of poverty through Medicaid, the Medicare Savings Programs, and the Part D Low-Income Subsidy. (January 2012)
Do Health Problems Reduce Consumption at Older Ages? suggests that holes in the health care safety net for those under age 65 (before they are eligible for Medicare) force some low-income people to lower their living standards to cover medical expenses. For example, older adults with health problems may have to deplete their savings, forgo necessary care, or reduce their use of other essential services to pay their medical bills. (March 2009)
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