Medicare: Information on Low-Income Issues
From Families USA:
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 Center on Budget and Policy Priorities:
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:
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:
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 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:
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 Kaiser Family Foundation:
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:
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 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.
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