Transcript PowerPoint
Enrollment in the Medicare Drug Benefit Medicare Congress Audioconference October 19, 2005 Jennifer Bowman Avalere Health LLC Avalere Health LLC | The intersection of business strategy and public policy Choosing to Enroll in the Medicare Drug Benefit Is a Complex Decision Beneficiary decision includes considering: » Current drug coverage’s formulary, premium and cost-sharing offerings » Eligibility and application for low-income assistance » Comparing plans (many more PDP and MA-PD plans than expected) CMS plan comparison tools will enable beneficiaries to compare: » Pharmacy networks » Formulary, including drug list and management tools » Premiums » Coinsurance or copayment © Avalere Health LLC Page 2 CBO Assumptions about Part D Enrollment (1) Small group of beneficiaries do not enroll in Part D 6% of Medicare beneficiaries who do not participate in Part B 7% of beneficiaries enrolled in Part B who are either: » Active workers receiving drug coverage through employers, or » Beneficiaries receiving coverage through federal programs (veterans, federal retirees, and military retirees) © Avalere Health LLC Page 3 CBO Assumptions about Part D Enrollment (2) All retirees either receive drug coverage through an employer, or enroll in a Part D plan 30% of beneficiaries enrolled in Part B receive coverage through a former employer » Two-thirds of those beneficiaries will see their employers take the retiree drug subsidy and receive drug benefits through the employer » One-third are expected to enroll in Part D plans © Avalere Health LLC Page 4 CBO Assumptions about Part D Enrollment (3) All remaining Medicare beneficiaries (25.8 million) are expected to enroll Dual eligible beneficiaries (6.4 million) Medicare Advantage enrollees (5.5 million) Beneficiaries currently receiving Medigap coverage (3.2 million) Beneficiaries currently without drug coverage (7.7 million) Overall, CBO assumes 80% of Medicare beneficiaries will enroll in Part D or receive benefits through a former employer that takes the retiree drug subsidy © Avalere Health LLC Page 5 Experience with MMA Thus Far: Enrollment in the Medicare Replacement Drug Demonstration 60,000 50,000 50,000 37,359 40,000 30,000 20,000 10,000 0 Number of Beneficiaries allowed to enroll (cap instituted by Congress) Beneficiaries Enrolled (as of September 8, 2005) * According to Avalere Health email communications with Sharon Cardinale, MRDD Outreach Coordinator, March 29, 2005 © Avalere Health LLC Page 6 Enrollment in the Medicare Drug Discount Card Has Also Been Lower than Expected 8 7.3 million 7.3 6.4 million 6.4 7 6 5 4 3 2 1 0 CMS' Initial Projected Enrolled Beneficiaries by End of 2005 Source: CMS Press Office. Beneficiaries Enrolled in July 2005 © Avalere Health LLC Page 7 Key Questions About Enrollment Will all Medicare beneficiaries feel comfortable navigating the enrollment process? What will be the impact of low enrollment on participation in private plans? If enrollment is lower than CBO projected, what happens? » Impact on beneficiaries’ costs » Impact on the federal government’s costs What policy changes may be needed if enrollment uptake occurs more slowly than expected? © Avalere Health LLC Page 8