Transcript Summer Presentation - Medicare Part D: How Vulnerable

Medicare Part D
How are Vulnerable
Beneficiaries Faring?
Laura Summer
Health Policy Institute, Georgetown University
With Support from The Commonwealth Fund
Alliance for Health Reform
November 5, 2007
Issues Related to Auto-Enrollment
(Percent of Respondents Reporting How Often Issues Occur)
Medicaid beneficiaries who become
eligible for Medicare are not autoenrolled in a plan, and therefore have
no prescription drug coverage
Beneficiaries are enrolled in more
than one plan
6%
Auto-enrollment occurs, but the
pharmacy has no record of the plan
assignment
Beneficiaries are auto-enrolled in
plans that do not contract with
pharmacies near their homes
Very Often
12%
5%
10%
42%
16%
59%
38%
22%
60%
38%
3%
Often
8%
20%
31%
Sometimes
Source: Georgetown University Health Policy Institute Survey of Beneficiary Counselors: Part D and
Vulnerable Medicare Beneficiaries, November 2006.
70%
Resolving Issues Related to Auto-Enrollment
(Percent of Respondents Reporting on Average Time Required to Resolve Issues)
Medicaid beneficiaries who
become eligible for Medicare are
not auto-enrolled in a plan, and
therefore have no prescription
drug coverage
Auto-enrollment occurs, but the
pharmacy has no record of the
plan assignment
50%
8%
16%
3%
59%
Beneficiaries are enrolled in more
than one plan
32%
0%
< 2 Weeks
1 Month or more
26%
18%
25%
50%
16%
19%
27%
100%
2 Weeks to 1 Month
Frequently unresolved
Source: Georgetown University Health Policy Institute Survey of Beneficiary Counselors: Part D
and Vulnerable Medicare Beneficiaries, November 2006.
Difficulties Related to Obtaining Drugs
(Percent of Respondents Reporting how Often Issues Occur)
A needed drug is not on the plan's
formulary
A needed drug is on the formulary
but utilization management rules limit
access
12%
13%
Beneficiaries with multiple drug needs
have difficulty finding plans
Drugs on formulary are
subsequently taken off
Beneficiaries cannot find
appropriate plans that contract
with pharmacies near home
Very often
25%
28%
19%
5%
50%
15%
41%
25%
34%
37%
54%
2%
20%
26%
4%
Often
Sometimes
Source: Georgetown University Health Policy Institute Survey of Beneficiary Counselors: Part D
and Vulnerable Medicare Beneficiaries, November 2006.
87%
82%
81%
Consequences of Difficulties Related to
Procedures to Obtain Drugs
(Percent of Respondents Reporting How Often Consequences Occur)
100%
85%
83%
77%
75%
64%
48%
44%
48%
50%
25%
0%
28%
27%
11%
10%
Must pay outof-pocket
8%
16%
26%
21%
8%
40%
22%
2%
2%
Delays
Unable to get Health or well- More ER or
getting
needed drugs
being
other care
needed drugs
negatively
needed
affected
Very often
Often
Sometimes
Source: Georgetown University Health Policy Institute Survey of Beneficiary Counselors: Part D
and Vulnerable Medicare Beneficiaries, November 2006.
Reasons to Choose
New Part D Plans in 2008
100
90
>5 million beneficiaries
Newly eligible
All
80
Percent
70
60
50
Plans leave market
All
(except
most LIS)
Plan features change
(premiums or copays)
40
30
20
10
0
Marketing issues
LIS
Not below benchmark
Not below benchmark
(choosers)
Source: Georgetown University Health Policy Institute calculations based on 2008 program and
plan data. October 2007.
Choosing and Using New Part D Plans in 2008
>5 million
beneficiaries
Randomly reassigned by
CMS
New Plans
Initiate
change to
new plan
Newly eligible
Plans leave market
Not below
benchmark
(choosers)
*


*











Marketing issues
Plan features
change
Not below
benchmark
Choose new
plan
New Procedures
New formulary New utilization
management
rules



*Some beneficiaries with LIS will be randomly assigned or re-assigned by CMS.
Source: Georgetown University Health Policy Institute, October 2007
Issues Affecting Low-Income
Beneficiaries
(Number of beneficiaries affected)
Lost deemed status
Active LIS
redetermination
Plan no longer below
benchmark
Eligible for LIS but not
enrolled
447,000
500,000
2,567,000
3,300,000
Challenges Associated with the Part D Program
(Open-ended Responses: “Based on your experience, what are the two biggest
challenges in assuring that Part D works well for beneficiaries?”(
Challenges
Percent of
Responses
Difficult to get and understand information
23%
Program complexity
17%
Computer system problems
13%
Coverage restrictions
13%
Affordability
11%
Enrollment difficulties
9%
Other*
14%
* ”Other” includes various challenges, each representing 4% or less of responses.
Source: Georgetown University Health Policy Institute Survey of Beneficiary Counselors: Part D
and Vulnerable Medicare Beneficiaries, November 2006.
Policies and practices to reduce program
complexity for beneficiaries
• “Beneficiary-Centered” rather than “Random”
Assignment
• Uniform utilization management practices
• More monitoring: utilization management and marketing
• Improve electronic communication
• Simplify LIS enrollment: resource tests, MSP alignment