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The Summer Student Intern Experience

 

Medicare Part D

- GETTING THE MOST OUT OF MEDICARE'S NEW DRUG COVERAGE

Enactment of the 2003 Medicare Modernization Act created a new market for prescription drug coverage that is overseen by the Centers for Medicare and Medicaid Services (CMS) and is commonly referred to as Medicare Part D. There are approximately 45 million Medicare beneficiaries. About 26 million of these beneficiaries currently have Part D prescription drug coverage, of which 17.5 million are enrolled in stand-alone drug plans. As Medicare has evolved into a program giving seniors an increasing number of choices about plans and coverage options, the role for community outreach and education becomes crucial in order for seniors to gain the most from Medicare. Through outreach and education efforts, this project can improve the health and financial well being of the elderly community in New York.

Research conducted by Dr. Kosali Simon in the College of Human Ecology's Department of Policy Analysis and Management has analyzed the differences in generosity among plans offered to 3 million beneficiaries in New York State, many of whom may not be selecting the best plan for them due to the complexity of choices offered. Plans vary dramatically in ways that depend on the specific set of drugs needed by seniors. CMS has a web-based tool which allows seniors to determine which plan is the most affordable for them, but recent evidence from the Kaiser Family Foundation shows that only 6% of seniors used this tool. In fact, 72% of seniors have never even been on-line.

Some seniors who are not yet enrolled may benefit from gaining drug insurance if counseled about the benefits. Other seniors who are enrolled may not have chosen the most affordable plan for them. A key goal of this program is to educate the community educators, trainers, volunteers, and ultimately the seniors about the benefits and complexities in choosing a Part D plan, resulting in increased numbers of enrollees as well as increasing the number who choose the most cost effective plans.

Experience with Medicare Part D enrollment last year showed that many seniors were left in a position of making poorly informed decisions. Helping seniors conduct an optimal search for a drug plan can lead to substantial savings as out of pocket drug costs vary substantially by plan and by drug. Utilizing the data sets developed in Dr. Simon's research, the tables on this website have been developed to portray plan coverage profiles of individual drugs, plan coverage profiles of sample medication regimens, and profiles of insurance plan coverages. Promotional materials from the CMS Partnering web site have been collected and are also provided here.

With the information in this database it is possible to compare the different stand alone prescription drug plans available in your New York State. Comparisons across plans are shown in a way that will show consumers the extent of plan variation in things that will matter most to them-notably the co-pays needed for specific commonly used drugs, the monthly premium, the prior authorization rules applied to them etc. We hope that this user-friendly format material will encourage seniors to seek more assistance in conducting a plan comparison to find the most financially suitable plan for them.

MEET THE PROJECT LEADERS

Kosali Simon

Principal Investigator

Bob Harris

Project Manager

Links to relevant articles from our program:
Medicare Part D's Effects on Elderly Patients' Drug Costs and Utilization
Older Adults Prefer Less Choice Than Young Adults


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This material is based upon work supported by a grant from the Dean of the College of Human Ecology and Smith Lever funds from the Cooperative State Research, Education, and Extension Service, U.S. Department of Agriculture. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the U.S. Department of Agriculture.
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