Medicare Part D Shows Welcome Improvements, but There's Work Ahead

By Burke, Georgia | Aging Today, November/December 2011 | Go to article overview

Medicare Part D Shows Welcome Improvements, but There's Work Ahead


Burke, Georgia, Aging Today


Changes to the Medicare Part D prescription drug program brought about by the Affordable Care Act (ACA), though important, are not enough to fix outstanding problems, especially those affecting low-income beneficiaries.

The benefit designs of Medicare Part D plans vary greatly, making it difficult for consumers to make reasoned choices. Moreover, according to a June 2011 report from the Government Accountability Office (www.gao.gov/new.items/ dllS46r.pdf), requirements for managing its use, such as restrictions on drug access (requiring doctors to try an alternate drug first), have increased over the life of the program. Medicare Part D, now six years old, had a very rocky start, but has improved over time.

Dual Eligibles Still Tricky

The program continues to be a particular challenge to people who are dually eligible for Medicare and Medicaid, and others who qualify for the Low Income Subsidy (LIS).

Delays in data transmission from state Medicaid agencies create gaps in coverage for new dual eligibles. And, many low-income beneficiaries are randomly assigned to plans that may not meet their needs. The ACA sought to address some issues affecting low-income beneficiaries and also went further.

In order to fix a perennial problem of coverage delays from last-minute enrollments and to more closely synchronize Medicare open enrollment with periods commonly used by employer plans, ACA moved the Part D enrollment period up this year to begin Oct. 15 and close Dec. 7. New enrollments will be effective Jan. 1. The old closing date had been Dec. 31.

Another change for 2012 eliminates drug co-payments for individuals who qualify for both Medicare and Medicaid and are receiving nursing home-level care, but living in the community. Residents of nursing homes had already been in zero co-pay status. The change reflects a broader theme in health reform, a "rebalancing" of financial incentives so people receiving equivalent care in the community are on an equal footing with those in institutions.

Goodbye, Donut Hole

The biggest positive change for Part D in health reform is the gradual elimination of the donut hole, the coverage gap in which beneficiaries had to cover the full cost of their drugs while still paying premiums. …

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Medicare Part D Shows Welcome Improvements, but There's Work Ahead
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