Medicare Part D: Issues for Dual Eligibles on the Eve of Implementation

This issue brief describes how dual eligibles are treated under the Medicare drug benefit and the issues raised by their transition from Medicaid to Medicare drug coverage. The brief also explores key differences in the Medicare drug benefit compared to Medicaid drug coverage (formularies, copayments, and appeals policies) which could make the shift especially challenging for dual eligibles.

Issue Brief (.pdf)

These issue briefs, prepared by the Centers for Medicare Advocacy, Inc., provide information about how the Medicare drug benefit will affect beneficiaries. The briefs address issues related to dual eligibles, residents of nursing home and assisted living facilities, and the Part D exceptions and appeals processes.

Medicare Part D: Issues for Dual Eligibles on the Eve of Implementation

Medicare Prescription Drug Coverage for Residents of Nursing Homes and Assisted Living Facilities: Special Problems and Concerns

The Exceptions and Appeals Process: Issues and Concerns in Obtaining Coverage Under the Medicare Part D Prescription Drug Benefit

This issue brief describes how Medicare beneficiaries navigate the Medicare Part D exceptions, appeals, and grievances processes to get access to medically necessary prescriptions not covered under their Medicare prescription drug plans. It identifies and describes policy issues that may make it difficult for beneficiaries to utilize the processes.

Issue Brief (.pdf)

This issue brief describes Medicare drug benefit policy issues for residents of nursing homes and other long-term care settings, such as assisted living facilities and board and care facilities. The brief addresses differing rules for nursing home and non-nursing home settings, as well as for dual eligibles residing in long-term care facilities.

Issue Brief (.pdf)

Still keeping in mind that many employers are trying to find ways to deal with the rising cost of health insurance…  Suppose your employer gave you the following two options.  Which option would you choose?

Based on those who have health insurance through their or their spouse’s employer (n=1542)

                76                OPTION ONE: You continue to receive the same health care coverage you have now, but you are required to pay a higher monthly premium

                19                OPTION TWO: Your employer switches to a health plan that is more restrictive and offers fewer benefits, but you continue to pay the same monthly premium you pay now

                5                Don’t know

                1                Refused

Would you prefer to have your employer pay for all or part of your health insurance at work, or would you rather buy health insurance yourself, with your employer giving you the cash amount they would have contributed – or doesn’t it make much difference to you? 

Based on those who have health insurance through their or their spouse’s employer (n=1542)

                55                Employer pay for all or part of your health insurance at work

                7                Buy health insurance yourself, with your employer giving you the cash amount they would have contributed

                37                Doesn’t it make much difference to you

                1                Don’t know

                *                Refused

What if your employer gave you the cash amount they would have contributed to your insurance, and you had to buy health insurance on your own.  Do you think purchasing your own coverage would make it EASIER or HARDER for you to …, or wouldn’t it make much difference? 

Based on those who have health insurance through their or their spouse’s employer (n=1542)

Asked of one-half of sample (n=755):

a              get a good price for health insurance

                6                Easier

                81                Harder

                10                Would not make a difference

                3                Don’t know

b              find or keep health insurance if you are sick

                4                Easier

                79                Harder

                15                Would not make a difference

                2                Don’t know

Asked of one-half of sample (n=787):

c              handle administrative issues, such as filing a claim or signing up for a policy

                4                Easier

                73                Harder

                21                Would not make a difference

                2                Don’t know

d              find a plan that matches your needs well

                9                Easier

                71                Harder

                17                Would not make a difference

                2                Don’t know

This fact sheet summarizes the early and periodic screening, diagnostic, and treatment (EPSDT) Medicaid benefit for children and the current issues and debates that could impact the benefit.

Fact Sheet (.pdf)

Dual eligible beneficiaries who participate in Medicaid home and community-based waiver programs usually do not have a centralized care provider to manage their health care benefits and services. For the new Medicare prescription drug benefit, no individual is designated to assist participants with their prescription drug plan selection, comparison of formularies, and if necessary, management of their exceptions and appeals should a medication be denied by their plan.

This paper offers state and federal policymakers ideas for what to monitor to ensure that waiver participants maintain equal access to prescription drugs as their institutionalized peers, and can remain in waiver programs without increased physical harm or financial hardship

Issue Brief (.pdf)

Executive Summary (.pdf)

Health Care Coverage and Financing Issues in California: An October 2005 Update

This brief summarizes recent health insurance coverage trends in California and the Medi-Cal program, provides an overview of the state’s newly adopted FY 2005-06 budget agreement, and discusses key issues driving the current health policy agenda. The brief concludes with a discussion on Medicaid reform actions at the federal level and the potential implications for California.

Issue Brief (.pdf)

This survey conducted jointly by the Washington Post, the Kaiser Family Foundation and the Harvard School of Public Health assesses the views and attitudes of DC-area teens and their parents on priorities involving career, child-rearing and family; their personal hopes and fears; their outlook towards the nation’s future; and generational differences in experiences and expectations. The survey also includes comparative data from a national survey of teens.

The was conducted among 800 pairs of parents and teenagers in the region, including the District of Columbia, Maryland, and Virginia. Interviews were conducted by telephone between April 26 and May 29, 2005 by ICR/International Communication Research. Not all questions were asked of parents. Teenagers were defined as those between 14 and 18 years of age. The survey also includes additional questions asked of a national sample of 570 teenagers between 14 and 18 years of age.

Survey (.pdf)