Juliette Cubanski

Medicare Part D Update — Lessons Learned and Unfinished Business

In this report, the authors review the experience to date with the Medicare Part D prescription-drug plan and discuss the challenges facing policymakers.

Medicare Doesn’t Work As Well For Younger, Disabled Beneficiaries As It Does For Older Enrollees

Medicare is not working as well for its eight million disabled beneficiaries under age sixty-five as it is for its older beneficiaries. We report on a 2008 survey that found significant differences between the two Medicare populations, with the younger group experiencing more problems of cost and access. Even with the Medicare Part D prescription drug program, the nonelderly disabled reported greater difficulty in affording medications, and more adverse health consequences as a result. One potential remedy is the Patient Protection and Affordable Care Act. The law includes reforms that could improve access to care and limit out-of-pocket expenses for the nonelderly disabled in Medicare-as well as those who are waiting to become eligible for the program.

Medicare Per Capita Spending By Age And Service: New Data Highlights Oldest Beneficiaries

Medicare per capita spending for beneficiaries with traditional Medicare over age 65 peaks among beneficiaries in their mid-90s and then declines, and it varies by type of service with advancing age. Between 2000 and 2011 the peak age for Medicare per capita spending increased from 92 to 96. In contrast, among decedents, Medicare per capita spending declines with age.

Health Coverage and Expenses: Impact on Older Women's Economic Well-Being

The health issues women face over the course of their lives, as well as policies that shape Medicare, Medicaid, and other supplemental coverage can affect retired womens economic well‐being. This study uses a nationally representative sample of Medicare beneficiaries aged 65 and older in 2002 to explore gender‐based differences in health and long‐term care use, spending patterns, and the financial burden of health and long‐term care out‐of‐pocket health expenses. Womens health care expenses were higher than mens; older women paid for a greater share of their total spending out of pocket and they faced a greater financial burden by shouldering these out‐of‐pocket costs with less income at their disposal. Low‐income women, those with Medigap or no supplemental coverage, and white women, who are less likely to qualify for Medicaid which covers long term care, faced the greatest financial burdens associated with health and long‐term care costs. The implications of these findings for women in the context of the current health policy landscape are discussed. Controlling health spending and developing options to finance long‐term care are key elements of the policy solutions that will need to be developed to preserve and support economic security for millions of retired women in the United States.

Medicare’s Part D Drug Benefit At 10 Years: Firmly Established But Still Evolving

Despite initial controversy and uncertainties, Medicare Part D now provides drug coverage to thirty-nine million beneficiaries through dozens of private plans in each region. Although firmly established, the program faces challenges, including projected spending growth. Enrollees also face challenges as plans adopt new strategies to control costs.

The Private Health Insurance Choices of Medicare Beneficiaries How Much Does Price Matter

This article presents, critiques, and analyzes the influence of prices on insurance choices made by Medicare beneficiaries in the Medicare Advantage, Part D, and Medigap markets. We define price as health insurance premiums for the Medicare Advantage and Medigap markets, and total out-of-pocket costs (including premiums and cost sharing) for the Part D market. In Medicare Advantage and Part D, prices only partly explain insurance choices. Enrollment decisions also may be influenced by other factors such as the perceived quality of the higher-premium plans, better provider networks, lower cost-sharing for services, more generous benefits, and a preference for certain brand-name products. In contrast, the one study available on the Medigap market concludes that price appears to be associated with plan selection. This may be because Medigap benefits are fully standardized, making it easier for beneficiaries to compare alternative policies. The article concludes by discussing policy options available to Medicare.