The Medicare Drug Benefit: How Good Are the Options?
A new report prepared for the California Health Foundation report says that dual eligibles don’t have the same access to medications that they did under Medi Cal.
From the onslaught of TV ads to stacks of direct mail appeals, California’s 4.3 million Medicare beneficiaries face a dizzying array of choices for the new prescription drug benefit. Depending on the county where they live, Medicare consumers in California have 50 to 71 Part D plans to choose from.In the first analysis of its kind, The Medicare Drug Benefit: How Good Are the Options? examines the state’s Medicare drug plan offerings and attempts to answer two important questions. First, does it matter which plan a beneficiary chooses? And second, is coverage for low income beneficiaries better under Medicare Part D or Medi-Cal?
Among the positive findings of the issue brief are:
- Federal protections for certain drug classes have led to more extensive coverage by all plans for drugs in protected classes than in unprotected classes.
- On average, the ten auto-enrollment plans for dual-eligibles—low income beneficiaries who qualify for Medicare and Medi-Cal—do not offer distinctively different coverage than higher-cost plans.
Other key findings should be of concern to policymakers and consumer advocates, including:
- There are significant differences in coverage among the plans, yet several factors, including the sheer number of plans and the absence of a clear relationship among plan features like premiums and the number of drugs covered, contribute to a very complex decision-making process for beneficiaries.
- On average, Part D coverage for dual-eligibles is inferior to coverage under Medi-Cal. Moreover, coverage varies widely for dual-eligibles depending on the plan into which they were auto-enrolled. Both findings have important implications for the health of these beneficiaries.