The Impact of Medicare Part D

Running Title : Medicare Part D

THE IMPACT OF MEDICARE PART D

ON DUAL ELIGIBLE BENEFICIARIES

2007 TABLE OF CONTENTS

Part I : The Selected Contemporary Benefits Issue 4

Part II : of the Nature of the Issue and its Origins 6

Part III : Literature Review 8

Part IV : Business Environment Impact 13

Part V : Employer Impact 15

Part VI : Employee Impact 16

Part VII : State and Federal Laws and Regulations 17

Part VIII : Recommendations 19

Part IX : References 23 LIST OF COMMONLY USED ABBREVIATIONS

CMS Centers for

Medicare and Medicaid Centers

EBRI Employee Benefit Research Institute

HSA Health Savings Account

MA Medicare Advantage Plan

MMA Medicare Prescription Drug , Improvement , and Modernization Act

PDP Prescription Drug Plan

SPAP State Pharmaceutical Assistance Program Part I : The Selected Contemporary Benefits Issue

Affordable drug coverage under Medicare has been a pressing issue in the US for quite some time now (Slaughter , 2006 . In response to this issue , the Medicare Prescription Drug , Improvement , and Modernization Act (MMA ) was passed on December 8 , 2003 , establishing a voluntary drug benefit for Medicare beneficiaries and creating a new Medicare Part D (Medicare-PartD .com , 2007 . Under the original Medicare program , which includes Part A for hospital care , and Part B for physician , outpatient care , and durable medical equipment , prescription drug benefits were not available (Wikipedia , The Free Encyclopedia , 2007 . Part D gives elderly and disabled people already enrolled or eligible for Medicare access to drug coverage beginning January 2006 (Medicare-PartD .com 2007

Unfortunately , Medicare 's new prescription drug benefit had a rocky start , particularly in terms of implementation (Rovner , 2006 . The program is administered by private insurance plans which are in turn reimbursed by the Centers for Medicare and Medicaid Centers (CMS )Center for Medicare Advocacy , Inc , 2007 . the organization which replaced the Health Care Finance Association (HCFA (Medicare-PartD .com 2007 Wikipedia , The Free Encyclopedia , 2007 . Implementation of this new prescription drug benefit has specifically raised concerns for individuals eligible for both Medicare and full Medicaid benefits otherwise known as dual eligible beneficiaries

The for this thesis was selected since the issue on dual eligible beneficiaries , and the difficulties they encountered during the roll-out of the Part D program , affects approximately 6 .5 million Americans (Rovner , 2006 ) who used to receive their drug benefit under the Medicaid program . Upon the roll-out of Part D in January 1 , 2006 , these dual eligibles were assigned to one of the eight Medicare programs , and were then mandated by law (MMA ) to receive their drug benefit from Medicare Part D , not Medicaid . Problems with disclosing information to Medicare as to who were the dual eligibles (who largely come from low-income families ) have resulted in these peoples being charged as higher-income beneficiaries under the Part D program , and thus made them incapable of affording the medicine they needed

Part D is a voluntary program and this where the issue arises . Unlike coverage in Medicare Parts A and B , Part D coverage is not provided for within the traditional Medicare program . Beneficiaries have to enroll...