Medicare Part D Helps Beneficiaries, Changes Are Needed
Medicare Part D
Two-thirds of respondents to the latest Commonwealth Fund Health Care Opinion Leaders Survey agree (strongly agree or agree) that enactment of Part D was on balance good for beneficiaries, but majorities also support basic changes to the law. Opinion leaders in the business/insurance/other health care industry sector were most supportive of the law, with 95% agreeing it was good for beneficiaries, while 56% to 67% of respondents in academic/research institutions, health care delivery, or other sectors said it was good for beneficiaries.
Fewer than one-third (30%) of respondents agreed that making Medicare drug coverage available only through private plans was, on balance, good for beneficiaries. About one-third (36%) agree that the current benefit structure - including a "coverage gap" during which most enrollees are responsible for all of their covered costs - will, on balance, help beneficiaries who are most vulnerable to high drug costs.
Respondents were asked about approaches to address problems with the structure and complexity of the benefit, with majorities voicing support for several proposed changes. Just 8 percent of all respondents favored leaving the deadline and penalty for late enrollment in place, although 22 percent of the business/insurance/or other health care industry sector respondents favored this option. Fifty-one percent of all respondents favor extending the enrollment deadline and removing the penalty, while 39 percent favor leaving the deadline in place, but allowing people to enroll in the program next year without penalty (39%).
Three-fourths (77%) of respondents agreed that benefits should be more standardized to reduce variation among plans, and 69 percent said better information on cost-sharing and formulary structure should be provided to beneficiaries. Only 2 percent said the system should be left as it is.
In a commentary on the survey findings, "The Medicare Modernization Act at Midyear," John Rother, Group Executive Officer of Policy and Strategy for AARP says "Part D is really helping millions of people afford prescription drugs," but also notes that to date, Part D has fallen short in providing generous coverage to people with limited incomes, and recommends changes such as eliminating the asset test and simplifying the application process for the low-income subsidy.
In another commentary, "Medicare Part D: A Successful Public-Private Partnership," Karen Ignagni, President and CEO of America's Health Insurance Plans (AHIP), says the drug benefit is "one of this country's most remarkable success stories," adding that "there is more to be done, for example: Ensuring that the asset test does not arbitrarily exclude low-income beneficiaries from participating in the Part D subsidy; ensuring that every beneficiary has the coverage most appropriate for his or her needs; repealing the "lock-in" requirement to allow beneficiaries to enroll in a Medicare Advantage plan secure in the knowledge that they can change their mind if it is not the right delivery system for them."
Majorities of the 180 survey respondents favor (strongly favor or favor) additional policy changes in the Medicare drug benefit:
- 79 percent favor allowing plans to offer coverage through the coverage gap as an option to the enrollee, with an additional premium, without pushing back the catastrophic threshold.
- 71 percent favor filling in the donut hole by some combination of increased co-payments and additional government funding.
- 62 percent favor raising the income level needed to qualify for a low-income subsidy.
- 57 percent favor eliminating the asset test needed to qualify for a low-income subsidy.
- 78 percent favor offering a comprehensive benefits option that combines all Medicare benefits in one package as an alternative to having to supplement basic Medicare coverage with both private drug plan coverage and Medigap insurance.
- 64 percent favor offering an alternative option for prescription drug coverage through the traditional Medicare program, in addition to private plans under Part D.
- 82 percent favor giving Medicare the authority to negotiate drug prices.