State Responses to Medicare Part D

17
State Responses to Medicare Part D Presented by: Kimberley Fox, Senior Policy Analyst, Institute for Health Policy Academy Health Annual Research Meeting Seattle, WA June 2006

description

State Responses to Medicare Part D. Presented by: Kimberley Fox, Senior Policy Analyst, Institute for Health Policy Academy Health Annual Research Meeting Seattle, WA June 2006. Survey Methods. Funded by the National Pharmaceutical Council Literature and document review - PowerPoint PPT Presentation

Transcript of State Responses to Medicare Part D

Page 1: State Responses to Medicare Part D

State Responses to Medicare Part DPresented by:

Kimberley Fox,

Senior Policy Analyst,

Institute for Health Policy

Academy Health Annual Research Meeting

Seattle, WA

June 2006

Page 2: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

Survey Methods

Funded by the National Pharmaceutical Council Literature and document review Fall 2005 survey w/ telephone follow-up

Snapshot of states’ plans for adapting programs to MMA 24 existing SPAP programs 14 Medicaid agencies (representing 66% of Medicaid drug

spend), 11 in states with SPAPs. Response rate: @96% Findings reflect responses at time of survey completion.

Page 3: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

State Responsibilities/Options Under Part D Medicaid

Assist w/ transitioning duals Clawback payments LIS application and MSP screening responsibilities. May fill Part D gaps with state-only dollars

State Pharmacy Assistance Programs (SPAP) May fill Part D gaps Qualified SPAP expenditures count toward TROOP Part D plans must coordinate Transitional grant funding available

Page 4: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

Key Differences between Part D and State Pharmacy CoverageMedicaid

May face higher copayments Loss of guaranteed access if they can’t afford copayments No coverage of excluded drugs under Part D Formularies may not include drugs covered under Medicaid Loss of coverage of denied drugs during appeal More limited pharmacy networks.

State Pharmacy Assistance Programs (SPAPs) Tighter formularies/ more limited pharmacy networks LIS eligible – potentially lower cost-sharing Non-LIS eligible –

Up-front costs such as premiums and deductibles previously not required in many programs

Higher cost-sharing before and in the donut hole (varies by state).

Page 5: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

Part D Transitional Enrollment Issues for SPAP Enrollees and Duals Duals

Medicaid drug coverage ends Jan 2006 All duals ‘deemed eligible’ for low income subsidies Randomly assigned to below benchmark PDPs by CMS – Nov 2005 State Medicaid agencies can conduct formulary matches to recommend

more appropriate plans.

SPAP Enrollees Most not deemed eligible for LIS, must apply (exc. MSPs) All enrollees must voluntarily enroll in PDP/MA-PD Qualified SPAPs cannot auto-enroll enrollees into a preferred plan Various options to ‘facilitate’ LIS application/Part D enrollment

Page 6: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

SPAP and Medicaid Part D Gap-filling Options Medicaid

Premium assistance above LIS benchmark Copayments Off-formulary/PDP denied drugs or during appeals Non-Part D covered drugs (eligible for FFP)

SPAP Premium assistance (LIS or full premium) Wrap around full/partial LIS or non-LIS out-of-pocket costs

Deductibles, copayments, donut hole, Off-formulary/PDP denied drugs or out-of-network pharmacies Non-Part D covered drugs

Page 7: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

Filling Part D Gaps for Duals: Selected Medicaid Plans 2006

Source: Part D Survey of SPAP and Medicaid Directors, Fall 2005.

NY

NJ

NJ

NY,NJ

NY

NJ

NY,NJ

NJ

0 2 4 6 8 10 12 14

Part D Excluded Drugs

Drugs during appeal

Drugs Denied by PDP

Part D Copays

Premiums Above LIS

# of States

Source: Part D Survey of Medicaid and SPAP Directors, Fall 2005

Source:

N=14

Page 8: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

Medicaid Transition Plans for Part D Enrollment, 2005

Source: Part D Survey of SPAP and Medicaid Directors, Fall 2005.

4

3

5

13

13

0 2 4 6 8 10 12 14

Screening Applicationssent to SSA for MSP

3 Mo. Supply in Dec

Info to Duals on FormularyMatch

Collaborating w / RelatedAgencies

Educating Providers

# of StatesSource: Part D Survey of Medicaid and SPAP Directors, Fall 2005

Page 9: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

SPAP Plans Once Part D Begins, 2006

1

1

5

17

0 5 10 15 20

Maintaining Medicaidwaiver

Closing to MedicareEligibles*

Program Closing

Maintaining SomeCoverage

# of States

Source: Part D survey of SPAP and Medicaid Directors, Fall 2005.*Maryland is also closing its waiver program to Medicare eligible but will continue a second state-only program to provide wrap assistance for non-LIS eligible persons.

N=24

Page 10: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

Specific Part D Gaps Filled by SPAPs, 2006

Source: Part D Survey of SPAP and Medicaid Directors, Fall 2005.

3

10

4

5

14

11

13

4

12

0 5 10 15

Out of Netw ork

Non-Part D Covered

Appeal for Bene

Formulary

Donut Hole

Copayment

Deductible

Late Penalty

Premium

# of States

Source: Part D Survey of Medicaid and SPAP Directors, Fall 2005

N=17

Page 11: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

More than Half of SPAP Enrollees Will Not Qualify for Full LIS*

N=26 programs/23 states

Source: Part D Survey of SPAP and Medicaid Directors, Fall 2005.

44%

13%

43%

<135% FPL

135-150% FPL

>150%FPL

*Percentages based on estimates by state officials from income data, generally do not include assets.

Page 12: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

SPAP Efforts to Enroll Members in LIS, 2005

Source: Part D Survey of SPAP and Medicaid Directors, Fall 2005.

*For LIS and/or Part D Enrollment

4

5

12

9

14

0 5 10 15

State w ill Appeal LIS

Plans to Collect Assets/submit applicationsfor enrollees

Help w / Completing LIS application

LIS Authorized Rep

Mandating LIS

# of StatesSource: Part D Survey of Medicaid and SPAP Directors, Fall 2005

N=17

Page 13: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

SPAP Efforts to Enroll Members in Part D Plans, 2005

Source: Part D Survey of SPAP and Medicaid Directors, Fall 2005.

*For LIS and/or Part D Enrollment

N=17

5

5

6

11

14

0 5 10 15

Intelligent RandomAssignment

Random Assignment

Co-branding

Authorized Rep forPart D enrollment

Mandate Part D

# of StatesSource: Part D Survey of Medicaid and SPAP Directors, Fall 2005

Page 14: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

Few States Expanding SPAPs to New Groups

Source: Part D Survey of SPAP and Medicaid Directors, Fall 2005.

0

5

10

15

Excluding LISeligible

Expanding IncomeEligibility

Expanding toDisabled

Including Duals

# of

Sta

tes

N=17 states

Source: Fox and Schofield, Medicaid and SPAP Part D Survey, Fall 2005

Page 15: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

Summary of State Actions Short-term emergency coverage (Medicaid/ some

SPAPs) Medicaid largely not filling Part D gaps for duals over

time, except Part D excluded drugs. SPAPs holding existing enrollees harmless, but not

expanding benefits/eligibility Only a few states starting new SPAPs

States generally exercising caution… wait and see approach.

Page 16: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

Policy Implications/ Discussion Differences in State D-Gap plans for duals and SPAP enrollees

Larger cost-sharing differences for non-LIS SPAP enrollees relative to prior coverage than for duals.

Large potential savings to SPAP as secondary payer; little savings and potential short-term losses from the clawback for Medicaid.

Formularies – to wrap or not to wrap. Don’t want to encourage Part D plans to limit formularies to narrowest possible

standard Adverse effects from reduced drug coverage as a result of restricted formularies may

result in more cost to the state if that leads to use of more expensive medical services. States may want to reserve the right to cover in limited circumstances where likelihood

of adverse events is higher. At minimum, could help duals appeal. Reconsideration of federal match (?)

SPAPs Can Do More to Maximize SPAP Savings allowing them to potentially fill more gaps or expand eligibility.

Monitor state coverage decisions on duals and SPAP enrollees.

Page 17: State Responses to Medicare Part D

6/27/06 Muskie School of Public Service

Further Information

For copies of this presentation: [email protected]

Full report of survey findings available at:

http://muskie.usm.maine.edu/m_view_publication.jsp?id=3409


2015 Medicare Product Medicare Advantage - … Medicare Product Medicare Advantage 1 . ... • What is a Special Needs Plan? • Medicare “Part C” Medicare Advantage Program Basics

2015 Medicare Product Medicare Advantage - … Medicare Product Medicare Advantage 1 . ... • What is a Special Needs Plan? • Medicare “Part C” Medicare Advantage Program Basics

Deciphering Medicare Part D

Deciphering Medicare Part D

Medicare Advantage and Part D Plans, Medicare Marketing Rules

Medicare Advantage and Part D Plans, Medicare Marketing Rules

Enrolling in Medicare Part A and Part B. › phcaadmin › docs... · won’t have to apply for Part B. Medicare will enroll you in Part B automatically. Your Medicare card will be

Enrolling in Medicare Part A and Part B. › phcaadmin › docs... · won’t have to apply for Part B. Medicare will enroll you in Part B automatically. Your Medicare card will be

Medicare Coverage of Diabetes Supplies & Services · Medicare Part C (Medicare Advantage Plans) is another way to get your Medicare benefits. It combines Part A, Part B, and, sometimes,

Medicare Coverage of Diabetes Supplies & Services · Medicare Part C (Medicare Advantage Plans) is another way to get your Medicare benefits. It combines Part A, Part B, and, sometimes,

Medicare Part C & Part D Member A&G 101 · 12/26/2013  · Medicare Part C & Part D Member A&G 101 Medicare Part C & Part D Training Breakout Session 2 2013 Annual Conference Definitions

Medicare Part C & Part D Member A&G 101 · 12/26/2013  · Medicare Part C & Part D Member A&G 101 Medicare Part C & Part D Training Breakout Session 2 2013 Annual Conference Definitions

Medicare Part B Presents: Medicare Updates 2013 - Valley Health System

Medicare Part B Presents: Medicare Updates 2013 - Valley Health System

Medicare Part D

Medicare Part D

Day 2 Medicare Advantage (Part C). Review Medicare For people 65+ and under 65 with a disability 4 parts of Medicare Part A: Hospital Insurance Part.

Day 2 Medicare Advantage (Part C). Review Medicare For people 65+ and under 65 with a disability 4 parts of Medicare Part A: Hospital Insurance Part.

Medicare Understanding your options PART A PART B D PART D PART C MEDICARE SUPPLMENT.

Medicare Understanding your options PART A PART B D PART D PART C MEDICARE SUPPLMENT.

Medicare Part A and Part B - Office of Inspector General 1 Medicare Part A and Part B ... (SNF) and some home health services. Medicare Part B covers designated ... Previous OIG work

Medicare Part A and Part B - Office of Inspector General 1 Medicare Part A and Part B ... (SNF) and some home health services. Medicare Part B covers designated ... Previous OIG work

January 1 – December 31, 2020 - Cigna … · Getting started as a member. You have both Medicare Part A and Medicare Part B (Section 2.2 tells you about Medicare Part A and Medicare

January 1 – December 31, 2020 - Cigna … · Getting started as a member. You have both Medicare Part A and Medicare Part B (Section 2.2 tells you about Medicare Part A and Medicare

Medi-Cal Handbook Medicare Coverage 30. Medicare Coverage · Medicare Coverage 30. Medicare Coverage 30.1 Medicare - Part A & Part B 30.1.1 Overview Medicare is a federal health insurance

Medi-Cal Handbook Medicare Coverage 30. Medicare Coverage · Medicare Coverage 30. Medicare Coverage 30.1 Medicare - Part A & Part B 30.1.1 Overview Medicare is a federal health insurance

MEDICARE PART B

MEDICARE PART B

Medicare Health Plans · Medicare Health Plans Under the Medicare Advantage (MA) program, private companies offer health plans that cover all Medicare Part A and Part B benefits.

Medicare Health Plans · Medicare Health Plans Under the Medicare Advantage (MA) program, private companies offer health plans that cover all Medicare Part A and Part B benefits.

2010 MEDICARE PART B

2010 MEDICARE PART B

1 1 Medicare. 2 2 Four Parts of Medicare: Medicare Part A – Hospital Insurance Medicare Part B – Medical Insurance Medicare Part C – Medicare Advantage.

1 1 Medicare. 2 2 Four Parts of Medicare: Medicare Part A – Hospital Insurance Medicare Part B – Medical Insurance Medicare Part C – Medicare Advantage.

Medicare Prescription Drug Coverage. 06/08/20102 Medicare Prescription Drug Coverage Referred to as Medicare Part DReferred to as Medicare Part D Available.

Medicare Prescription Drug Coverage. 06/08/20102 Medicare Prescription Drug Coverage Referred to as Medicare Part DReferred to as Medicare Part D Available.

Medicare Made Simple - EmblemHealth€¦ · Medicare Advantage Plans (Part C) Medicare Advantage Plans combine what Original Medicare covers, and often Part D, into a single plan.

Medicare Made Simple - EmblemHealth€¦ · Medicare Advantage Plans (Part C) Medicare Advantage Plans combine what Original Medicare covers, and often Part D, into a single plan.

MEDICARE GUIDE 2020 - AMAC€¦ · also applies to Medicare Advantage Plans and Medicare Prescription Drug Plans. 1-844-652-4663 | . MEDICARE HAS: Part A (Hospital) Part B (Medical)

MEDICARE GUIDE 2020 - AMAC€¦ · also applies to Medicare Advantage Plans and Medicare Prescription Drug Plans. 1-844-652-4663 | . MEDICARE HAS: Part A (Hospital) Part B (Medical)