Implications of the 2003 Medicare law for older adults and people with disabilities

Translating “Legislative Sausage” into Understandable Choices

Diane Archer, Founder & Special CounselMedicare Rights Center

Academy Health, June 28, 2005

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Overview of Today’s Talk

1. Back to the Basics: Medicare as we know it and the 42 million Americans it serves.

2. “But it’s good for you:” Challenges enrolling people in benefits programs.

3. Lessons learned the hard way: Key ingredients to a successful enrollment campaign.

4. New program, new challenges: The Medicare prescription drug benefit.

5. Tried and true: Ensuring access to benefits for America’s most vulnerable.

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Back to the Basics: Medicare as we know it

Automatic enrollment: Medicare Part B has a 95.5% participation rate.

No need to choose a plan: Medicare covers services that are “reasonable and necessary”

Nationwide and open access to doctors: People with Original Medicare can see doctors and use facilities across the country. Currently, over 90% of doctors accept Medicare.

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42 million Americans

Health: Currently, 78% of the Medicare population suffer from one or more chronic conditions that require ongoing medical management.

Income: Many on Medicare live with modest incomes and assets;

51% have incomes below 200% of poverty ($19,140/single and $25,660/couple in 2005); and

48% have countable assets (savings accounts, stocks, bonds, etc.) below $10,000.

Health Literacy: One-third of men and women with Medicare are unable to properly understand basic health-care information

70% of people over 85 have low health literacy. 23% of the Medicare population have cognitive

impairments

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“But it’s good for you” Only one-third of eligible persons are

enrolled in a Medicare Savings Programs (MSP) after 15 years.

Only twenty five percent of people eligible for “transitional assistance” under the Medicare drug discount card program have been enrolled. The program expires in six months.

Most were enrolled automatically by their state or private health plan.

Little data is available on actual usage of discounts cards.

Even with a one-page application and few documentation requirements, New York State’s pharmaceutical assistance program (“EPIC”) has a 50 percent enrollment rate for all eligible residents.

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20

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Enrolled Eligible

Medicare Savings Programs

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Lessons learned the hard way Simplify, simplify, simplify: The simpler the program, the more

likely people will access and benefit from it.

Tailored answers: Federal message is only a piece of the message, need to integrate state and local messages.

Repeat interventions: People need to hear messages several times to act on information. SSA’s one-time outreach to over 20 million people likely eligiblefor a Medicare Savings Program yielded less than 3percent enrollment.

Adequate professional support network: Current State Health Insurance Assistance Program (SHIP) funding inadequate to meet consumer needs.

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New Program, New Challenge: The Medicare Prescription Drug Benefit

New Program Design Process for securing drug benefit different from

Medicare Part B (which is automatic) Other low-income assistance programs (MSPs)

“Extra Help” requires two steps: enrolling in program, picking plan.

New Coordination Issues What will happen to existing State Rx programs? Will they

wraparound? If people are happy with their SPAP, will they still need to enroll in Medicare’s drug benefit?

People with Medicaid likely to fall through cracks. How will “extra help” affect eligibility for other public benefits

such as Food Stamps and housing assistance?

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New Program, New Challenge: The Medicare Prescription Drug Benefit

New Coverage Issues Formularies: How to know what drugs are covered

when formularies can be changed monthly? Pharmacy networks: Will people know where to go to

get their prescriptions filled? New Cost Issues

Copays for people with Medicaid Tradeoffs for people with incomes under 300% of FPL

who don’t qualify for “extra help.” Premiums and penalties: Will people delay enrolling

because of high premium?

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What works? Tried & True Strategies for Increasing Enrollment

Hotline follow up: One call generally will not get people to act; continued follow

up to track client through application process helps ensure enrollment.

Seniors Out Speaking on Medicare (SOS Medicare): Keep it short: brief, focused messages keep audience

engaged Empower people with information: Emphasis on

understanding health benefits, rights and options before being confronted with a crisis.

Create relationships: Peer counselors have become trusted source of information and audience members now turn to them with questions.

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New Challenges, New Strategies:

Linking Individuals in Need to Care and Services (LINCS):

The LINCS program will create a network of remotely trained and remotely operating volunteer counselors who help older adults complete and submit the application for the new Medicare drug benefits “extra help” for people with low incomes.

Volunteers will also maintain a supportive relationship with prospective enrollees by following up with timely health care messages and referring them as necessary to other resources.

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