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The launch of the Medicare Part D in 2006 offered senior citizens and disabled individuals an opportunity to select insurance plans as per their requirements following the Medicare Modernization Act (MMA) of 2003. The article assesses the success of this program and the benefits offered to users of the plan.

The health issues women face over the course of their lives, as well as policies that shape Medicare, Medicaid, and other supplemental coverage can affect retired women's economic well-being. This study uses a nationally representative sample of Medicare beneficiaries aged 65 and older in 2002 to explore gender-based differences in health and long-term care use, spending patterns, and the financial burden of health and long-term care out-of-pocket health expenses. Women's health care expenses were higher than men's; older women paid for a greater share of their total spending out of pocket and they faced a greater financial burden by shouldering these out-of-pocket costs with less income at their disposal. Low-income women, those with Medigap or no supplemental coverage, and white women, who are less likely to qualify for Medicaid which covers long term care, faced the greatest financial burdens associated with health and long-term care costs. The implications of these findings for women in the context of the current health policy landscape are discussed. Controlling health spending and developing options to finance long-term care are key elements of the policy solutions that will need to he developed to preserve and support economic security for millions of retired women in the United States. KEYWORDS women, Medicare, Medicaid, long-term care, financial burden, health care costs, retirement, health expenses, retirement, low-income DOI: 10.1080/15544770902901874

The article provides answers to questions about Medicare's current coverage of telehealth, changes made at the public health emergency, additional changes adopted by Congress and the administration, and some of the policy considerations.

OBJECTIVES: To evaluate whether increased placement of generic drugs on higher cost-sharing tiers in Medicare Part D is associated with coverage of multisource brandname drugs, plan type, or product characteristics. STUDY DESIGN: Descriptive study of Medicare Prescription Drug Formulary Files. METHODS: We analyzed plan coverage and tiering of brand-name drugs and matched generics from 2013-2019. We compared tiering changes and estimated out-of-pocket spending by tier for all Part D plans and by plan type (Medicare Advantage prescription drug [MA-PD] vs stand-alone prescription drug plan [PDP]) for covered generic drugs. Finally, we identified the generic products commonly placed on higher tiers in 2019 and categorized them based on clinical characteristics. RESULTS: Across 5,220,488 plan-product combinations in 2019, 76.4% of generic drug observations reflected coverage on Part D plan formularies, compared with only 12.1% of brand-name drugs. Between 2013 and 2019, the share of observations reflecting covered generics on lower tiers decreased from 76.8% to 53.9%, whereas the share on higher tiers increased from 7.5% to 28.0%. MA-PD plans were more likely than PDPs to place generic drugs on lower tiers, even among plan sponsors offering both plan types. Despite these trends, higher tier placement does not appear to be related to more generous coverage of brand-name products. Instead, in 2019, 70% of high-tier generics had multiple formulations, required heightened clinical monitoring, or had head-to-head treatment options available. CONCLUSIONS: Although Part D plans have increasingly placed covered generic drugs on higher formulary tiers over time, this may be partly explained by a drug's clinical profile and availability of substitutes rather than preferred brand-name drug coverage. [ABSTRACT FROM AUTHOR]

Medicare is a primary source of health insurance coverage for several million people younger than age sixty-five who have long-term disabilities. This analysis compared measures of access to care, cost concerns, and satisfaction with care for beneficiaries younger than age sixty-five versus those ages sixty-five and older, using the 2019 Medicare Current Beneficiary Survey. We also compared beneficiaries in traditional Medicare with those in Medicare Advantage, given that a growing share of younger beneficiaries with disabilities are enrolled in private plans. We found that Medicare beneficiaries younger than age sixty-five reported worse access to care, more cost concerns, and lower satisfaction with care than beneficiaries ages sixty-five and older, regardless of their type of Medicare coverage. Among beneficiaries younger than age sixty-five in traditional Medicare, the share reporting cost concerns was highest among those without supplemental coverage. All of these differences were statistically significant. Addressing gaps in coverage for people with disabilities could improve experiences for this often-overlooked segment of the Medicare population. [ABSTRACT FROM AUTHOR]

Rising health costs and an aging population present critical policy challenges. This paper examines the financial burden of out-of-pocket health spending among Medicare beneficiaries between 1997 and 2003. Over this period, median out-of-pocket spending as a share of income increased from 11.9 percent to 15.5 percent. In 2003, the 25 per- cent of beneficiaries with the largest burden spent at least 29.9 percent of their income on health care, while 39.9 percent spent more than a fifth of their income on health care. Results suggest that sustained increases in out-of-pocket spending could make health care less affordable for all but the highest-income beneficiaries. [ABSTRACT FROM AUTHOR]

The centerpiece of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was the Part D drug benefit, provided through new stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug (MA-PD) plans. We examine 2006 Part D enrollment data to analyze organization- and plan-level market share and enrollment by plan type, benefit design, and gap coverage. Ten organizations captured 72 percent of Part D enrollment, primarily in low-premium plans and those with name recognition. More than twelve million Part D enrollees without low-income subsidies enrolled in plans with limited or no gap coverage in 2006, but the number with actual spending in the gap remains to be seen. [Health Affairs 26, no. 1(2007): w1-w12 (published online 21 November 2006; 10.1377/hlthaff.26.1.wl)] [ABSTRACT FROM AUTHOR]

Several graphs are presented that show Medicare and end-of-life (EOL) care, including total Medicare beneficiary deaths in 2014, the share of total Medicare spending for people at the EOL from 2000-2014, and Medicare hospice use and spending in 2000 and 2014.

Several graphs are presented with figures on the U.S. Medicare and Medicaid programs including the annual out-of-pocket medical care costs of Medicare recipients by age group, trends in the share of Medicaid recipients enrolled in managed care programs, and per-person Medicaid spending for different categories of recipients.

Current approaches to reducing the number of uninsured include insurance tax credits for individuals and employers, expanding private group coverage, expanding eligibility for public programs, creating new public programs, and reforming insurance markets. Proposals vary in how they would expand coverage, how many uninsured would be covered, and how much they would cost. Although the costs of expanding coverage are significant, so are the costs of high uninsured rates. Moreover, expanding coverage would likely lead to substantial gains in health and productivity.

This Issue Brief was prepared for The Commonwealth Fund/John F. Kennedy School of Government Bipartisan Congressional Health Policy Conference, January 15-17, 2004.

This Issue Brief was prepared for The Commonwealth Fund/John F. Kennedy School of Government Bipartisan Congressional Health Policy Conference, January 15-17, 2004.