Press Release

Embargoed Until Contact

May 13, 2010
12:01 AM EST

Kay Campbell
(301) 652-1558


Sue Ducat
Director of Communications
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From Health Affairs

Why Many Low-Income Beneficiaries Opt Out of the Medicare Subsidy


Bethesda, MD -- The first in-depth analysis of Part D Medicare enrollment among senior citizens lacking prior drug coverage found that 63 percent of all eligible participants and 69 percent of low-income beneficiaries chose the program in 2006. However, only 29 percent of low-income senior citizens opted to also participate in the special subsidy program. These findings were released today in a Web First article in Health Affairs.


Lessons Learned: Who Didn't Enroll In Medicare Drug Coverage in 2006, And Why?
By Amy J. Davidoff, Bruce Stuart, Thomas Shaffer, J. Samantha Shoemaker, Melissa Kim, and Christopher Zacker


Davidoff, Stuart, Shaffer, Shoemaker and Kim are all affiliated with the University of Maryland School of Pharmacy in Baltimore; Kim is also affiliated with that University's law program; Zacker is director of regional outcomes research for Novartis Pharmaceuticals Corporation in East Hanover, New Jersey. Funding for this paper's research was provided by a grant from Novartis.


The authors examined the 2005 and 2006 Medicare Current Beneficiary Survey (MCBS), a nationally representative panel survey of the Medicare population linked to Medicare insurance claims and Part D enrollment data. A total of 9,909 people in that survey were enrolled in Medicare both years, 3,361 of whom lacked prescription drug coverage in 2005. The data show that many who chose Medicare Part D already had supplemental medical coverage, and this group enrolled in Part D at higher rates; for instance, 65 percent of those with private supplemental coverage enrolled in Part D in 2006, while 82 percent with other types of supplemental coverage enrolled. In evaluating whether Part D implementation succeeded in enrolling the most vulnerable beneficiaries, based on having multiple chronic conditions or pre-existing financial barriers to prescription drug use, the authors found the enrollment rates were high for this group -- 69 percent overall and 74 percent among the low income. By contrast, 39 percent of seniors not deemed vulnerable did not enroll in the program, claiming a lack of need for prescription drugs. And among the vulnerable low-income seniors who chose not to participate in Part D, many claimed that premiums were too high, enrollment instructions were confusing, or that they lacked knowledge of the plan.


The authors concluded: "The success of the Part D program will depend on its impact on access to needed pharmaceuticals, reduced financial hardship, and improved health status. It is clear from our results that the vulnerable were more likely than others to participate in Part D. However, the fact that participation was far from universal among these beneficiaries suggests that barrier to enrollment remain."

About Health Affairs

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears each month in print, with additional Web First papers published weekly at The full text of each Health Affairs Web First paper is available free of charge to all Web-site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund.