For immediate release
Tuesday, Aug 1, 2006
12:01 a.m. EDT


Christopher Fleming

New Study Confirms That Medicare Has Met
Its 90 Percent Enrollment Goal For Medicare Part D

But, Study Says, Vulnerable Groups Have Been Left Behind

Bethesda, MD -- Medicare has met its target of 90 percent prescription drug coverage for seniors, but millions of older people who could benefit from the Medicare Part D program are still not enrolled, according to a study published today on the Web site of the journal Health Affairs.

The study, which is the first to provide early results on the demographics of those enrolling in Medicare Part D, shows that enrollment rates are lowest among people who are healthy now and are using no prescription drugs and among the less healthy who currently use prescription drugs but had no insurance coverage prior to Part D. The most problematic groups are widows, unmarried women, and less-educated people who were not previously covered through veterans, employer, or union plans.

According to the authors, most people with one or more prescriptions benefit right away from enrolling in the program. The study shows that nevertheless about two million elderly people who use one or more prescriptions have not yet enrolled. Many of the non-enrollees who use one or more prescriptions have no more than a high school education and might have failed to enroll as a result of procrastination or confusion, according to the authors.

“The Part D program has performed better than some people feared, but it has also left a significant chunk of people uncovered,” said Daniel McFadden, a study author and a professor of economics at the University of California, Berkeley. “Many are people that any system would have difficulty reaching and helping make informed choices.” Florian Heiss, a postdoctoral fellow in economics at the University of Munich, was the lead study author, and Joachim Winter, a University of Munich economics professor, also coauthored the study.

“This study has provided real-time before-and-after information about the enrollment process for the Medicare prescription drug program, as well as information about participants’ perceptions of Part D,” comments Richard M. Suzman, Ph.D., director of the Behavioral and Social Research Program at the National Institute on Aging, which funded the research. “One important finding is that despite high rates of enrollment, many people who have not yet enrolled would benefit if they did.”

The study was conducted between November 2005 and June 2006. Researchers surveyed a core of 1,571 people who were age sixty-five and older in May 2006 and were eligible for Medicare Part D. Respondents were interviewed before enrolling in Part D and again after the enrollment period closed.

The study results confirmed earlier results presented by the federal Centers for Medicare and Medicaid Services (CMS). Of the 35.84 million people age sixty-five and older who are eligible for Medicare Part D, 24.67 million were enrolled in Part D as of June 2006, 8.5 million had other comparable coverage, and 2.66 million had no creditable coverage. A large number of the elderly were automatically enrolled in Part D or other creditable drug coverage programs by their employer or union plans.

According to the authors, enrollment rates are much lower for those without any prior prescription coverage.

Reaching The Healthy
A significant number of elderly people who are currently healthy and not taking any prescriptions chose not to enroll in Medicare Part D, the study found. Data show that of the 35.8 million elderly people who were eligible for Part D, 3.7 million were not taking any prescriptions at all. Of these 3.7 million people, 18.5 percent chose not to enroll. Within this group, 38.2 percent of those with low incomes remained uncovered, and 22.8 percent of those with low education were uncovered.

The authors indicate that many in this group might not have enrolled because the benefits were not immediately visible, and they might also have felt financially constrained. This, however, could pose a problem if their health deteriorates in the future.

Consumers Express Substantial Dissatisfaction With New Program

A majority of those surveyed saw Medicare Part D as a major benefit that worked well once they got through the enrollment stage. Only a third, however, felt that the program is well-designed overall. Although the majority liked having alternative insurers to choose from, many expressed concerns about whether their particular drugs would be covered in the future.

More than half had difficulty understanding how the program worked and what savings it would yield. An overwhelming majority, 90.2 percent, expressed concern that coverage for specific drugs could change, and 88.4 percent viewed the gap in coverage (the “doughnut hole”) as a significant drawback. More than half said that their experience with the program so far left them less satisfied with the Medicare program as a whole.

Recommendations For Reaching More Elderly People

Despite initial confusion and low satisfaction marks from many Medicare beneficiaries, the authors caution Congress against making any immediate legislative changes to the program. Instead, they advise assessing how the program is working in the near future, and they make the following recommendations:

-- Increase efforts to bring in the 0.8 million remaining nonenrolled low-income people into the program
-- Increase efforts to reach the 1.5 million nonenrolled unhealthy people who should be in the program
-- Target healthy people with low education who have not yet enrolled
-- Require insurers to present information on plan features and costs in an easily understood, comparable format
-- Encourage people to choose enhanced plans that offer gap coverage
-- Simplify the enrollment process

You can read the article by Heiss, McFadden, and Winter at


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at


©2006 Project HOPE–The People-to-People Health Foundation, Inc.