Perspectives on Medicare Part D and Dual Eligibles: Key Informants’ Views From Three States
In 2006, low-income individuals receiving health coverage through both the Medicaid and Medicare programs, “dual eligibles,” experienced a change in their prescription drug benefit when their Medicaid prescription coverage was replaced by the Medicare prescription drug program known as Medicare Part D. This study provides information on the ongoing successes and challenges that dual eligibles faced in the first eight months of Part D and how different state approaches may affect dual eligibles’ ability to access prescription medications.
It was conducted in three states that adopted different approaches to helping dual eligibles with their Part D expenses: Connecticut, Washington and Florida. Connecticut offers substantial assistance, paying co-payments and providing a “wraparound” to Part D that covers prescription drugs that are not on a dual eligible’s Part D plan formulary. Washington pays dual eligibles’ co-payments but does not cover non-formulary medications. Florida offers neither type of assistance to dual eligibles. In addition, all three states cover certain drugs excluded from Medicare Part D through their Medicaid programs.
also of interest
- One Year into Duals Demo Enrollment: Early Expectations Meet Reality
- Financial and Administrative Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS
- Financial Alignment Demonstrations for Dual Eligible Beneficiaries: A Look at CMS’s Evaluation Plan
- State Demonstration Proposals to Integrate Care and Align Financing and/or Administration for Dual Eligible Beneficiaries