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Early Experiences of Medicare Beneficiaries in Prescription Drug Plans

This report offers insights into Medicare beneficiaries’ experiences with the new drug benefit, based on observations of State Health Insurance Assistance Plan (SHIP) directors convened for a moderated focus group discussion. Because SHIP directors work closely with the Centers for Medicare and Medicaid Services and are on the front lines providing one-on-one counseling for beneficiaries who have questions or problems related to the new drug benefit, they are a key resource for understanding issues that have emerged during the first six months of the new Medicare benefit. At the same time, because SHIPs are a resource for people who need help and seek assistance, the issues identified in this report should not be construed to apply generally to the Medicare population.

SHIP directors who participated in the focus group reported significant casework related to data system errors resulting in beneficiaries being enrolled in a plan other than the one they had selected, being enrolled into multiple plans, or inadvertently disenrolled from a plan. Another major source of casework involved Part D premium payments, particularly for those who elected to have premiums deducted from their Social Security checks. Other issues include concerns about marketing practices by some Part D plans, prior authorization requirements, beneficiaries’ limited knowledge of Medicare Advantage products, emerging concerns related to the “doughnut hole,” and problems with the automatic enrollment of the dual eligible population.

Report