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Consumer Protection Issues Raised by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003

This paper identifies and examines consumer protection issues that arise from the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Key issue areas include: beneficiary information, marketing, enrollment and disenrollment, the drug benefit package and cost-sharing, the appeals process, concerns for low-income beneficiaries, challenges for nursing home issues, and…

Medicare: A Primer

This primer explains key elements of the Medicare program, which now provides health coverage to 47 million people — including 39 million people age 65 and older and another 8 million younger adults with permanent disabilities. It looks at the characteristics of the Medicare population, what benefits are covered, how…

Implications of the New Medicare Prescription Drug Benefit for State Medicaid Budgets

For a number of years, Governors and other state policymakers have maintained that Medicare – rather than state Medicaid programs – should play the key role in providing prescription drug coverage to Medicare beneficiaries, including those who also qualify for Medicaid because they are impoverished and/or have extensive health care…

The Emerging Role of Group Medicare Private Fee-for-Service Plans

This issue brief examines the recent boom in Medicare Advantage enrollment attributable to employers contracting with Private Fee-for-Service (PFFS) plans to cover their Medicare-eligible retirees. Between 2006 and 2008, the number of Medicare beneficiaries enrolled in Medicare Advantage group plans nearly doubled from 900,000 to nearly 1.7 million as of…

An In-Depth Examination of Formularies and Other Features

of Medicare Drug PlansThis study examines formularies, drug costs and utilization management tools in drug plans offered by 14 national and near-national organizations. Collectively, these organizations account for 1,222 of the 1,429 packages available to Medicare beneficiaries.The analysis finds that Medicare’s new, private, stand-alone drug plans vary significantly in terms…

Prescription Drug Procurement and the Federal Budget

This brief commissioned by the Foundation considers areas where Medicare faces limited opportunity for market-based competition and price negotiation to drive down drug spending. These areas include drug purchasing for low-income people enrolled in Part D plans who face minimal cost-sharing requirements, and purchasing certain unique drugs, such as biologicals,…

Targeting Medicare Drug Benefits: Costs and Issues

This report, written by Marilyn Moon and Matthew Storeygard of the Urban Institute, estimates the potential cost of targeting drug benefits to low-income Medicare beneficiaries and those with catastrophic drug expenses and discusses some of the key programmatic issues that could arise under this approach. The authors predict that a…