The standard Medicare Part D benefit structure contains a gap in coverage (or so-called "doughnut hole") which requires beneficiaries to pay 100% of the cost for prescription drugs until they reach the catastrophic coverage phase. This coverage gap has been linked to a financial burden for beneficiaries resulting in poor medication adherence and other cost-related access problems. Under the 2010 Affordable Care Act (ACA) reform, the coverage gap has been gradually phasing out since 2011 such that beneficiaries will only pay 25% of drug costs by 2020. This study evaluated the impact of closing the coverage gap under the ACA by conducting three separate studies using data from the 2008-2015 Medicare Current Beneficiary Survey. Outcomes assessed included the utilization of and expenditures for prescription drugs, as well as cost-related access problems. Chapter 3 (Manuscript #1) analyzes trends in the distribution of beneficiaries in each benefit phase, prescription drug utilization, and expenditures among Part D beneficiaries not receiving the Low-Income Subsidy (LIS). After the ACA, the proportion of beneficiaries reaching the catastrophic coverage threshold increased (from 4% in 2010 to 6% in 2015), and they reached the threshold earlier in the year. The overall number of 30-day drug fills also increased after the ACA, although no significant changes in the number of 30-day drug fills were seen among those reaching the catastrophic coverage threshold. Total drug spending steadily increased after the ACA, with the largest increase seen in those reaching the catastrophic threshold; however, out-of-pocket spending significantly decreased among all beneficiaries (17% decrease in 2015 compared to 2009). Chapter 4 (Manuscript #2) evaluates the effects of the ACA coverage gap reform on drug utilization and expenditures using a difference-in-differences study design. Over the first five years after implementation of the ACA, out-of-pocket drug spending significantly decreased among non-LIS beneficiaries (treatment) relative to LIS beneficiaries (control), with growing decreases over time (average decreases of $41 in 2011 versus $135 in 2015). This was particularly noticeable among those who reached the coverage gap but not the catastrophic threshold. Despite seemingly large reductions in cost-sharing in the coverage gap, there were no significant changes in the number of 30-day drug fills and total drug spending after the ACA reform between non-LIS and LIS beneficiaries. Chapter 5 (Manuscript #3) evaluates the effects of the ACA coverage gap reform on cost-related access problems among beneficiaries using a difference-in-differences study design. Cost-related access problems were estimated by the likelihood of having cost-related nonadherence (CRN) or the adoption of drug cost-reduction strategies (CRS) by beneficiaries. Compared to LIS beneficiaries, no significant changes in CRN were seen among non-LIS beneficiaries after the ACA; furthermore, the likelihood of adopting CRS increased by 4 percentage points for non-LIS beneficiaries relative to LIS beneficiaries. Although the ACA reform has helped reduce out-of-pocket drug costs for beneficiaries by gradually reducing the beneficiary cost-sharing rate in the Part D coverage gap, the significant reduction in cost-sharing rate did not translate into an increased use of prescription drugs or resolved cost-related access problems for beneficiaries. Additionally, this study provides evidence of increased Part D spending, which has been a growing concern for the Medicare program. The findings of this study provide empirical evidence on the effects of closing the Part D coverage gap and address gaps in the limited existing literature. Overall, although the ACA decreased out-of-pocket drug costs, this study suggests additional initiatives will be needed to provide better protection against the cost of prescription drugs for Part D beneficiaries.

Medicare Prescription Drug Coverage For Dummies offers strategies to cut through the confusions of Part D, either for yourself or for someone you're helping. It explains the programs ins and outs in plain words. It shows you how to avoid or cope with pitfalls and suggests how you can lower your costs or find a better deal. Best of all, it convinces you that you can - yes, you can - handle Medicare Part D!

Medicare For Dummies, 2nd Edition (9781119293392) was previously published as Medicare For Dummies, 2nd Edition (9781119079422). While this version features a new Dummies cover and design, the content is the same as the prior release and should not be considered a new or updated product. Make your way through the Medicare maze with help from For Dummies America's baby boomers are now turning 65 at the rate of about 10,000 a day. Yet very few have any idea about how Medicare works, when they should sign up, or how the program fits in with other health insurance they may have. Medicare For Dummies, 2nd Edition provides a detailed road map for navigating Medicare's often-baffling complexities and helps consumers avoid pitfalls that could otherwise cost them dearly. In plain language, the new edition explains: How to qualify for Medicare, according to your personal circumstances, including new information on the rights of people in same-sex marriages When to sign up at the time that’s right for you, to avoid lifelong late penalties How to weigh Medicare’s many options so you can be confident of making the decision that's best for you What Medicare covers and what you pay, with up-to-date details of the costs of premiums, deductibles, and copays—and how you may be able to reduce those expenses By conveying not only the basics but also how to troubleshoot problems and where to find assistance, Medicare For Dummies, 2nd Edition helps you to get the most out of Medicare.

Provides information on one-time $250 rebate for Medicare beneficiaries who have not already been receiving Medicare Extra Help.

"The Patient Protection and Affordable Care Act of 2010 established the Discount Program to help Medicare Part D beneficiaries with their prescription drug costs while in the coverage gap, which occurs between the initial and catastrophic coverage periods where Medicare helps pay for drug costs. Until the Discount Program began in 2011, beneficiaries in the coverage gap paid 100 percent of drug costs. The Discount Program required manufacturers to provide a 50 percent discount on the price of brand-name drugs for beneficiaries in the gap.GAO was asked to describe (1) CMS's oversight of the Discount Program; (2) perspectives of plan sponsors, manufacturers, and PBMs on effects of the Discount Program; and (3) how prices for brand-name drugs used by beneficiaries in the coverage gap and by those who did not reach the gap changed before and after the start of the Discount Program. To describe CMS's oversight, GAO reviewed CMS documents and interviewed CMS officials. To describe perspectives on the effects of the Discount Program, GAO interviewed the 7 largest Part D plan sponsors based on enrollment data, 8 of 10 manufacturers of brand-name drugs with the highest expenditures in the gap, and 3 PBMs who contracted with sponsors GAO interviewed. To describe price changes, GAO used CMS Part D data from 2007 to 2011 to track prices for high-expenditure brand-name drugs used by those in and those who did not reach the gap. GAO compared prices"

A unique feature of the Medicare Part D drug benefit is the coverage gap, or so-called "doughnut hole," where Part D enrollees are required to pay 100 percent of total drug costs after their spending exceeds the initial coverage limit and before reaching the catastrophic coverage limit. The coverage gap exists because the cost of providing continuous coverage with no gap exceeded the budgetary limit imposed on the legislation that established the Medicare drug benefit. In 2010, most Part D plans have a coverage gap, which totals $3,610 in drug costs for plans offering the standard Medicare Part D benefit; by 2019, the gap is projected to be nearly $6,000. Part D sponsors are permitted to offer an alternative benefit design that covers at least some drug costs in the gap. Part D enrollees who qualify for the low-income subsidy (LIS) are generally not responsible for costs in the coverage gap. This Part D Data Spotlight examines the coverage gap in Medicare stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug (MA-PD) plans, based on the authors' analysis of data from the Centers for Medicare & Medicaid Services (CMS). This research is part of a broader effort analyzing Medicare Part D plans in 2010 and trends since 2006, with key findings summarized in a series of data spotlights.

Medicare Part D provides prescription drug coverage through Medicare approved plans offered by private insurance companies and HMOs. In this paper, we study the role of current prescription drug use and health risks, related expectations, and subjective factors in the demand for prescription drug insurance. To characterize rational behavior in the complex Part D environment, we develop an intertemporal optimization model of enrollment decisions. We generally find that seniors' choices respond to the incentives provided by their own health status and the market environment as predicted by the optimization model. The proportion of individuals who do not attain the optimal choice is small, but the margin for error is also small since enrollment is transparently optimal for most eligible seniors. Further, there is also evidence that seniors over-react to some salient features of the choice situation, do not take full account of the future benefit and cost consequences of their decisions, or the expected net benefits and risk properties of alternative plans.