Trends in medicare supplemental insurance and prescription drug coverage, 1996-1999

Health Affairs

Volumn 22, Issue SUPPL., 2003, Pages

  Laschober, Mary A ^a   Kitchman, Michelle ^b   Neuman, Patricia ^c   Strabic, Allison A ^d  

^a KPMG LLP   (United States)

^b HENRY J KAISER FAMILY FOUNDATION   (United States)

^c Medicare Policy Project   (United States)

^d Health Practice of Barents Group   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 27544480877     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: None     Document Type: Review

References (19)

1. N. Pourat et al., "Socioeconomic Differences in Medicare Supplemental Coverage," Health Affairs (Sep/Oct 2000): 186-196.
2. See, for example, J. Poisal and L. Murray, "Growing Differences between Medicare Beneficiaries with and without Drug Coverage," Health Affairs (Mar/Apr 2001): 74-85;
3. J. Poisal and G. Chulis, "Medicare Beneficiaries and Drug Coverage," Health Affairs (Mar/Apr 2000): 248-256;
4. and M. Davis et al., "Prescription Drug Coverage, Utilization, and Spending among Medicare Beneficiaries," Health Affairs (Jan/Feb 1999): 231-243.
5. The Access to Care files also differ from the Cost and Use files in that they reference different beneficiary populations. The Cost and Use files include all individuals who had Medicare coverage at any time during the calendar year, while the Access to Care files include only beneficiaries who were Medicare-eligible for the entire year. In addition, the Access to Care files, in contrast to the Cost and Use files, do not permit reconciliation of self-reported drug coverage with drug payment data, leading to lower estimates of drug coverage rates. Davis et al., "Prescription Drug Coverage," estimates that such reconciliation contributes between four and nine percentage points to their drug coverage estimates. However, conversations (in January 2002) with John Poisal and Frank Eppig of the Centers for Medicare and Medicaid Services (CMS) suggest that this estimate is much lower for the more current releases of MCBS data.
6. B. Stuart, D. Shea, and B. Briesacher, "Dynamics in Drug Coverage of Medicare Beneficiaries: Finders, Losers, Switchers," Health Affairs (Mar/Apr 2001): 86-99.
7. Based on personal communication with Poisal and Eppig (May 2001), the "other public insurance" category in the Access to Care files primarily includes beneficiaries enrolled in state pharmacy assistance programs and, less frequently, some beneficiaries who have access to Department of Veterans Affairs (VA) or other military benefits.
8. This methodology is adopted from Poisal and Murray, "Growing Differences between Medicare Beneficiaries with and without Drug Coverage," and Poisal and Chulis, "Medicare Beneficiaries and Drug Coverage," in which each beneficiary is assigned to one primary supplemental insurance category, but the individual may or may not obtain their drug insurance from that source. Assigning drug coverage to primary supplemental insurance, rather than to the secondary source that includes the drug benefits, changes the estimates only slightly. For example, the 1999 estimate of prescription drug coverage for Medicaid beneficiaries would decline by 0.1 percentage points if the alternative method were used.
9. Again, it is important to note that these drug coverage estimates were not supplemented by drug source-of-payment data. For example, Poisal and Murray, whose drug coverage estimates are supplemented by payment information, report that 73 percent of noninstitutionalized Medicare beneficiaries had drug coverage at some point during 1998. See Poisal and Murray, "Growing Differences between Medicare Beneficiaries with and without Drug Coverage."
10. Employer-sponsored coverage may be understated and Medicare HMO enrollment overstated, as a result of MCBS data collection methods. If a beneficiary is enrolled in a Medicare HMO, he or she is coded as having Medicare HMO coverage even if the Medicare HMO is offered through an employer.
11. L. Nelson et al., "Access to Care in Medicare HMOs, 1996," Health Affairs (Mar/Apr 1997): 148-155.
12. Families USA, "The Crushing Costs of Medicare Supplemental Policies," October 1996, 〈www. familiesusa.org/media/reports/famsup. htm〉 (30 May 2001);
13. Weiss Ratings, Inc., "Medigap Consumers Face Erratic Price Increases," 17 April 2001, 〈www.weissratings.com/NewsReleases/ Ins_Medigap/20010416Medigap.htm〉 (31 May 2001);
14. and American Academy of Actuaries, Report to the National Association of Insurance Commissioners (Washington: AAA, 8 June 2000).
15. M. Gold, "Medicare+Choice: An Interim Report Card," Health Affairs (July/Aug 2001): 120-138.
16. Centers for Medicare and Medicaid Services, "CY 2002 Nonrenewal Report, by State, County, Plan," 29 September 2001, 〈www.cms.hhs.gov/ healthplans/nonrenewal/markprintedoutnew.asp〉 (23 January 2002).
17. Weiss Ratings, Inc., "Prescription Drug Costs Boost Medigap Premiums Dramatically," 26 March 2001, 〈www.weissratings.com/NewsReleases/ Ins_Medigap/0010326Medigap.htm〉 (31 May 2001).
18. Hewitt Associates, Retiree Health Coverage: Recent Trends and Employer Perspectives on Future Benefits, report prepared for the Henry J. Kaiser Family Foundation (Washington: Kaiser Family Foundation, October 1999);
19. and Kaiser Family Foundation and Health Research and Educational Trust, Survey of Employer-Sponsored Health Benefits, 2001, as reported by J. Gabel et al., "Job-Based Health Insurance in 2001: Inflation Hits Double Digits, Managed Care Retreats," Health Affairs (Sep/Oct 2001): 180-186.