Translating “Legislative Sausage”
into Understandable Choices
Implications of the 2003 Medicare law for
older adults and people with disabilities
Diane Archer, Founder & Special Counsel
Medicare Rights Center
Academy Health, June 28, 2005
Overview of Today’s Talk
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Back to the Basics: Medicare as we know it and the 42
million Americans it serves.
“But it’s good for you:” Challenges enrolling people in
benefits programs.
Lessons learned the hard way: Key ingredients to a
successful enrollment campaign.
New program, new challenges: The Medicare prescription
drug benefit.
Tried and true: Ensuring access to benefits for America’s
most vulnerable.
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Back to the Basics:
Medicare as we know it
 Automatic enrollment: Medicare Part B has a
95.5% participation rate.
 No need to choose a plan: Medicare covers
services that are “reasonable and necessary”
 Nationwide and open access to doctors:
People with Original Medicare can see doctors
and use facilities across the country. Currently,
over 90% of doctors accept Medicare.
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42 million Americans
 Health: Currently, 78% of the Medicare population
suffer from one or more chronic conditions that
require ongoing medical management.
 Income: Many on Medicare live with modest
incomes and assets;
 51% have incomes below 200% of poverty
($19,140/single and $25,660/couple in 2005); and
 48% have countable assets (savings accounts, stocks,
bonds, etc.) below $10,000.
 Health Literacy: One-third of men and women with
Medicare are unable to properly understand basic
health-care information
 70% of people over 85 have low health literacy.
 23% of the Medicare population have cognitive
impairments
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“But it’s good for you”
 Only one-third of eligible persons are
enrolled in a Medicare Savings
Programs (MSP) after 15 years.
 Only twenty five percent of people
eligible for “transitional assistance”
under the Medicare drug discount card
program have been enrolled. The
program expires in six months.
 Most were enrolled automatically by
their state or private health plan.
 Little data is available on actual usage
of discounts cards.
 Even with a one-page application and
few documentation requirements, New
York State’s pharmaceutical assistance
program (“EPIC”) has a 50 percent
enrollment rate for all eligible
residents.
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50
40
30
20
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0
Enrolled
Eligible
Medicare Savings Programs
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Lessons learned the hard way
 Simplify, simplify, simplify: The simpler the program, the more
likely people will access and benefit from it.
 Tailored answers: Federal message is only a piece of the
message, need to integrate state and local messages.
 Repeat interventions: People need to hear messages several
times to act on information.
SSA’s one-time outreach to over 20 million people likely eligible
for a Medicare Savings Program yielded less than 3
percent enrollment.
 Adequate professional support network: Current State Health
Insurance Assistance Program (SHIP) funding inadequate to meet
consumer needs.
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New Program, New Challenge:
The Medicare Prescription Drug Benefit
 New Program Design
 Process for securing drug benefit different from
 Medicare Part B (which is automatic)
 Other low-income assistance programs (MSPs)
 “Extra Help” requires two steps: enrolling in program,
picking plan.
 New Coordination Issues
 What will happen to existing State Rx programs? Will they
wraparound? If people are happy with their SPAP, will they
still need to enroll in Medicare’s drug benefit?
 People with Medicaid likely to fall through cracks.
 How will “extra help” affect eligibility for other public
benefits such as Food Stamps and housing assistance?
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New Program, New Challenge:
The Medicare Prescription Drug Benefit
 New Coverage Issues
 Formularies: How to know what drugs are covered
when formularies can be changed monthly?
 Pharmacy networks: Will people know where to go to
get their prescriptions filled?
 New Cost Issues
 Copays for people with Medicaid
 Tradeoffs for people with incomes under 300% of FPL
who don’t qualify for “extra help.”
 Premiums and penalties: Will people delay enrolling
because of high premium?
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What works?
Tried & True Strategies for Increasing Enrollment
 Hotline follow up:
 One call generally will not get people to act; continued follow
up to track client through application process helps ensure
enrollment.
 Seniors Out Speaking on Medicare (SOS Medicare):
 Keep it short: brief, focused messages keep audience
engaged
 Empower people with information: Emphasis on
understanding health benefits, rights and options before being
confronted with a crisis.
 Create relationships: Peer counselors have become trusted
source of information and audience members now turn to them
with questions.
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New Challenges, New Strategies:
Linking Individuals in Need to Care and Services (LINCS):
 The LINCS program will create a
network of remotely trained and
remotely operating volunteer
counselors who help older adults
complete and submit the
application for the new Medicare
drug benefits “extra help” for
people with low incomes.
 Volunteers will also maintain a
supportive relationship with
prospective enrollees by following
up with timely health care
messages and referring them as
necessary to other resources.
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How Do I Stay Informed?
 Sign up for regular updates from MRC:
www.medicarerights.org/subscribeframeset.html
 Medicare Interactive (MI) web tool
Visit www.medicareinteractive.org/aarp to stay in the
loop about health care benefits, rights and options.
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