{ "id": "R40611", "type": "CRS Report", "typeId": "R", "number": "R40611", "active": true, "source": "CRSReports.Congress.gov, EveryCRSReport.com, University of North Texas Libraries Government Documents Department", "versions": [ { "source_dir": "crsreports.congress.gov", "title": "Medicare Part D Prescription Drug Benefit", "retrieved": "2023-12-24T04:03:36.770768", "id": "R40611_20_2023-11-14", "formats": [ { "filename": "files/2023-11-14_R40611_954ba89a60382f57bae4e533e2c8504899cba1a2.pdf", "format": "PDF", "url": "https://crsreports.congress.gov/product/pdf/R/R40611/20", "sha1": "954ba89a60382f57bae4e533e2c8504899cba1a2" }, { "format": "HTML", "filename": "files/2023-11-14_R40611_954ba89a60382f57bae4e533e2c8504899cba1a2.html" } ], "date": "2023-11-14", "summary": null, "source": "CRSReports.Congress.gov", "typeId": "R", "active": true, "sourceLink": "https://crsreports.congress.gov/product/details?prodcode=R40611", "type": "CRS Report" }, { "source_dir": "crsreports.congress.gov", "title": "Medicare Part D Prescription Drug Benefit", "retrieved": "2023-12-24T04:03:36.768182", "id": "R40611_16_2020-12-18", "formats": [ { "filename": "files/2020-12-18_R40611_77d277055de691f1620426500a62fa95a4b803f6.pdf", "format": "PDF", "url": "https://crsreports.congress.gov/product/pdf/R/R40611/16", "sha1": "77d277055de691f1620426500a62fa95a4b803f6" }, { "format": "HTML", "filename": "files/2020-12-18_R40611_77d277055de691f1620426500a62fa95a4b803f6.html" } ], "date": "2020-12-18", "summary": null, "source": "CRSReports.Congress.gov", "typeId": "R", "active": true, "sourceLink": "https://crsreports.congress.gov/product/details?prodcode=R40611", "type": "CRS Report" }, { "source": "EveryCRSReport.com", "id": 584986, "date": "2018-08-13", "retrieved": "2019-12-20T21:01:53.899936", "title": "Medicare Part D Prescription Drug Benefit", "summary": "The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA; P.L. 108-173) established a voluntary, outpatient prescription drug benefit under Medicare Part D, effective January 1, 2006. Medicare Part D provides coverage through private prescription drug plans (PDPs) that offer only drug coverage, or through Medicare Advantage (MA) prescription drug plans (MA-PDs) that offer coverage as part of broader, managed care plans. Private drug plans participating in Part D bear some financial risk, although federal subsidies cover most program costs in an effort to encourage participation and keep benefits affordable.\nAt a minimum, Medicare drug plans must offer a \u201cstandard coverage\u201d package of benefits or alternative coverage that is actuarially equivalent to a standard plan. Plans also may offer enhanced benefits. Although all plans must meet certain minimum requirements, there can be significant differences among offerings in terms of benefit design, specific drugs included in formularies (i.e., lists of covered drugs), cost sharing for particular drugs, or the level of monthly premiums. In general, beneficiaries can enroll in a plan, or change plan enrollment, when they first become eligible for Medicare or during open enrollment periods each October 15 through December 7. For plan year 2018, there are between 19 and 26 PDPs in the nation\u2019s 34 PDP regions, in addition to Medicare Advantage plans. Because sponsors are allowed to change plan offerings from year to year, beneficiaries annually face the need for careful review of their choices to select the plans that best meet their needs. \nA key element of the Part D program is enhanced coverage for low-income individuals. Persons with incomes up to 150% of the federal poverty level (FPL) and assets below set limits are eligible for extra assistance with Medicare Part D premiums and cost sharing. Individuals enrolled in both Medicare and Medicaid (so-called dual eligibles) and certain other low-income beneficiaries are automatically enrolled in no-premium plans, which are Part D plans that have premiums at or below specified levels. \nIn 2017, about 42.5 million out of a total of 58.6 million Medicare beneficiaries received prescription drug benefits through a PDP or an MA-PD, with almost one-third receiving a low-income subsidy. Another 1.6 million received drug assistance through a Part D-subsidized retiree health plan. Of the remaining 25% of Medicare beneficiaries not enrolled in Part D, about half had coverage through health care plans that was at least as generous as Part D; the other half had no coverage or coverage less generous than Part D. Overall, about 88% of Medicare beneficiaries had drug coverage through either PDP or MA-PD plans, retiree coverage, or private insurance of comparable scope. Total Part D expenditures were approximately $100.0 billion in calendar year 2017.\nMedicare Part D has cost less than originally forecasted, due in part to lower-than-predicted enrollment and increased use of less expensive generic drugs. However, the Medicare Trustees project that spending on Part D benefits will accelerate over the next 10 years due to the expectation of further increases in the number of enrollees, costs associated with the gradual elimination of the out-of-pocket cost coverage gap, changes in the distribution of enrollees among coverage categories, a slowing of the trend toward greater generic drug utilization, and an increase in the use and the prices of specialty drugs.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "https://www.crs.gov/Reports/R40611", "sha1": "4732a242dc26db45c005b6da54ea9bb0b5c89053", "filename": "files/20180813_R40611_4732a242dc26db45c005b6da54ea9bb0b5c89053.html", "images": { "/products/Getimages/?directory=R/html/R40611_files&id=/2.png": "files/20180813_R40611_images_e334785d77d460fc23984a33a20de46fbee6313c.png", "/products/Getimages/?directory=R/html/R40611_files&id=/0.png": "files/20180813_R40611_images_b92b542f4d6e2c5903951595b7ce1b19d2e67040.png", "/products/Getimages/?directory=R/html/R40611_files&id=/3.png": "files/20180813_R40611_images_9ec65487247ac64dc6167086f34d8979e9292f04.png", "/products/Getimages/?directory=R/html/R40611_files&id=/1.png": "files/20180813_R40611_images_e37c1fa65e0590ef5f35ab6a4d32c29365411e24.png" } }, { "format": "PDF", "encoding": null, "url": "https://www.crs.gov/Reports/pdf/R40611", "sha1": "61b5bb0452e7467ecd05855b62064a4007a48d09", "filename": "files/20180813_R40611_61b5bb0452e7467ecd05855b62064a4007a48d09.pdf", "images": {} } ], "topics": [ { "source": "IBCList", "id": 4912, "name": "Medicare" } ] }, { "source": "EveryCRSReport.com", "id": 456712, "date": "2016-10-27", "retrieved": "2016-10-28T18:16:47.402744", "title": "Medicare Part D Prescription Drug Benefit", "summary": "The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA, P.L. 108-173) established a voluntary, outpatient prescription drug benefit under Medicare Part D, effective January 1, 2006. Medicare Part D provides coverage through private prescription drug plans (PDPs) that offer only drug coverage, or through Medicare Advantage (MA) prescription drug plans (MA-PDs) that offer coverage as part of broader, managed care plans. Private drug plans participating in Part D bear some financial risk, though federal subsidies cover most program costs in an effort to encourage participation and keep benefits affordable.\nAt a minimum, Medicare drug plans must offer a \u201cstandard coverage\u201d package of benefits or alternative coverage that is actuarially equivalent to a standard plan. Plans also may offer enhanced benefits. Although all plans must meet certain minimum requirements, there can be significant differences among offerings in terms of benefit design, specific drugs included in formularies (i.e., list of covered drugs), cost sharing for particular drugs, or the level of monthly premiums. In general, beneficiaries can enroll in a plan, or change plan enrollment, when they first become eligible for Medicare or during open enrollment periods each October 15 through December 7. For plan year 2016, there are between 19 and 29 PDPs in each of the nation\u2019s 34 PDP regions, as well as Medicare Advantage plans. Because sponsors are allowed to change plan offerings from year to year, beneficiaries must review their annual choices carefully to select the plans that best meet their needs. \nA key element of the Part D program is enhanced coverage for low-income individuals. Persons with incomes up to 150% of the federal poverty level (FPL) and assets below set limits are eligible for extra assistance with Medicare Part D premiums and cost sharing. Individuals enrolled in both Medicare and Medicaid (so-called dual eligibles), and certain other low-income beneficiaries, are automatically enrolled in no-premium plans, which are Part D plans that have premiums at or below specified levels. \nIn 2015, about 39 million Medicare beneficiaries received prescription drug benefits through a PDP or an MA-PD, with almost one-third receiving a low-income subsidy. Another 2 million received drug assistance through a Part D-subsidized retiree health plan, and 8 million Medicare beneficiaries had separate, private drug coverage. Overall, about 88% of Medicare beneficiaries had drug coverage through either PDP or MA-PD plans, retiree coverage, or private insurance of comparable scope. Total Part D expenditures were close to $90 billion in calendar year 2015.\nMedicare Part D has cost less than originally forecasted, due in part to lower-than-predicted enrollment and increased use of less expensive generic drugs. However, the Medicare Trustees project that spending on Part D benefits will accelerate over the next 10 years due to expectations of further increases in the number of enrollees, costs associated with the gradual elimination of the out-of-pocket cost coverage gap, changes in the distribution of enrollees among coverage categories, a slowing of the trend toward greater generic drug utilization, and an increase in the use and the prices of specialty drugs.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R40611", "sha1": "7011eb8ab098088a50d16a8dc742e368afdadc03", "filename": "files/20161027_R40611_7011eb8ab098088a50d16a8dc742e368afdadc03.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R40611", "sha1": "a36d91c1cfbd025695c0bf9adceaaa473b82fe6a", "filename": "files/20161027_R40611_a36d91c1cfbd025695c0bf9adceaaa473b82fe6a.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 4912, "name": "Medicare" } ] }, { "source": "EveryCRSReport.com", "id": 438545, "date": "2015-02-19", "retrieved": "2016-04-06T19:28:37.401512", "title": "Medicare Part D Prescription Drug Benefit", "summary": "The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA, P.L. 108-173) established a voluntary, outpatient prescription drug benefit under Medicare Part D, effective January 1, 2006. Medicare Part D provides coverage through private prescription drug plans (PDPs) that offer only drug coverage, or through Medicare Advantage (MA) prescription drug plans (MA-PDs) that offer coverage as part of broader, managed care plans. Private drug plans participating in Part D bear some financial risk, though federal subsidies cover most program costs in an effort to encourage participation and keep benefits affordable.\nAt a minimum, Medicare drug plans must offer a \u201cstandard coverage\u201d package of benefits or alternative coverage that is actuarially equivalent to a standard plan. Plans also may offer enhanced benefits. Although all plans must meet certain minimum requirements, there can be significant differences among offerings in terms of benefit design, specific drugs included in formularies (i.e., list of covered drugs), cost sharing for particular drugs, or the level of monthly premiums. In general, beneficiaries can enroll in a plan, or change plan enrollment, when they first become eligible for Medicare or during open enrollment periods each November-December. For plan year 2015, there are between 24 and 33 PDPs in each of the nation\u2019s 34 PDP regions, as well as Medicare Advantage and additional low-income plans. Because sponsors are allowed to change plan offerings from year to year, beneficiaries must review their annual choices carefully to select the plans that best meet their needs. \nA key element of the Part D program is enhanced coverage for low-income individuals. Persons with incomes up to 150% of the federal poverty level (FPL) and assets below set limits are eligible for extra assistance with Medicare Part D premiums and cost sharing. Individuals enrolled in both Medicare and Medicaid (so-called dual-eligibles), and certain other low-income beneficiaries, are automatically enrolled in no-premium plans, which are Part D plans that have premiums at or below specified levels. In recent years, the number of no-premium plans available to low-income subsidy recipients has been declining.\nIn 2012, the most recent year for which comprehensive CMS data is available, about 31.9 million Medicare beneficiaries received prescription drug benefits through a PDP or an MA-PD, with about one-third receiving a low-income subsidy. Another 5.6 million received drug assistance through a Part D-subsidized retiree health plan, and 5.7 million Medicare beneficiaries had separate, private drug coverage. Overall, about 63% of Medicare beneficiaries had drug coverage through Part D plans, and 85% had some type of drug coverage, either PDP or MA-PD plans, retiree coverage, or private insurance of comparable scope. Part D expenditures were estimated to be about $70 billion in calendar year 2013.\nMedicare Part D has cost less than forecast since its inception, due in part to lower-than-predicted enrollment and high use of less expensive generic drugs.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R40611", "sha1": "d9449e6e2fa595e0dbd9cf2f711f63386c40e323", "filename": "files/20150219_R40611_d9449e6e2fa595e0dbd9cf2f711f63386c40e323.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R40611", "sha1": "f58ea4533c8ffaa939151a7429409ea8885162fc", "filename": "files/20150219_R40611_f58ea4533c8ffaa939151a7429409ea8885162fc.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 2177, "name": "Medicare" } ] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc818024/", "id": "R40611_2014Oct08", "date": "2014-10-08", "retrieved": "2016-03-19T13:57:26", "title": "Medicare Part D Prescription Drug Benefit", "summary": null, "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20141008_R40611_5071e2ee258603bb4c377eec18ef06be78b967f4.pdf" }, { "format": "HTML", "filename": "files/20141008_R40611_5071e2ee258603bb4c377eec18ef06be78b967f4.html" } ], "topics": [] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc806659/", "id": "R40611_2009Jun01", "date": "2009-06-01", "retrieved": "2016-03-19T13:57:26", "title": "Medicare Part D Prescription Drug Benefit", "summary": null, "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20090601_R40611_72d377d67d90e3f605de9161196f6b1bb87b9f20.pdf" }, { "format": "HTML", "filename": "files/20090601_R40611_72d377d67d90e3f605de9161196f6b1bb87b9f20.html" } ], "topics": [] } ], "topics": [ "Health Policy" ] }