Medicare Part D Prescription Drug Benefit Frequently Asked Questions

• What is the Medicare Prescription Drug Benefit, and when can Medicare beneficiaries enroll?
• What is the difference between a prescription drug plan (PDP) and Medicare Advantage Prescription Plan (MA-PD)?
• Do pharmacies need to contract with Medicare Part D plans in order to be reimbursed for services to Medicare enrollees?
• How many rural Medicare beneficiaries have enrolled in Medicare Part D?
• Do rural Medicare beneficiaries have access to the same range of Medicare prescription drug plans as urban beneficiaries?
• Do rural Medicare beneficiaries have access to pharmacies that participate in a Medicare Prescription Drug network?
• Are there special considerations when conducting outreach for Medicare Part D in rural communities?

Question: What is the Medicare Prescription Drug Benefit, and when can Medicare beneficiaries enroll?

Answer: The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) provides elderly and disabled people on Medicare access to prescription drug coverage from private prescription drug plans. Medicare beneficiaries can choose from two or more drug plans in their area. People who choose to enroll in a drug plan pay a monthly premium to receive prescription drug benefits, and deductible and copayment costs may also apply. Assistance with paying premiums, deductibles and copayments is available to low-income beneficiaries. For an overview of the Medicare Prescription Drug Benefit, please see the Kaiser Family Foundation's fact sheet The Medicare Prescription Drug Benefit.

The initial enrollment period ended May 15, 2006. The next opportunity to enroll will occur between November 15 and December 31, for enrollment beginning January 1st of the following year. You may also enroll within 63 days after you first become eligible for Medicare and do not have coverage at least as generous as standard Medicare Part D prescription drug coverage.

Question: What is the difference between a prescription drug plan (PDP) and Medicare Advantage Prescription Plan (MA-PD)?

Answer: Medicare prescription drug plans (PDPs) provide only prescription drug coverage, as a supplement to traditional fee-for-service Medicare. Medicare Advantage prescription drug (MA-PD) plans cover both drugs and other Medicare benefits. For more information, please see the Kaiser Family Foundation publications, The Medicare Prescription Drug Benefit and Medicare Advantage Fact Sheet.

Question: Do pharmacies need to contract with Medicare Part D plans in order to be reimbursed for services to Medicare enrollees?

Answer: Yes. As of January 1, 2006, pharmacies will be able to receive reimbursement only for those Medicare patients (including dual eligibles, patients covered by both Medicaid and Medicare) enrolled in Prescription Drug Plans (PDPs) that the pharmacy has contracts with. Pharmacies will no longer be reimbursed by state Medicaid programs for prescriptions provided to dual eligible patients. For information about contracting with PDPs, please see the Health Resources and Services Administration's
Medicare Part D & Safety Net Providers: Contracting with Prescription Drug Plans.

Question: How many rural Medicare beneficiaries have enrolled in Medicare Part D?

Answer: As of June 2006, over half of rural Medicare beneficiaries had Medicare Part D coverage. Another 21% had employer or federal sponsored prescription drug coverage. A higher percent of rural Medicare beneficiaries enrolled in Part D are in a stand-alone prescription drug plans, compared to urban Part D enrollees. A lower percent of rural Part D enrollees than urban are in Medicare Advantage prescription drug plans, which cover both drugs and other Medicare benefits. Overall, 74% of rural Medicare beneficiaries have creditable prescription drug coverage, compared to 76% of those living in urban areas.  For more details about rural versus urban enrollment in Medicare Part D, please see the RUPRI Center for Rural Health Policy Analysis brief, Enrollment in Medicare Part D for Rural Beneficiaries Is Encouraging.

Question: Do rural Medicare beneficiaries have access to the same range of Medicare prescription drug plans as urban beneficiaries?

Answer: Rural Medicare beneficiaries have access to stand-alone prescription drug plans that are generally the same as the plans available to urban beneficiaries. However, the Medicare Advantage prescription drug plans available in rural areas tend to be less generous than those offered in urban areas. For more information about the characteristics of Medicare prescription drug plans available in rural versus urban areas, please see the RUPRI Center for Rural Health Policy Analysis brief, Medicare Part D: Early Findings on Enrollment and Choices for Rural Beneficiaries.

Question: Do rural Medicare beneficiaries have access to pharmacies that participate in a Medicare Prescription Drug network?

Answer: Prescription drug plans (PDPs), which provide only prescription drug coverage, and Medicare Advantage prescription drug (MA-PD) plans, which cover both drugs and other Medicare benefits, are required to have participating pharmacies in their networks to provide adequate pharmacy access to participants. For rural areas, "at least 70 percent of Medicare beneficiaries in the plan's service area, on average, live within 15 miles of a retail pharmacy participating in the prescription drug plan's or MA-PD plan's network." Please see A Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act Of 2003 (MMA) for more information.

Question: Are there special considerations when conducting outreach for Medicare Part D in rural communities?

Answer: Yes. When trying to educate rural communities about Part D and the low-income subsidy, some considerations include the following:

• Rural communities place value on preserving and respecting history and traditions.
• Enrollment plans need to be practical and useful to the local situation.
• Content of outreach materials need to be personalized to targeted groups.
• Outreach activities need to be sensitive to the cultural diversity of the rural area. Materials should be culturally competent and take into consideration special language needs.
• Rural communities may need information for short-term decision-making as well as long-term decision-making.
• Careful thought should be given before assuming that new technologies are appropriate for use in educating rural communities. Will the community members be receptive; do we know anything about past use of technology in these communities; will many members of the community have access to the technology?
• Methods of communication need to fit life patterns and resources.
• Consider educational levels when developing outreach materials.
• Work through well respected local organizations.
• Use community members to develop and test outreach materials. Community approved methods and materials will have better success. Meet with key informants from the community.
• Use various outreach approaches to better reach all community members.
• Be prepared to change methods, materials, approaches depending upon community responses.

 

Credits

Past contributors: Craig Caplan, American Legacy Foundation; Dan Ermann and Cliff Binder, AARP Public Policy Institute

Sources: 2006 Report to the Secretary: Rural Health and Human Service Issues, National Advisory Committee on Rural Health and Human Services; Prescription Drug Spending and Coverage Among Rural Medicare Beneficiaries in 2003, AARP; Protecting Rural Beneficiaries with a Medicare Prescription Drug Benefit, National Rural Health Association.

Maintained by: Alex McEllistrem-Evenson, alex@raconline.org

Last revised 08/19/2008