The Selected Contemporary Benefits Issue Affordable drug coverage under Medicare has been a pressing issue in the US for quite some time now (Slaughter, 2006). In response to this issue, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) was passed on December 8, 2003, establishing a voluntary drug benefit for Medicare beneficiaries and creating a new Medicare Part D (Medicare-PartD. com, 2007).
Under the original Medicare program, which includes Part A for hospital care, and Part B for physician, outpatient care, and durable medical equipment, prescription drug benefits were not available (Wikipedia, The Free Encyclopedia, 2007). Part D gives elderly and disabled people already enrolled or eligible for Medicare access to drug coverage beginning January 2006 (Medicare-PartD. com, 2007). Unfortunately, Medicare’s new prescription drug benefit had a rocky start, particularly in terms of implementation (Rovner, 2006).
The program is administered by private insurance plans which are in turn reimbursed by the Centers for Medicare and Medicaid Centers (CMS) )Center for Medicare Advocacy, Inc. , 2007). the organization which replaced the Health Care Finance Association (HCFA) (Medicare-PartD. com, 2007; Wikipedia, The Free Encyclopedia, 2007). Implementation of this new prescription drug benefit has specifically raised concerns for individuals eligible for both Medicare and full Medicaid benefits, otherwise known as “dual eligible beneficiaries.
” The topic for this thesis was selected since the issue on dual eligible beneficiaries, and the difficulties they encountered during the roll-out of the Part D program, affects approximately 6. 5 million Americans (Rovner, 2006) who used to receive their drug benefit under the Medicaid program. Upon the roll-out of Part D in January 1, 2006, these dual eligibles were assigned to one of the eight Medicare programs, and were then mandated by law (MMA) to receive their drug benefit from Medicare Part D, not Medicaid.
Problems with disclosing information to Medicare as to who were the dual eligibles (who largely come from low-income families) have resulted in these peoples being charged as higher-income beneficiaries under the Part D program, and thus made them incapable of affording the medicine they needed. Part D is a voluntary program and this where the issue arises. Unlike coverage in Medicare Parts A and B, Part D coverage is not provided for within the traditional Medicare program.
Beneficiaries have to enroll in one of many hundreds of Part D plans offered by private companies (Center for Medicare Advocacy, Inc. , 2007) which makes it imperative for this thesis to also examine the impact of Part D on the overall business community and employers. In relation to dual eligible beneficiaries, their drug costs are covered under Part D rather than under the state Medicaid programs.
The MMA requires the CMS to enroll these dual eligible beneficiaries in a Medicare prescription drug plan (PDP) if they do not select a plan of their own (U. S. General Accounting Office, 2007). The thesis topic thus will focus specifically on the impact of Medicare Part D on dual eligible beneficiaries. In exploring this impact, the thesis will explore the nature of dual eligibility, as well as the impact of Part D to the overall business community, employers, and employees.