Medicare Prescription Drug Plan Enrollees Report Less Positive Experiences Than Their Medicare Advantage Counterparts

Published in: Health Affairs, v. 35, no. 3, Mar. 2016, p. 456-463

Posted on on March 14, 2016

by Marc N. Elliott, Bruce E. Landon, Alan M. Zaslavsky, Carol A. Edwards, Nathan Orr, Megan K. Beckett, Joshua Mallett, Paul Cleary

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Research Questions

  1. How do the prescription drug experiences of fee-for-service Medicare beneficiaries who are enrolled in standalone prescription drug plans compare to the experiences of Medicare Advantage beneficiaries who have integrated prescription drug plans?
  2. Are there regional variations in how these two groups of Medicare beneficiaries rate their prescription drug plans?
  3. How do their prescription drug experiences compare to other aspects of their health care?
  4. Have these Medicare prescription drug experiences changed over time?

Since 2006, Medicare beneficiaries have been able to obtain prescription drug coverage through standalone prescription drug plans or their Medicare Advantage (MA) health plan, options exercised in 2015 by 72 percent of beneficiaries. Using data from community-dwelling Medicare beneficiaries older than age sixty-four in 700 plans surveyed from 2007 to 2014, we compared beneficiaries' assessments of Medicare prescription drug coverage when provided by standalone plans or integrated into an MA plan. Beneficiaries in standalone plans consistently reported less positive experiences with prescription drug plans (ease of getting medications, getting coverage information, and getting cost information) than their MA counterparts. Because MA plans are responsible for overall health care costs, they might have more integrated systems and greater incentives than standalone prescription drug plans to provide enrollees medications and information effectively, including, since 2010, quality bonus payments to these MA plans under provisions of the Affordable Care Act.

Key Findings

  • Nationally, Medicare Advantage beneficiaries with integrated prescription drug plans (MA-PD enrollees) had better prescription drug experiences than Medicare beneficiaries enrolled in standalone prescription drug plans.
  • MA-PD enrollees reported greater ease of getting medications, as well as information about cost and coverage, than did standalone prescription drug plan enrollees.
  • Both groups of beneficiaries rated their prescription drug plans less positively than other aspects of health care, although in general ratings were quite positive.
  • Ratings in both populations increased over time, from 2007 to 2014, including reports on the ease of obtaining needed drugs.

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