MCBS profiles

2 Pages·2000·0.14 MB·English

by  United States. Health Care Financing Administration. Office of Strategic Planning

InformationandMethodsGroup,OSP July2000 IssueNo.6
Drug Coverage In Metropolitan and
Non-metropolitan Areas, 1997
In1997beneficiarieslivinginnon-metropolitanareaswerelesslikelytohavedrugcoverage
thanthoselivinginmetropolitanareas. Amajorreasonforthedisparitywasthesmallnum-
berofbeneficiariesinnon-metropolitanareasthatwereenrolledinMedicareriskHMOs.
Regardlessoftypeofdrugcoverage,beneficiarieslivinginnon-metropolitanareaspaida
largerportionoftheirtotaldrugexpensesoutofpocketthanbeneficiarieslivinginmetropoli-
tanareas.
Forntony-mpeetrrcoepnotliotfabnenaerfeiacsiawreierselwiivtinhgouitn SionuMrecteroopfolPirteasncrainpdtiNononC-omveetrroapgoeliftoranBeAnreefaisc:ia1r9i9e7s
drug coverage in 1997 versus about 100%
one-quarterofbeneficiarieswithoutcov-
erageinmetropolitanareas. In 1997
thelargestsourceofdrugcoveragefor Other
beneficiaries in both metropolitan and Medigap
non-metropolitanareaswasanemploy- E3Brployer
er-sponsored supplemental plan. Sponsored
Medicaid was the second largest Medicaid
providerofdrugbenefitsforbeneficiar- IRiskHMO
ies living in non-metropolitan areas, None
reflectinggenerallylowerincomelevels
inthoseareas. Medicaiddrugcoverage Metropolitan Non-Metropolitan
accountedfor24percentofcoveragein
non-metro areas. Twenty-one percent of beneficiaries with coverage in non-metro
areasand14percentofbeneficiarieswithcoverageinmetroareas receivedtheircov-
eragethroughaprivatelypurchasedMedigapplan.
Onereasonforthelargedisparityincoveragerateswasthesmallpercentageof
beneficiariesinnon-metropolitanareasthatareinriskHMOplans. RiskHMOplans
accounted for 23 percent ofthe drug
coverage in metropolitan areas and 3 CovPeerracgeen,tboyfBAegneefaincidarMieetsroWpiotlhiotuatnDSrtuatgus:
percentofthe coverage in non-metro- 1997
politanareas. ThelowriskHMOmem-
bershiprateswerepartlyaresultoflack 60%
of availability--in 1997, eighty-seven 50%
percentofbeneficiariesinmetropolitan 40%
areasandonly36percentofbeneficiar- 30%
iesinnon-metropolitanareashadarisk 20% ^ ^ rj^j^^j^
HMOplanavailabletothem. 10% r|~|
Theoldestbeneficiarieswerethe 0%
least likely to have coverage in both 0-44 45-64 65-69 70-74 75-79 80-84 85+
populations,butthedisparitywaseven MetropolitanhNon-metropolitan
MCBSProfilesPage1
greaterforthoseinnon-metropolitanareas.
Nearlyhalfofbeneficiaries85orolderliving PercentofBeneficiariesWithoutDrugCoverage,
innon-metropolitanareasdidnothavedrug 60% byIncomeLevel:1997
coverage.
Beneficiarieswithincomesjustabove
the level where Medicaid assistance was
availableweretheleastlikelyto havedrug
coverageinbothmetropolitanandnon-met-
ropolitanareas. In non-metropolitanareas,
however, the percent of uncovered was <Poverty Poverty- 151-200% 201-300% 301-400% >400%
especiallyhigh--50percentforbeneficiaries •60%
withincomesbetweenthepovertyleveland IncomeasapercentoftheFederalPovertyLevel
150percentofpoverty.
Metropolitan Non-metropolitan
In 1997, beneficiarieswithdrugcov-
erage living in non-metropolitan areas paid
more out of pocket for prescription drugs, PercentofDrugCostsPaidforOutofPocketby
thanthoselivinginmetropolitanareas.The 80% BeneficiarieswithCoverage:1997
higher out of pocket costs ($310 versus 70%
$265) reflected the larger number of pre- 60%
scriptionsusedbybeneficiarieslivinginnon-
metropolitanareasandalargershareoftotal
drug expenses that beneficiaries living in
non-metropolitanareaspaid. Regardlessof
thetypeofdrugcoverage, beneficiariesliv- -J-
ing innon-metropolitanareaspaida higher
aprvoeproargteioonf3of7tpheericrentottailn1d9r9u7gveexrpseunss3e3s-p-earn- RiskHvlO Medicaid SBpropnlsooyreerd Medigap AllOther
centpaidby beneficiarieslivinginmetropol- Metropolitan Non-Metropolitan
itanareas.
The largest out of pocket costs for
beneficiarieswithprescriptiondrugcoverage AverageOutofPocketSpendingforBeneficiaries
were for those with incomes between the withDrugCoverage,byIncomeLevel:1997
poverty level and 200 percent of poverty. $450
Thisgroupofbeneficiarieswaslesslikelyto
have had an employer-sponsored plan,
whichtypicallyprovidesmoregenerousdrug
coverage than most other insurers and
more likely to have had a medigap plan,
which generally has high deductibles, high
coinsurance,andanannuallimitoncovered
expenses. Medigapplanswereevenmore <Poverty Poverty- "61-200%201300%301400% =400%
driosmkiHnaMnOtpinlannsonw-emreteronpootlaivtaainlabalree.as where Income-M6eat0sr%oapopleirtcaennatoNfonF-emdeetrraolppoloivtearntyLevel
ThisissueofMCBSProfilesby MCBSProfilesPage2
LaurenMurrayandJohnPoisal.