younger medicare bene

PRESCRIPTION DRUGS AND
YOUNGER MEDICARE BENEFICIARIES WITH DISABILITIES

The language used to discuss Medicare prescription drug coverage perpetuates the myth that Medicare beneficiaries are all over age 65. BNA's Medicare Report for February 2, 2001 proclaims, "Bush Unveils Prescription Drug Plan to Help Seniors Through State Grants." (Emphasis added.). The Congressional Progressive Caucus titles its more comprehensive prescription drug bill, "The Medicare Extension of Drugs to Seniors (MEDS) Plan." (Emphasis added.) But what about the over five million Medicare beneficiaries who are under 65 and who are eligible based on disability? No Medicare prescription drug benefit should be designed, intentionally or unintentionally, to exclude this population.

According to "Disability, Medicare, and Prescription Drugs," a report issued July 31, 2000 by the White House National Economic Council and Domestic Policy Council,

About 75% of younger disabled Medicare beneficiaries, as compared with half of elderly beneficiaries, have incomes of less than 200% of poverty, about $17,000 per year for an individual;

About 60% of younger, disabled Medicare beneficiaries with disabilities report "fair to poor" health status as compared with about 22% of elderly beneficiaries. Moreover, 30% have functional limitations due to health problems, compared with 18% of the elderly.

Beneficiaries with disabilities use an average of 28 prescriptions per year, compared with 20 for the overall Medicare population. Moreover, those with disabilities also use more expensive medications; as a result, beneficiaries with disabilities spend on average $1,016 per year for prescription drugs compared with $674 for all Medicare beneficiaries.

Beneficiaries with disabilities are also less likely than older beneficiaries to have prescription drug coverage through retiree health plans, Medicare managed care plans, or Medigap insurance.

It would indeed be ironic if Congress's response to the lack of drug coverage for Medicare beneficiaries would exclude Medicare beneficiaries under 65 who are more vulnerable than most aged Medicare beneficiaries. Yet that is exactly what Congress has done by allowing Medigap insurers to medically underwrite Medicare beneficiaries under 65, while requiring that Medicare beneficiaries over 65 are treated as a community rated group. Moreover, many states have created state pharmaceutical assistance programs for low income Medicare beneficiaries that exclude Medicare beneficiaries under 65. It also appears that the Administration's proposed state block grant for pharmaceutical assistance for low income Medicare beneficiaries may have the unintended consequence of perpetuating these inequitable exclusions of Medicare beneficiaries under 65.

In crafting a Medicare prescription drug benefit, law-makers need to assure that all Medicare beneficiaries, regardless of income, age or basis for Medicare eligibility, have access to a uniform and affordable prescription drug benefit. In discussing the prescription drug issue law-makers and the press should also be careful to correct the mistaken impression that Medicare is a program only for older people.