Drug coverage uneven in Medicare HMOs
Prescription drug coverage varies widely among the 6.2 million elderly enrolled in Medicare HMOs, a recently released report by the Kaiser Family Foundation in Washington, DC, states.
While one in six Medicare HMO enrollees are in a plan with no prescription drug coverage, one in four have unlimited drug benefits. Copays ranged from $0 to $12 for generic drugs and $0 to $20 for brand name drugs. Annual limits ranged from $600 to none. (See table, below.)
| County and state | Monthly supplemental premium | Generic drug copay per prescription | Brand name drug copay per prescription | Drug benefit limits |
| Los Angeles | $0 | $0 to $7 | $5 to $2 | Unlimited or $2,000 to $4,500 for those imposing limit |
| Dade, FL | $0 | $0 | $0 | $2,400 for one plan, no limits on all other plans |
| Maricopa, AZ | $0 | $3 to $7 | $5 to $15 | Unlimited or $1,500 to $3,000 for those imposing limit |
| Cook, IL | $0 to $63 | $5 to $10 for all plans except one plan not offering benefit | $10 to $15 for all plans except one not offering benefit | Unlimited or $600 to $1000 for those imposing limit. One plan does not offer |
| Allegheny, PA | $0 to $13 | $5 to $12 for all plans except one plan not offering benefit | $10 to $12 for all plans except one not offering benefit | $1,000-$1,500 for all plans except one plan not offering benefit |
| King, WA | $0 to $29 | Benefit not offered | Benefit not offered | Benefit not offered |
The authors concluded that, given the rapid rise in prescription drug costs, the more generous Medicare HMOs may present the "best alternative" to high out-of-pocket payments. However, they note that the "rapid increases in prescription drug costs, coupled with reductions in the growth of Medicare payments to plans, may place increasing financial pressure on Medicare HMOs, potentially jeopardizing the availability of relatively generous, affordable drug coverage under Medicare HMOs in the future."
A copy of the full report is available on the Web at http://www.kff.org/content/1999/1511/HMOAnalysisBarents.pdf.
Source: "Analysis of Benefits Offered by Medicare HMOs, 1999: Complexities and Implications." Washington, DC: Kaiser Family Foundation; August 1999.
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