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Take-Up of Medicare Part D and the SSA Subsidy: Early Results from the Health and Retirement Study
Helen Levy David Weir
August 2007
University of Michigan
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Background
• The Medicare Modernization Act of 2003 added a prescription drug benefit (“Part D”) to Medicare starting in 2006
• Part D is optional: most Medicare beneficiaries had a choice about whether to enroll
• Beneficiaries could also apply for the low-income subsidy (“Extra Help”) administered by SSA
-
Our questions for this project:
• Who enrolled in Part D? • Who applied for the subsidy? • What were respondents’ subjective
experiences of enrollment?
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Why care about Part D takeup?
• Is program reaching intended audience? • Low takeup means there are costs of
enrolling, so transfer is inefficient even for people who take up.
• Part D as test case for managed competition.
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Background: Literature on program takeup
• Takeup of most programs is very low – Stigma – Transaction costs/hassle – Information
• For a given program, takeup is lower among the elderly (Food Stamps [Haider et al. 2003]; Medicaid [Pezzin & Kasper 2000])
• Important Part D difference: rational non-takeup due to direct cost even if there were no transaction or stigma costs
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Source: Remler et al. 2001
Take-up of public programs
-
Background on Part D
Part D affected people very differently depending on what drug coverage they already had:
1. “Other creditable coverage:” keep coverage 2. Medicaid/SSI recipients: auto-enrolled in both
Part D and subsidy 3. Medicare HMOs: almost inevitable Part D
coverage 4. Privately purchased coverage 5. No coverage
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Part D subsidy rules Income and asset cutoffs, 2006
Full subsidy Partial subsidy
Income 135% FPL 150% FPL Assets Single $6,000 $9,000
Couple $10,000 $20,000
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Definition of income
• Earnings, capital income, transfer income, Social Security, pension
• Income of other household members not counted (unlike FPL calculation)
• Disregard first $240 of income • Disregard first $780 of earnings plus half
of remaining earnings
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Assets
• Does not include primary residence or vehicles
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Data: The Health and Retirement Study
• Began in 1992 with cohort aged 51-61 • Interviewed every two years • Our sample: respondents who are 65 or
older, have Medicare in 2006, and participated in 2004 and 2006
• Sample size: 10,175
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Sample
11,355 65 and older 7,116 under age 65
10,940 with Medicare
10,175 with 2004 data
415 no Medicare
765 no 2004 data
19,928 respondents
in 2006
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Determining Rx coverage in 2004
Respondents have multiple opportunities to give info on Rx coverage:
• Medicare HMO Rx coverage • Medicaid • Private insurance plan Rx coverage • Later (in q’s on utilization): Does respondent
have any insurance coverage that does/would help pay for use of prescription drugs?
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HRS 2006 questions on Part D
In 2006, the HRS core added questions on Part D upfront, including:
• “Beginning in 2006, Part D of Medicare provides coverage for prescription drugs. Have you signed up for the new Medicare prescription drug coverage?”
• “Have you applied to Social Security for Extra Help in paying for your prescription drugs?” (Note: initial flaw in skip pattern.)
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HRS 2006 questions on Part D (continued)
• Information resources used to make the decision
• Name of plan and monthly premium • Reasons for not signing up • How difficult was the decision? • Do you plan to sign up next year?
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Other HRS data used for our analysis
• Income, assets: can follow program rules very closely using HRS 2006 data
• Health: self-reported health status in 2004 • Rx use: # of conditions for which medications
taken in 2004: high blood pressure, diabetes, heart conditions, stroke, psychiatric conditions
• Cognitive functioning: word recall in 2004 (0-20, missing)
• Education at baseline • Race, gender, ethnicity, marital status
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Results to be presented 1. What choices did people make about Part D
coverage? 2. How many people applied for the subsidy? 3. Which characteristics predict takeup of Part D
or the subsidy? 4. Why do people say they didn’t sign up? 5. What was respondents’ subjective experience
of the process (difficulty with/confidence in decision), and do they plan to sign up next year?
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Caveats
These analyses are preliminary! • Weight is preliminary weight. • No imputation of income and asset data.
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Rx coverage in 2004 and 2006Medicare beneficiaries ages 65+ in 2006
HRS 2004 & 2006; n=10,175
35% 33%
7% 7%
12% 15%
26%23%
11%23%
7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2004 2006
NonePurchasePart D PDMedHMOMedicaidEmployer
table 1
EmployerMedicaidMedHMOPurchaseNoneTotal
Row percent:0.3450.0740.1190.2320.2301.000
Sample n3,5008911,1322,3062,34610,175
Age in 200673.375.775.676.876.475.3
Female0.4860.7140.5570.6500.6160.579
Black0.0610.2290.0620.0870.0690.081
Other nonwhite race0.0260.0960.0330.0220.0190.029
Hispanic0.0280.2750.0970.0420.0470.062
Fair/poor health0.2160.5940.2510.2910.2710.278
Any rx conds 04?0.6760.7820.6570.6960.6150.672
Number of rx conds 041.51.91.51.61.41.6
Any ADL limitations0.9370.9800.9430.9550.9560.950
No. of ADLS if >03.86.34.14.54.34.3
mean memory score9.77.29.08.68.79.0
mem missing0.0630.1370.0600.0710.0700.072
Education < HS0.1600.6590.2270.2960.2780.263777
Education = HS0.3570.2490.3760.3690.3810.359
Some college0.2060.0610.2060.1750.1890.184
College+0.2770.0310.1910.1590.1530.193
Subsidy eligible0.1760.8210.2600.3300.3250.304
Income too high0.3040.1420.3370.2730.2730.282
Assets too high0.0460.0130.0620.0690.0610.054
Both too high0.4750.0240.3410.3270.3410.360
|0.6760.7820.6570.6960.6150.672
|1.51.91.51.61.41.5
rxcov04
EmployerMedicaidMedHMOPurchaseNoneTotal
table 2
Row percents
Coverage in 2006
Coverage in 2004EmployerMedicaidMedHMOPart D PDPurchaseNoneTotalMcd + MA + PDP
Employer0.6850.0090.0800.1090.0980.0191.000
Medicaid0.0260.6830.0440.1710.0550.0221.000
MedHMO0.1150.0270.7050.0690.0710.0141.0000.475
Purchase0.2740.0460.0960.3340.1960.0561.0000.629
None0.0620.0350.0710.5220.0970.2121.000
Total0.3320.0730.1530.2570.1140.0721.000
Mcdn=10,175avg:0.55195
So, estimate of takeup is about 55% overall
if you count Medicaid, MA and PDP as "takeup".
EmployerMedicaidMedHMOPart D PDPurchaseNoneTotal
Employer2,40839261387334713,500
Medicaid22629381394320891
MedHMO129387888674171,132
Purchase6151382157644411332,306
None1441011731,2152264872,346
Total3,3189451,4752,5911,11872810,175
tables 3 4
EligibleIncome toAssets toBoth tooTotalOutcomeBEligibleIncome toAssets toBoth tooTotal
Row percent0.3040.2820.0540.3611.000Row percent0.3040.2820.0540.3611.000
Employer0.2120.3450.3260.4150.329
Employer0.2120.3450.3260.4150.329Medicaid0.1970.0430.0170.0060.075
Medicaid0.1970.0430.0170.0060.075MedHMO/no0.0940.1250.1330.1100.111
MedHMO0.1280.1850.1580.1530.155MedHMO/yes subs0.0040.0020.0000.0000.002
Part D PDP0.2730.2450.2950.2470.257medHMO/denied0.0020.0030.0000.0020.002
Purchase0.1170.1120.1210.1110.114medHMO/waiting0.0000.0000.0000.0000.000
None0.0730.0700.0820.0690.071HMO/dk0.0270.0550.0250.0410.040
Total1.0001.0001.0001.0001.000PDP/no su0.2370.2220.2660.2420.236
PDP/got s0.0200.0070.0060.0020.009
PDP or MedHMO: p(apply for subsidy)PDP/denie0.0130.0150.0190.0020.010
Yes0.1070.0650.0650.0160.061PDP/wait0.0040.0020.0050.0000.002
No0.8160.8060.8800.8810.839Purchase0.1170.1120.1210.1110.114
Not asked0.0780.1280.0550.1030.100None0.0730.0700.0820.0690.071
Sample N3,3022,9235233,42710,175
PDP: p(apply for xh)
10.1340.0940.1000.0190.081OutcomeAEligibleIncome toAssets toBoth tooTotal
Employer0.2120.3450.3260.4150.329
MedHMO: p(apply for subsidy)Medicaid0.1970.0430.0170.0060.075
Yes0.0520.0280.0000.0130.027MedHMO/no0.0940.1250.1330.1100.111
No0.7360.6760.8430.7210.716MedHMO/ye0.0070.0050.0000.0020.004
Not asked0.2120.2960.1570.2660.257MedHMO/dk0.0270.0550.0250.0410.040
PDP/no su0.2370.2220.2660.2420.236
Outcome of subsidy application, conditional on applyingPDP/yes s0.0360.0230.0290.0050.021
PDP or MedHMOPurchase0.1170.1120.1210.1110.114
Approved0.5660.2900.1870.3290.430None |0.0730.0700.0820.0690.071
Denied0.3280.6440.6560.6030.477Total1.0001.0001.0001.0001.000
Waiting0.1070.0670.1570.0680.094
PDP
Approved0.5460.2900.1870.4520.430
Denied0.3410.6420.6560.4550.470
Waiting0.1130.0680.1570.0930.101
MedHMO
Approved0.6820.287-0.0000.431
Denied0.2500.652-1.0000.514
Waiting0.0690.062-0.0000.056
Sample N3,3022,9235233,42710,175
table 6
Subsidy eligIncome too highAssets too highBoth too highTotalDenominator n
takeupD10.4170.4240.4360.4420.4294,652
takeupD20.5410.5830.5910.5760.5685,784
takeupD30.6550.6070.6020.5800.6166,675
takeupD40.5900.5750.5920.5790.5824,437
takeupD50.6790.7030.6910.6900.6915,912
takeupD60.7590.7230.6990.6930.7256,857
takeupD70.4970.3840.4310.3550.41110,175
Subsidy eligIncome too highAssets too highBoth too highTotal
takeupX10.1340.0940.1000.0190.0812,572
takeupX20.1160.0750.0690.0180.0673,667
takeupX30.1070.0650.0650.0160.0604,066
takeupX40.1850.1940.1200.1190.1614,066
takeupX50.5000.2280.1490.0430.2903,517
takeupX60.4230.1700.1050.0350.2244,612
takeupX70.4010.1500.0990.0310.2055,011
takeupX80.4530.2660.1520.1330.2905,011
takeupX90.0780.0470.0430.0120.0447,796
table 9
Reasons for not taking up Part D
PurchaseNoneTotal
already rx cov0.6170.1130.423
didn't know0.0230.0140.019
heard too late0.0080.0190.012
too expensive0.0290.1070.059
too restrictive0.0020.0050.003
haven't decided yet0.0320.1290.069
9700.0110.0360.021
other: no meds0.0620.2170.122
other: other cov0.0450.0380.042
other: other0.1090.2730.172
9800.0130.0100.012
9900.0000.0020.001
.0.0500.0380.046
Total1.0001.0001.000
PurchaseNoneTotal
Advised not to314Advised314
Can't afford134Can't134
Confusion375592Confusion375592
Enrolled/ing358Enrolled/ing358
Family didn't allow134Family134
Foreign Meds055Foreign055
Forgot257Forgot257
Free meds257Free257
Future527Future527
Government6410Government6410
Ineligible151631Ineligible151631
Misc7714Misc7714
No Benefit41014No41014
No Info received235No235
No need101222No101222
No reason81422No81422
No time123No123
Prefers Natural Herbs044PrefersNatural044
Rip off71825Rip71825
Skeptical71724Skeptical71724
Still deciding369Still369
Total124197321----------------------+----------------------+----------
Total124197321
table 10
Reasons for not applying for the subsidysubs elig
MedHMOPart D PDTotalMedHMOPart D PDTotal
too much income0.0000.0000.0000.0000.0000.000
too much wealth0.0000.0000.0000.0000.0000.000
too much resources0.0000.0000.0000.0000.0000.000
didn't know about it0.0000.0000.0000.0000.0000.000
too much bother0.0000.0000.0000.0000.0000.000
haven't gotten around0.0000.0000.0000.0000.0000.000
other, no text0.0000.0000.0000.0000.0000.000
no meds0.0000.0000.0000.0000.0000.000
Other coverage0.0000.0000.0000.0000.0000.000
No need for it0.0000.0000.0000.0000.0000.000
Financially OK w/o it0.0000.0000.0000.0000.0000.000
Other text reason0.0000.0000.0000.0000.0000.000
no Part D, missing xh0.0000.0000.0000.0000.0000.000
DK0.0000.0000.0000.0000.0000.000
RF0.0000.0000.0000.0000.0000.000
Total0.0000.0000.0000.0000.0000.000
Subs eligSubs eligSubs elig
MedHMOPart D PDTotalMedHMOPart D PDTotal
Advised not to112000
Believe Ineligible9273641216
Confusion821292810
Didn't make decision268112
Didn't want to213101
Dislike program055022
Enrolled369033
Foreign meds011000
Forgot022011
Free meds426213
Future123022
Government112000
Misc21012077
No SS202000
No reason10283841519
En Espanol9615246
Total54119173165672
tables 11 12
Difficult?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.0280.0690.0410.1540.0440.0540.069
Somewhat0.0510.0550.0390.2170.0720.0710.096
Not very0.0970.0880.0750.1640.1190.1370.116
Not at all0.6930.2130.4010.2150.5480.4530.455
Didn't decide myself0.0260.0640.0230.0560.0380.0350.038
Auto-enrolled0.0310.3930.3480.1420.0000.0000.130
DK0.0030.0050.0060.0030.0270.0190.007
RF0.0000.0000.0000.0000.0000.0000.000
Missing0.0700.1130.0670.0490.1520.2300.089
Total1.0001.0001.0001.0001.0001.0001.000
Very or somewhat difficult
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
40.1170.1390.0850.3270.1640.1190.182
60.0930.1720.0890.3420.1470.1500.184
70.0810.1390.0500.3590.0960.1870.168
80.1150.1490.1290.4150.1320.1530.195
90.1040.1360.0730.4560.1180.1310.200
100.0510.1650.1220.4000.1120.2670.174
110.0790.1360.0780.4320.1030.1480.183
130.0710.1200.0790.4310.1850.1750.188
140.0850.0320.0730.4140.1960.1980.189
Total0.0860.1450.0880.3970.1410.1690.185
Confident?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.7520.2860.4360.4040.5820.4320.535
Somewhat0.1100.1370.1040.2900.1710.1970.171
Not very0.0130.0400.0220.0530.0350.0390.031
Not at all0.0130.0180.0100.0370.0230.0460.023
Auto-enrolled0.0310.3930.3480.1420.0000.0000.130
DK0.0070.0130.0100.0250.0310.0400.018
RF0.0010.0000.0000.0000.0010.0010.000
Missing0.0730.1130.0700.0490.1580.2450.092
Total1.0001.0001.0001.0001.0001.0001.000
Sign up next year?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.0780.5150.3300.7030.0820.1700.318
Somewhat0.0660.1480.0990.1590.1330.1760.117
Not very0.1670.0800.1480.0360.2410.2250.136
Not at all0.6560.1520.3710.0440.4520.3300.370
Missing0.0330.1060.0530.0580.0920.0990.059
Total1.0001.0001.0001.0001.0001.0001.000
chart rx cov in 04
Employer
Medicaid
MedHMO
Purchase
None
Distribution of Rx coverage in 2004Medicare beneficiaries ages 65+ in 2006HRS 2004 & 2006; n=10,175
0.3477
0.07
0.1178
0.2333
0.2312
chart rx cov in 06
Employer
Medicaid
MedHMO
Part D PD
Purchase
None
Distribution of Rx coverage in 2006Medicare beneficiaries ages 65+ in 2006HRS 2004 & 2006; n=10,175
0.3317
0.0729
0.1526
0.2567
0.1142
0.0718
chart rx cov in 04 & 06
200420042004200420042004
200620062006200620062006
Employer
Medicaid
MedHMO
Part D PD
Purchase
None
Rx coverage in 2004 and 2006Medicare beneficiaries ages 65+ in 2006HRS 2004 & 2006; n=10,175
0.3477
0.07
0.1178
0
0.2333
0.2312
0.3317
0.0729
0.1526
0.2567
0.1142
0.0718
chart takeup PDP
0.41741370.42416580.43551350.44231670.4287533
0.5405050.58276840.59145580.57586260.5677456
0.65496260.60741550.60184120.57965930.6163917
0.58992420.57471590.59233660.57913160.5821737
0.67886370.7034410.69057120.6901320.6906147
0.75917670.7227830.69852370.6934220.7252178
0.49725070.38411990.43114340.35541980.4106762
Subsidy elig
Income too high
Assets too high
Both too high
Total
Different definitions of Part D Takeup
chart takeup xh
takeupX1takeupX1takeupX1takeupX1takeupX1
takeupX2takeupX2takeupX2takeupX2takeupX2
takeupX3takeupX3takeupX3takeupX3takeupX3
takeupX4takeupX4takeupX4takeupX4takeupX4
takeupX5takeupX5takeupX5takeupX5takeupX5
takeupX6takeupX6takeupX6takeupX6takeupX6
takeupX7takeupX7takeupX7takeupX7takeupX7
takeupX8takeupX8takeupX8takeupX8takeupX8
takeupX9takeupX9takeupX9takeupX9takeupX9
Subsidy elig
Income too high
Assets too high
Both too high
Total
Different definitions of subsidy application
0.1343534
0.0936731
0.0995932
0.0187037
0.0810085
0.1157002
0.075055
0.0686082
0.018278
0.0671875
0.1066981
0.0654303
0.0648409
0.0163955
0.0604617
0.184504
0.1936655
0.1197516
0.1193901
0.1605671
0.5003701
0.2282423
0.1494935
0.0428462
0.2897248
0.4230446
0.1695421
0.1047905
0.0350066
0.2243548
0.4009723
0.1497627
0.0992481
0.0314563
0.2053593
0.4531472
0.2664264
0.1521385
0.1328739
0.2900263
0.0779181
0.0467455
0.0432914
0.0118238
0.0438569
response patterns by rxcov
yesP(auto|yes)P(xh|Partd)yesnomissing
Employer0.0790.4100.0310.0070.6870.306
Medicaid0.7050.5380.0940.0680.7700.162
MedHMO0.4830.6970.0550.0280.7150.258
Part D PDP1.0000.1460.0850.0840.9090.007
Purchase0.000-0.0120.5660.422
None0.000-0.0060.5290.466
Total0.4160.3170.0780.0360.7300.234
pdp takeup gradient in income
Fraction of respondents with no coverage or privately purchased coverage in 2004 who took up Part D in 2006
by income and assets relative to subsidy eligibility thresholds
Taking up Part D means having rx coverage from Medicaid, a Medicare HMO, or a PDP in 2006.
Assets3x|Total
00.5880.4900.5860.6600.7440.4750.5000.5150.502
-
RX coverage in 2006 by 2004 status n = 10,175
Coverage in 2006Coverage in 2004 Employer Medicaid MedHMO Part D Purchase None Total Employer 0.685 0.009 0.080 0.109 0.098 0.019 1.000 Medicaid 0.026 0.683 0.044 0.171 0.055 0.022 1.000 MedHMO 0.115 0.027 0.705 0.069 0.071 0.014 1.000 Purchase 0.274 0.046 0.096 0.334 0.196 0.056 1.000 None 0.062 0.035 0.071 0.522 0.097 0.212 1.000Total 0.332 0.073 0.153 0.257 0.114 0.072 1.000
Sheet1
Coverage in 2006
Coverage in 2004EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Employer0.6850.0090.0800.1090.0980.0191.000
Medicaid0.0260.6830.0440.1710.0550.0221.000
MedHMO0.1150.0270.7050.0690.0710.0141.000
Purchase0.2740.0460.0960.3340.1960.0561.000
None0.0620.0350.0710.5220.0970.2121.000
Total0.3320.0730.1530.2570.1140.0721.000
-
How should we define “takeup”?
• Who belongs in the numerator and the denominator?
• For example: – Do you count Medicaid recipients as “taking
up” the program? – Do you exclude people who had employer
coverage in 2004?
-
Alternative definitions of Part D takeup
D1 PDP06 / (PDP06 + PVT06 + UNINS06)
D2 (PDP06 + HMO06) / (PDP06 + PVT06 + UNINS06 + HMO06)
D3 (PDP06 + HMO06 + MCD06) / (PDP06 + PVT06 + UNINS06 + HMO06 + MCD06)
D4 PDP06 / (PVT04 + UNINS04)
D5 (PDP06 + HMO06) / (PVT04 + UNINS04 + HMO04)
D6 (PDP06 + HMO06 + MCD06) / (PVT04 + UNINS04 + HMO04 + MCD04)
D7 (“Yes” to “did you sign up for Part D?”)/(All respondents)
-
Different definitions of Part D Takeup
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
1 2 3 4 5 6 7
Subsidy eligIncome too highAssets too highBoth too highTotal
table 1
EmployerMedicaidMedHMOPurchaseNoneTotal
Row percent:0.3450.0740.1190.2320.2301.000
Sample n3,5008911,1322,3062,34610,175
Age in 200673.375.775.676.876.475.3
Female0.4860.7140.5570.6500.6160.579
Black0.0610.2290.0620.0870.0690.081
Other nonwhite race0.0260.0960.0330.0220.0190.029
Hispanic0.0280.2750.0970.0420.0470.062
Fair/poor health0.2160.5940.2510.2910.2710.278
Any rx conds 04?0.6760.7820.6570.6960.6150.672
Number of rx conds 041.51.91.51.61.41.6
Any ADL limitations0.9370.9800.9430.9550.9560.950
No. of ADLS if >03.86.34.14.54.34.3
mean memory score9.77.29.08.68.79.0
mem missing0.0630.1370.0600.0710.0700.072
Education < HS0.1600.6590.2270.2960.2780.263777
Education = HS0.3570.2490.3760.3690.3810.359
Some college0.2060.0610.2060.1750.1890.184
College+0.2770.0310.1910.1590.1530.193
Subsidy eligible0.1760.8210.2600.3300.3250.304
Income too high0.3040.1420.3370.2730.2730.282
Assets too high0.0460.0130.0620.0690.0610.054
Both too high0.4750.0240.3410.3270.3410.360
|0.6760.7820.6570.6960.6150.672
|1.51.91.51.61.41.5
rxcov04
EmployerMedicaidMedHMOPurchaseNoneTotal
table 2
Row percents
Coverage in 2006
Coverage in 2004EmployerMedicaidMedHMOPart DPurchaseNoneTotalMcd + MA + PDP
Employer0.6850.0090.0800.1090.0980.0191.000
Medicaid0.0260.6830.0440.1710.0550.0221.000
MedHMO0.1150.0270.7050.0690.0710.0141.0000.475
Purchase0.2740.0460.0960.3340.1960.0561.0000.629
None0.0620.0350.0710.5220.0970.2121.000
Total0.3320.0730.1530.2570.1140.0721.000
Mcdn=10,175avg:0.55195
So, estimate of takeup is about 55% overall
if you count Medicaid, MA and PDP as "takeup".
EmployerMedicaidMedHMOPart D PDPurchaseNoneTotal
Employer2,40839261387334713,500
Medicaid22629381394320891
MedHMO129387888674171,132
Purchase6151382157644411332,306
None1441011731,2152264872,346
Total3,3189451,4752,5911,11872810,175
tables 3 4
EligibleIncome toAssets toBoth tooTotalOutcomeBEligibleIncome toAssets toBoth tooTotal
Row percent0.3040.2820.0540.3611.000Row percent0.3040.2820.0540.3611.000
Employer0.2120.3450.3260.4150.329
Coverage in 2004Medicaid0.1970.0430.0170.0060.075
Employer0.2000.3720.2910.4540.345MedHMO/no0.0940.1250.1330.1100.111
Medicaid0.1990.0370.0180.0050.074MedHMO/yes subs0.0040.0020.0000.0000.002
MedHMO0.1020.1430.1360.1130.119medHMO/denied0.0020.0030.0000.0020.002
Purchase0.2530.2250.2980.2110.232medHMO/waiting0.0000.0000.0000.0000.000
None0.2460.2230.2570.2170.230HMO/dk0.0270.0550.0250.0410.040
Total1.0001.0001.0001.0001.000PDP/no su0.2370.2220.2660.2420.236
PDP/got s0.0200.0070.0060.0020.009
Coverage in 2006PDP/denie0.0130.0150.0190.0020.010
Employer0.2120.3450.3260.4150.329PDP/wait0.0040.0020.0050.0000.002
Medicaid0.1970.0430.0170.0060.075Purchase0.1170.1120.1210.1110.114
MedHMO0.1280.1850.1580.1530.155None0.0730.0700.0820.0690.071
Part D PDP0.2730.2450.2950.2470.257Sample N3,3022,9235233,42710,175
Purchase0.1170.1120.1210.1110.114
None0.0730.0700.0820.0690.071OutcomeAEligibleIncome toAssets toBoth tooTotal
Total1.0001.0001.0001.0001.000Employer0.2120.3450.3260.4150.329
Medicaid0.1970.0430.0170.0060.075
PDP or MedHMO: p(apply for subsidy)MedHMO/no0.0940.1250.1330.1100.111
Yes0.1070.0650.0650.0160.061MedHMO/ye0.0070.0050.0000.0020.004
No0.8160.8060.8800.8810.839MedHMO/dk0.0270.0550.0250.0410.040
Not asked0.0780.1280.0550.1030.100PDP/no su0.2370.2220.2660.2420.236
PDP/yes s0.0360.0230.0290.0050.021
PDP: p(apply for xh)Purchase0.1170.1120.1210.1110.114
10.1340.0940.1000.0190.081None |0.0730.0700.0820.0690.071
Total1.0001.0001.0001.0001.000
MedHMO: p(apply for subsidy)
Yes0.0520.0280.0000.0130.027
No0.7360.6760.8430.7210.716
Not asked0.2120.2960.1570.2660.257
Outcome of subsidy application, conditional on applying
PDP or MedHMO
Approved0.5660.2900.1870.3290.430
Denied0.3280.6440.6560.6030.477
Waiting0.1070.0670.1570.0680.094
PDP
Approved0.5460.2900.1870.4520.430
Denied0.3410.6420.6560.4550.470
Waiting0.1130.0680.1570.0930.101
MedHMOTotal
Approved0.6820.287-0.0000.431100.000
Denied0.2500.652-1.0000.514100.000
Waiting0.0690.062-0.0000.056100.000
100.000
Sample N3,3022,9235233,42710,175100.000
table 3 simplified
Resources relative to eligibility
EligibleIncome toAssets toBoth tooTotal
Sample n1,2591,2082211,3784,066
Row percent0.2960.2950.0600.3501.000
PDP: p(apply for subisdy)0.1340.0940.1000.0190.081
MedHMO: p(apply for subsidy)
Yes0.0520.0280.0000.0130.027
No0.7360.6760.8430.7210.716
Not asked0.2120.2960.1570.2660.257
Outcome of subsidy application, conditional on applying
PDP or MedHMO
Approved0.5660.2900.1870.3290.430
Denied0.3280.6440.6560.6030.477
Waiting0.1070.0670.1570.0680.094
table 6
Subsidy eligIncome too highAssets too highBoth too highTotalDenominator n
takeupD10.58992420.57471590.59233660.57913160.58217374,437
takeupD20.67886370.7034410.69057120.6901320.69061475,912
takeupD30.75917670.7227830.69852370.6934220.72521786,857
takeupD40.41741370.42416580.43551350.44231670.42875334,652
takeupD50.5405050.58276840.59145580.57586260.56774565,784
takeupD60.65496260.60741550.60184120.57965930.61639176,675
takeupD70.49725070.38411990.43114340.35541980.410676210,175
Subsidy eligIncome too highAssets too highBoth too highTotal
takeupX10.13435340.09367310.09959320.01870370.08100852,572
takeupX20.11570020.0750550.06860820.0182780.06718753,667
takeupX30.10669810.06543030.06484090.01639550.06046174,066
takeupX40.1845040.19366550.11975160.11939010.16056714,066
takeupX50.50037010.22824230.14949350.04284620.28972483,517
takeupX60.42304460.16954210.10479050.03500660.22435484,612
takeupX70.40097230.14976270.09924810.03145630.20535935,011
takeupX80.45314720.26642640.15213850.13287390.29002635,011
takeupX90.07791810.04674550.04329140.01182380.04385697,796
table 9
Rx coverage in 2006Rx coverage in 2006
PurchaseNoneTotalPurchaseNoneTotal
Sample n1,1187281,846Sample n1,1187281,846
(1) Already have good coverage0.6170.1130.423(1) Already have good coverage0.6170.1130.423
(2) Didn't know it was available0.0230.0140.019(2) Didn't know it was available0.0230.0140.019
(3) Heard about it too late0.0080.0190.012(3) Heard about it too late0.0080.0190.012
(4) Medicare plan too expensive0.0290.1070.059(4) Medicare plan too expensive0.0290.1070.059
(5) Medicare plan too restrictive0.0020.0050.003(5) Medicare plan too restrictive0.0020.0050.003
(6) Haven't made a decision yet0.0320.1290.069(6) Haven't made a decision yet0.0320.1290.069
(7A) Other: no additional info0.0110.0360.021(7A) Other: no additional info0.0110.0360.021
(7B) Other: text = no meds0.0620.2170.122(7B) Other: text = no meds0.0620.2170.122
(7C) Other: text = other coverage0.0450.0380.042(7C) Other: text = other coverage0.0450.0380.042
(7D) Other: text = other0.1090.2730.172(7D) Other: text = other0.1090.2730.172
Advised not to314(8A) Why not enroll = DK0.0130.0100.012
Can't afford134(8B) Why not enroll = missing0.0000.0020.001
Confusion375592(8C) Missing data on Part D enrollment0.0500.0380.046
Enrolled/ing358Total1.0001.0001.000
Family didn't allow134
Foreign Meds055
Forgot257
Free meds257
Future527
Government6410
Ineligible151631
Misc7714
No Benefit41014
No Info received235
No need101222
No reason81422
No time123
Prefers Natural Herbs044
Rip off71825
Skeptical71724
Still deciding369
Total124197321
(8A) Why not enroll = DK0.0130.010.012
(8B) Why not enroll = missing00.0020.001
(8C) Missing data on Part D enrollment0.050.0380.046
Total111
table9 simplified
Rx coverage in 2006
PurchaseNoneTotal
Sample n1,1187281,846
(1) Already have good coverage0.6170.1130.423
(2) Didn't know it was available0.0230.0140.019
(3) Heard about it too late0.0080.0190.012
(4) Medicare plan too expensive0.0290.1070.059
(5) Medicare plan too restrictive0.0020.0050.003
(6) Haven't made a decision yet0.0320.1290.069
(7A) Other: no additional info0.0110.0360.021
(7B) Other: text = no meds0.0620.2170.122
(7C) Other: text = other coverage0.0450.0380.042
(7D) Other: text = other0.1090.2730.172
(8A) Why not enroll = DK0.0130.0100.012
(8B) Why not enroll = missing0.0000.0020.001
(8C) Missing data on Part D enrollment0.0500.0380.046
Total1.0001.0001.000
table 10
All income/asset levelsSubsidy-eligible only
MedHMOPart DTotalMedHMOPart DTotal
Sample n1,4752,5914,0663848751,259
(1) Too much income0.1830.3250.2690.1140.1730.153
(2) Too much wealth0.0310.0450.040.0180.030.026
(3) Too much resources0.0240.0450.0370.0140.0260.022
(4) Didn't know about it0.1890.2910.2520.260.4140.362
(5) Too much bother/confusing0.0060.0180.0130.010.0330.025
(6) Haven't gotten around to it0.0050.0160.0120.0130.030.025
(7A) Other: no additional info0.0280.0150.020.0310.0080.016
(7B) Other: text = no meds0.0350.0410.0390.0420.0370.039
(7C) Other: text = other coverage0.1050.0390.0650.1160.050.072
(7D) Other: text = no need for it0.0590.0660.0630.0670.0670.067
(7E) Other: text = OK w/o it0.0210.020.020.0290.0170.021
(7F) Other: text = other0.0360.0480.0440.0330.0710.058
Advised not to112000
Believe Ineligible9273641216
Confusion821292810
Didn't make decision268112
Didn't want to213101
Dislike program055022
Enrolled369033
Foreign meds011000
Forgot022011
Free meds426213
Future123022
Government112000
Misc.21012077
No Social Security202000
No reason10283841519
En Español9615246
Total54119173165672
(8A) Missing all subsidy data0.26300.1030.220.0010.076
(8B) Don’t know0.0150.0280.0230.0280.0380.034
(8C) Refused0.0010.0010.0010.0050.0050.005
Total111111
table 10 simplified
All income/asset levelsSubsidy-eligible only
MedHMOPart DTotalMedHMOPart DTotal
Sample n1,4752,5914,0663848751,259
(1) Too much income0.1830.3250.2690.1140.1730.153
(2) Too much wealth0.0310.0450.0400.0180.0300.026
(3) Too much resources0.0240.0450.0370.0140.0260.022
(4) Didn't know about it0.1890.2910.2520.2600.4140.362
(5) Too much bother/confusing0.0060.0180.0130.0100.0330.025
(6) Haven't gotten around to it0.0050.0160.0120.0130.0300.025
(7A) Other: no additional info0.0280.0150.0200.0310.0080.016
(7B) Other: text = no meds0.0350.0410.0390.0420.0370.039
(7C) Other: text = other coverage0.1050.0390.0650.1160.0500.072
(7D) Other: text = no need for it0.0590.0660.0630.0670.0670.067
(7E) Other: text = OK w/o it0.0210.0200.0200.0290.0170.021
(7F) Other: text = other0.0360.0480.0440.0330.0710.058
(8A) Missing all subsidy data0.2630.0000.1030.2200.0010.076
(8B) Don’t know0.0150.0280.0230.0280.0380.034
(8C) Refused0.0010.0010.0010.0050.0050.005
Total1.0001.0001.0001.0001.0001.000
tables 11 12
Difficult?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.0280.0690.0410.1540.0440.0540.069
Somewhat0.0510.0550.0390.2170.0720.0710.096
Not very0.0970.0880.0750.1640.1190.1370.116
Not at all0.6930.2130.4010.2150.5480.4530.455
Didn't decide myself0.0260.0640.0230.0560.0380.0350.038
Auto-enrolled0.0310.3930.3480.1420.0000.0000.130
DK0.0030.0050.0060.0030.0270.0190.007
RF0.0000.0000.0000.0000.0000.0000.000
Missing0.0700.1130.0670.0490.1520.2300.089
Total1.0001.0001.0001.0001.0001.0001.000
Very or somewhat difficult
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
40.1170.1390.0850.3270.1640.1190.182
60.0930.1720.0890.3420.1470.1500.184
70.0810.1390.0500.3590.0960.1870.168
80.1150.1490.1290.4150.1320.1530.195
90.1040.1360.0730.4560.1180.1310.200
100.0510.1650.1220.4000.1120.2670.174
110.0790.1360.0780.4320.1030.1480.183
130.0710.1200.0790.4310.1850.1750.188
140.0850.0320.0730.4140.1960.1980.189
Total0.0860.1450.0880.3970.1410.1690.185
Confident?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.7520.2860.4360.4040.5820.4320.535
Somewhat0.1100.1370.1040.2900.1710.1970.171
Not very0.0130.0400.0220.0530.0350.0390.031
Not at all0.0130.0180.0100.0370.0230.0460.023
Auto-enrolled0.0310.3930.3480.1420.0000.0000.130
DK0.0070.0130.0100.0250.0310.0400.018
RF0.0010.0000.0000.0000.0010.0010.000
Missing0.0730.1130.0700.0490.1580.2450.092
Total1.0001.0001.0001.0001.0001.0001.000
Sign up next year?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.0780.5150.3300.7030.0820.1700.318
Somewhat0.0660.1480.0990.1590.1330.1760.117
Not very0.1670.0800.1480.0360.2410.2250.136
Not at all0.6560.1520.3710.0440.4520.3300.370
Missing0.0330.1060.0530.0580.0920.0990.059
Total1.0001.0001.0001.0001.0001.0001.000
chart rx cov in 04
Employer
Medicaid
MedHMO
Purchase
None
Distribution of Rx coverage in 2004Medicare beneficiaries ages 65+ in 2006HRS 2004 & 2006; n=10,175
0.3477
0.07
0.1178
0.2333
0.2312
chart rx cov in 06
Employer
Medicaid
MedHMO
Part D
Purchase
None
Distribution of Rx coverage in 2006Medicare beneficiaries ages 65+ in 2006HRS 2004 & 2006; n=10,175
0.3317
0.0729
0.1526
0.2567
0.1142
0.0718
chart rx cov in 04 & 06
200420042004200420042004
200620062006200620062006
Employer
Medicaid
MedHMO
Part D PD
Purchase
None
Rx coverage in 2004 and 2006Medicare beneficiaries ages 65+ in 2006HRS 2004 & 2006; n=10,175
0.3477
0.07
0.1178
0
0.2333
0.2312
0.3317
0.0729
0.1526
0.2567
0.1142
0.0718
chart takeup PDP
0.58992420.57471590.59233660.57913160.5821737
0.67886370.7034410.69057120.6901320.6906147
0.75917670.7227830.69852370.6934220.7252178
0.41741370.42416580.43551350.44231670.4287533
0.5405050.58276840.59145580.57586260.5677456
0.65496260.60741550.60184120.57965930.6163917
0.49725070.38411990.43114340.35541980.4106762
Subsidy elig
Income too high
Assets too high
Both too high
Total
Different definitions of Part D Takeup
chart takeup xh
takeupX1takeupX1takeupX1takeupX1takeupX1
takeupX2takeupX2takeupX2takeupX2takeupX2
takeupX3takeupX3takeupX3takeupX3takeupX3
takeupX4takeupX4takeupX4takeupX4takeupX4
takeupX5takeupX5takeupX5takeupX5takeupX5
takeupX6takeupX6takeupX6takeupX6takeupX6
takeupX7takeupX7takeupX7takeupX7takeupX7
takeupX8takeupX8takeupX8takeupX8takeupX8
takeupX9takeupX9takeupX9takeupX9takeupX9
Subsidy elig
Income too high
Assets too high
Both too high
Total
Different definitions of subsidy application
0.1343534
0.0936731
0.0995932
0.0187037
0.0810085
0.1157002
0.075055
0.0686082
0.018278
0.0671875
0.1066981
0.0654303
0.0648409
0.0163955
0.0604617
0.184504
0.1936655
0.1197516
0.1193901
0.1605671
0.5003701
0.2282423
0.1494935
0.0428462
0.2897248
0.4230446
0.1695421
0.1047905
0.0350066
0.2243548
0.4009723
0.1497627
0.0992481
0.0314563
0.2053593
0.4531472
0.2664264
0.1521385
0.1328739
0.2900263
0.0779181
0.0467455
0.0432914
0.0118238
0.0438569
response patterns by rxcov
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
"Did you sign up for Part D?"0.0790.7050.4831.0000.0000.0000.416
If yes: "Were you automatically enrolled?"0.4100.5380.6970.146--0.317
If yes: "Did you apply for Extra Help?"0.0310.0940.0550.085--0.078
"Did you apply for Extra Help?"
Yes0.0070.0680.0280.0840.0120.0060.036
No0.6870.7700.7150.9090.5660.5290.730
Missing0.3060.1620.2580.0070.4220.4660.234
pdp takeup gradient in income
Fraction of respondents with no coverage or privately purchased coverage in 2004 who took up Part D in 2006
by income and assets relative to subsidy eligibility thresholds
Taking up Part D means having rx coverage from Medicaid, a Medicare HMO, or a PDP in 2006.
Assets3x|Total
00.5880.4900.5860.6600.7440.4750.5000.5150.502
-
Subsidy applications and outcomes Part D & Medicare HMO enrollees
Resources relative to eligibilityEligible Income too high Assets too high Both too high Total
Sample n 1,259 1,208 221 1,378 4,066Row percent 0.296 0.295 0.060 0.350 1.000
PDP: p(apply for subisdy) 0.134 0.094 0.100 0.019 0.081
MedHMO: p(apply for subsidy)Yes 0.052 0.028 0.000 0.013 0.027No 0.736 0.676 0.843 0.721 0.716Not asked 0.212 0.296 0.157 0.266 0.257
Outcome of subsidy application, conditional on applyingPDP or MedHMOApproved 0.566 0.290 0.187 0.329 0.430Denied 0.328 0.644 0.656 0.603 0.477Waiting 0.107 0.067 0.157 0.068 0.094
table 1
EmployerMedicaidMedHMOPurchaseNoneTotal
Row percent:0.3450.0740.1190.2320.2301.000
Sample n3,5008911,1322,3062,34610,175
Age in 200673.375.775.676.876.475.3
Female0.4860.7140.5570.6500.6160.579
Black0.0610.2290.0620.0870.0690.081
Other nonwhite race0.0260.0960.0330.0220.0190.029
Hispanic0.0280.2750.0970.0420.0470.062
Fair/poor health0.2160.5940.2510.2910.2710.278
Any rx conds 04?0.6760.7820.6570.6960.6150.672
Number of rx conds 041.51.91.51.61.41.6
Any ADL limitations0.9370.9800.9430.9550.9560.950
No. of ADLS if >03.86.34.14.54.34.3
mean memory score9.77.29.08.68.79.0
mem missing0.0630.1370.0600.0710.0700.072
Education < HS0.1600.6590.2270.2960.2780.263777
Education = HS0.3570.2490.3760.3690.3810.359
Some college0.2060.0610.2060.1750.1890.184
College+0.2770.0310.1910.1590.1530.193
Subsidy eligible0.1760.8210.2600.3300.3250.304
Income too high0.3040.1420.3370.2730.2730.282
Assets too high0.0460.0130.0620.0690.0610.054
Both too high0.4750.0240.3410.3270.3410.360
|0.6760.7820.6570.6960.6150.672
|1.51.91.51.61.41.5
rxcov04
EmployerMedicaidMedHMOPurchaseNoneTotal
table 2
Row percents
Coverage in 2006
Coverage in 2004EmployerMedicaidMedHMOPart DPurchaseNoneTotalMcd + MA + PDP
Employer0.6850.0090.0800.1090.0980.0191.000
Medicaid0.0260.6830.0440.1710.0550.0221.000
MedHMO0.1150.0270.7050.0690.0710.0141.0000.475
Purchase0.2740.0460.0960.3340.1960.0561.0000.629
None0.0620.0350.0710.5220.0970.2121.000
Total0.3320.0730.1530.2570.1140.0721.000
Mcdn=10,175avg:0.55195
So, estimate of takeup is about 55% overall
if you count Medicaid, MA and PDP as "takeup".
EmployerMedicaidMedHMOPart D PDPurchaseNoneTotal
Employer2,40839261387334713,500
Medicaid22629381394320891
MedHMO129387888674171,132
Purchase6151382157644411332,306
None1441011731,2152264872,346
Total3,3189451,4752,5911,11872810,175
tables 3 4
EligibleIncome toAssets toBoth tooTotalOutcomeBEligibleIncome toAssets toBoth tooTotal
Row percent0.3040.2820.0540.3611.000Row percent0.3040.2820.0540.3611.000
Employer0.2120.3450.3260.4150.329
Coverage in 2004Medicaid0.1970.0430.0170.0060.075
Employer0.2000.3720.2910.4540.345MedHMO/no0.0940.1250.1330.1100.111
Medicaid0.1990.0370.0180.0050.074MedHMO/yes subs0.0040.0020.0000.0000.002
MedHMO0.1020.1430.1360.1130.119medHMO/denied0.0020.0030.0000.0020.002
Purchase0.2530.2250.2980.2110.232medHMO/waiting0.0000.0000.0000.0000.000
None0.2460.2230.2570.2170.230HMO/dk0.0270.0550.0250.0410.040
Total1.0001.0001.0001.0001.000PDP/no su0.2370.2220.2660.2420.236
PDP/got s0.0200.0070.0060.0020.009
Coverage in 2006PDP/denie0.0130.0150.0190.0020.010
Employer0.2120.3450.3260.4150.329PDP/wait0.0040.0020.0050.0000.002
Medicaid0.1970.0430.0170.0060.075Purchase0.1170.1120.1210.1110.114
MedHMO0.1280.1850.1580.1530.155None0.0730.0700.0820.0690.071
Part D PDP0.2730.2450.2950.2470.257Sample N3,3022,9235233,42710,175
Purchase0.1170.1120.1210.1110.114
None0.0730.0700.0820.0690.071OutcomeAEligibleIncome toAssets toBoth tooTotal
Total1.0001.0001.0001.0001.000Employer0.2120.3450.3260.4150.329
Medicaid0.1970.0430.0170.0060.075
PDP or MedHMO: p(apply for subsidy)MedHMO/no0.0940.1250.1330.1100.111
Yes0.1070.0650.0650.0160.061MedHMO/ye0.0070.0050.0000.0020.004
No0.8160.8060.8800.8810.839MedHMO/dk0.0270.0550.0250.0410.040
Not asked0.0780.1280.0550.1030.100PDP/no su0.2370.2220.2660.2420.236
PDP/yes s0.0360.0230.0290.0050.021
PDP: p(apply for xh)Purchase0.1170.1120.1210.1110.114
10.1340.0940.1000.0190.081None |0.0730.0700.0820.0690.071
Total1.0001.0001.0001.0001.000
MedHMO: p(apply for subsidy)
Yes0.0520.0280.0000.0130.027
No0.7360.6760.8430.7210.716
Not asked0.2120.2960.1570.2660.257
Outcome of subsidy application, conditional on applying
PDP or MedHMO
Approved0.5660.2900.1870.3290.430
Denied0.3280.6440.6560.6030.477
Waiting0.1070.0670.1570.0680.094
PDP
Approved0.5460.2900.1870.4520.430
Denied0.3410.6420.6560.4550.470
Waiting0.1130.0680.1570.0930.101
MedHMOTotal
Approved0.6820.287-0.0000.431100.000
Denied0.2500.652-1.0000.514100.000
Waiting0.0690.062-0.0000.056100.000
100.000
Sample N3,3022,9235233,42710,175100.000
table 3 simplified
Resources relative to eligibility
EligibleIncome too highAssets too highBoth too highTotal
Sample n1,2591,2082211,3784,066
Row percent0.2960.2950.0600.3501.000
PDP: p(apply for subisdy)0.1340.0940.1000.0190.081
MedHMO: p(apply for subsidy)
Yes0.0520.0280.0000.0130.027
No0.7360.6760.8430.7210.716
Not asked0.2120.2960.1570.2660.257
Outcome of subsidy application, conditional on applying
PDP or MedHMO
Approved0.5660.2900.1870.3290.430
Denied0.3280.6440.6560.6030.477
Waiting0.1070.0670.1570.0680.094
table 6
Subsidy eligIncome too highAssets too highBoth too highTotalDenominator n
takeupD10.5820.5900.5750.5920.5794,437
takeupD20.6910.6790.7030.6910.6905,912
takeupD30.7250.7590.7230.6990.6936,857
takeupD40.4290.4170.4240.4360.4424,652
takeupD50.5680.5410.5830.5910.5765,784
takeupD60.6160.6550.6070.6020.5806,675
takeupD70.4110.4970.3840.4310.35510,175
Subsidy eligIncome too highAssets too highBoth too highTotal
takeupX10.0810.1340.0940.1000.0192,572
takeupX20.0670.1160.0750.0690.0183,667
takeupX30.0600.1070.0650.0650.0164,066
takeupX40.1610.1850.1940.1200.1194,066
takeupX50.2900.5000.2280.1490.0433,517
takeupX60.2240.4230.1700.1050.0354,612
takeupX70.2050.4010.1500.0990.0315,011
takeupX80.2900.4530.2660.1520.1335,011
takeupX90.0440.0780.0470.0430.0127,796
table 9
Rx coverage in 2006Rx coverage in 2006
PurchaseNoneTotalPurchaseNoneTotal
Sample n1,1187281,846Sample n1,1187281,846
(1) Already have good coverage0.6170.1130.423(1) Already have good coverage0.6170.1130.423
(2) Didn't know it was available0.0230.0140.019(2) Didn't know it was available0.0230.0140.019
(3) Heard about it too late0.0080.0190.012(3) Heard about it too late0.0080.0190.012
(4) Medicare plan too expensive0.0290.1070.059(4) Medicare plan too expensive0.0290.1070.059
(5) Medicare plan too restrictive0.0020.0050.003(5) Medicare plan too restrictive0.0020.0050.003
(6) Haven't made a decision yet0.0320.1290.069(6) Haven't made a decision yet0.0320.1290.069
(7A) Other: no additional info0.0110.0360.021(7A) Other: no additional info0.0110.0360.021
(7B) Other: text = no meds0.0620.2170.122(7B) Other: text = no meds0.0620.2170.122
(7C) Other: text = other coverage0.0450.0380.042(7C) Other: text = other coverage0.0450.0380.042
(7D) Other: text = other0.1090.2730.172(7D) Other: text = other0.1090.2730.172
Advised not to314(8A) Why not enroll = DK0.0130.0100.012
Can't afford134(8B) Why not enroll = missing0.0000.0020.001
Confusion375592(8C) Missing data on Part D enrollment0.0500.0380.046
Enrolled/ing358Total1.0001.0001.000
Family didn't allow134
Foreign Meds055
Forgot257
Free meds257
Future527
Government6410
Ineligible151631
Misc7714
No Benefit41014
No Info received235
No need101222
No reason81422
No time123
Prefers Natural Herbs044
Rip off71825
Skeptical71724
Still deciding369
Total124197321
(8A) Why not enroll = DK0.0130.010.012
(8B) Why not enroll = missing00.0020.001
(8C) Missing data on Part D enrollment0.050.0380.046
Total111
table9 simplified
Rx coverage in 2006
PurchaseNoneTotal
Sample n1,1187281,846
(1) Already have good coverage0.6170.1130.423
(2) Didn't know it was available0.0230.0140.019
(3) Heard about it too late0.0080.0190.012
(4) Medicare plan too expensive0.0290.1070.059
(5) Medicare plan too restrictive0.0020.0050.003
(6) Haven't made a decision yet0.0320.1290.069
(7A) Other: no additional info0.0110.0360.021
(7B) Other: text = no meds0.0620.2170.122
(7C) Other: text = other coverage0.0450.0380.042
(7D) Other: text = other0.1090.2730.172
(8A) Why not enroll = DK0.0130.0100.012
(8B) Why not enroll = missing0.0000.0020.001
(8C) Missing data on Part D enrollment0.0500.0380.046
Total1.0001.0001.000
table 10
All income/asset levelsSubsidy-eligible only
MedHMOPart DTotalMedHMOPart DTotal
Sample n1,4752,5914,0663848751,259
(1) Too much income0.1830.3250.2690.1140.1730.153
(2) Too much wealth0.0310.0450.040.0180.030.026
(3) Too much resources0.0240.0450.0370.0140.0260.022
(4) Didn't know about it0.1890.2910.2520.260.4140.362
(5) Too much bother/confusing0.0060.0180.0130.010.0330.025
(6) Haven't gotten around to it0.0050.0160.0120.0130.030.025
(7A) Other: no additional info0.0280.0150.020.0310.0080.016
(7B) Other: text = no meds0.0350.0410.0390.0420.0370.039
(7C) Other: text = other coverage0.1050.0390.0650.1160.050.072
(7D) Other: text = no need for it0.0590.0660.0630.0670.0670.067
(7E) Other: text = OK w/o it0.0210.020.020.0290.0170.021
(7F) Other: text = other0.0360.0480.0440.0330.0710.058
Advised not to112000
Believe Ineligible9273641216
Confusion821292810
Didn't make decision268112
Didn't want to213101
Dislike program055022
Enrolled369033
Foreign meds011000
Forgot022011
Free meds426213
Future123022
Government112000
Misc.21012077
No Social Security202000
No reason10283841519
En Español9615246
Total54119173165672
(8A) Missing all subsidy data0.26300.1030.220.0010.076
(8B) Don’t know0.0150.0280.0230.0280.0380.034
(8C) Refused0.0010.0010.0010.0050.0050.005
Total111111
table 10 simplified
All income/asset levelsSubsidy-eligible only
MedHMOPart DTotalMedHMOPart DTotal
Sample n1,4752,5914,0663848751,259
(1) Too much income0.1830.3250.2690.1140.1730.153
(2) Too much wealth0.0310.0450.0400.0180.0300.026
(3) Too much resources0.0240.0450.0370.0140.0260.022
(4) Didn't know about it0.1890.2910.2520.2600.4140.362
(5) Too much bother/confusing0.0060.0180.0130.0100.0330.025
(6) Haven't gotten around to it0.0050.0160.0120.0130.0300.025
(7A) Other: no additional info0.0280.0150.0200.0310.0080.016
(7B) Other: text = no meds0.0350.0410.0390.0420.0370.039
(7C) Other: text = other coverage0.1050.0390.0650.1160.0500.072
(7D) Other: text = no need for it0.0590.0660.0630.0670.0670.067
(7E) Other: text = OK w/o it0.0210.0200.0200.0290.0170.021
(7F) Other: text = other0.0360.0480.0440.0330.0710.058
(8A) Missing all subsidy data0.2630.0000.1030.2200.0010.076
(8B) Don’t know0.0150.0280.0230.0280.0380.034
(8C) Refused0.0010.0010.0010.0050.0050.005
Total1.0001.0001.0001.0001.0001.000
tables 11 12
Difficult?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.0280.0690.0410.1540.0440.0540.069
Somewhat0.0510.0550.0390.2170.0720.0710.096
Not very0.0970.0880.0750.1640.1190.1370.116
Not at all0.6930.2130.4010.2150.5480.4530.455
Didn't decide myself0.0260.0640.0230.0560.0380.0350.038
Auto-enrolled0.0310.3930.3480.1420.0000.0000.130
DK0.0030.0050.0060.0030.0270.0190.007
RF0.0000.0000.0000.0000.0000.0000.000
Missing0.0700.1130.0670.0490.1520.2300.089
Total1.0001.0001.0001.0001.0001.0001.000
Very or somewhat difficult
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
40.1170.1390.0850.3270.1640.1190.182
60.0930.1720.0890.3420.1470.1500.184
70.0810.1390.0500.3590.0960.1870.168
80.1150.1490.1290.4150.1320.1530.195
90.1040.1360.0730.4560.1180.1310.200
100.0510.1650.1220.4000.1120.2670.174
110.0790.1360.0780.4320.1030.1480.183
130.0710.1200.0790.4310.1850.1750.188
140.0850.0320.0730.4140.1960.1980.189
Total0.0860.1450.0880.3970.1410.1690.185
Confident?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.7520.2860.4360.4040.5820.4320.535
Somewhat0.1100.1370.1040.2900.1710.1970.171
Not very0.0130.0400.0220.0530.0350.0390.031
Not at all0.0130.0180.0100.0370.0230.0460.023
Auto-enrolled0.0310.3930.3480.1420.0000.0000.130
DK0.0070.0130.0100.0250.0310.0400.018
RF0.0010.0000.0000.0000.0010.0010.000
Missing0.0730.1130.0700.0490.1580.2450.092
Total1.0001.0001.0001.0001.0001.0001.000
Sign up next year?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.0780.5150.3300.7030.0820.1700.318
Somewhat0.0660.1480.0990.1590.1330.1760.117
Not very0.1670.0800.1480.0360.2410.2250.136
Not at all0.6560.1520.3710.0440.4520.3300.370
Missing0.0330.1060.0530.0580.0920.0990.059
Total1.0001.0001.0001.0001.0001.0001.000
chart rx cov in 04
Employer
Medicaid
MedHMO
Purchase
None
Distribution of Rx coverage in 2004Medicare beneficiaries ages 65+ in 2006HRS 2004 & 2006; n=10,175
0.3477
0.07
0.1178
0.2333
0.2312
chart rx cov in 06
Employer
Medicaid
MedHMO
Part D
Purchase
None
Distribution of Rx coverage in 2006Medicare beneficiaries ages 65+ in 2006HRS 2004 & 2006; n=10,175
0.3317
0.0729
0.1526
0.2567
0.1142
0.0718
chart rx cov in 04 & 06
200420042004200420042004
200620062006200620062006
Employer
Medicaid
MedHMO
Part D PD
Purchase
None
Rx coverage in 2004 and 2006Medicare beneficiaries ages 65+ in 2006HRS 2004 & 2006; n=10,175
0.3477
0.07
0.1178
0
0.2333
0.2312
0.3317
0.0729
0.1526
0.2567
0.1142
0.0718
chart takeup PDP
0.58217370.58992420.57471590.59233660.5791316
0.69061470.67886370.7034410.69057120.690132
0.72521780.75917670.7227830.69852370.693422
0.42875330.41741370.42416580.43551350.4423167
0.56774560.5405050.58276840.59145580.5758626
0.61639170.65496260.60741550.60184120.5796593
0.41067620.49725070.38411990.43114340.3554198
Subsidy elig
Income too high
Assets too high
Both too high
Total
Different definitions of Part D Takeup
chart takeup xh
takeupX1takeupX1takeupX1takeupX1takeupX1
takeupX2takeupX2takeupX2takeupX2takeupX2
takeupX3takeupX3takeupX3takeupX3takeupX3
takeupX4takeupX4takeupX4takeupX4takeupX4
takeupX5takeupX5takeupX5takeupX5takeupX5
takeupX6takeupX6takeupX6takeupX6takeupX6
takeupX7takeupX7takeupX7takeupX7takeupX7
takeupX8takeupX8takeupX8takeupX8takeupX8
takeupX9takeupX9takeupX9takeupX9takeupX9
Subsidy elig
Income too high
Assets too high
Both too high
Total
Different definitions of subsidy application
0.0810085
0.1343534
0.0936731
0.0995932
0.0187037
0.0671875
0.1157002
0.075055
0.0686082
0.018278
0.0604617
0.1066981
0.0654303
0.0648409
0.0163955
0.1605671
0.184504
0.1936655
0.1197516
0.1193901
0.2897248
0.5003701
0.2282423
0.1494935
0.0428462
0.2243548
0.4230446
0.1695421
0.1047905
0.0350066
0.2053593
0.4009723
0.1497627
0.0992481
0.0314563
0.2900263
0.4531472
0.2664264
0.1521385
0.1328739
0.0438569
0.0779181
0.0467455
0.0432914
0.0118238
response patterns by rxcov
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
"Did you sign up for Part D?"0.0790.7050.4831.0000.0000.0000.416
If yes: "Were you automatically enrolled?"0.4100.5380.6970.146--0.317
If yes: "Did you apply for Extra Help?"0.0310.0940.0550.085--0.078
"Did you apply for Extra Help?"
Yes0.0070.0680.0280.0840.0120.0060.036
No0.6870.7700.7150.9090.5660.5290.730
Missing0.3060.1620.2580.0070.4220.4660.234
pdp takeup gradient in income
Fraction of respondents with no coverage or privately purchased coverage in 2004 who took up Part D in 2006
by income and assets relative to subsidy eligibility thresholds
Taking up Part D means having rx coverage from Medicaid, a Medicare HMO, or a PDP in 2006.
Assets3x|Total
00.5880.4900.5860.6600.7440.4750.5000.5150.502
-
Alternative definitions of subsidy takeup X1 (PDP with subsidy=yes)/
PDP X2 (PDP w/subs=yes + MedHMO w/subs=yes)/
(PDP + MedHMO06), excluding missing data
X3 (PDP w/subs=yes + MedHMO w/subs=yes)/ (PDP + MedHMO06), including missing data
X4 (PDP w/subs=yes + MedHMO w/subs=yes + MedHMO w/ miss subs)/ (PDP+MedHMO06), including missing data
X5 (PDP with subsidy=yes + Mcd)/ (PDP + Mcd)
X6 (PDP w/subs=yes + MedHMO w/subs=yes + Mcd)/ (PDP + MedHMO06 + Mcd), excluding missing data
X7 (PDP w/subs=yes + MedHMO w/subs=yes + Mcd)/ (PDP + MedHMO06 + Mcd)), including missing data
X8 (PDP w/subs=yes + MedHMO w/subs=yes + MedHMO w/ miss subs + Mcd))/ (PDP+MedHMO06 + Mcd), including missing data
X9 (Anyone with subsidy=yes)/(anyone with Part D=yes)
-
Different definitions of subsidy application
0
0.1
0.2
0.3
0.4
0.5
0.6
takeupX1 takeupX2 takeupX3 takeupX4 takeupX5 takeupX6 takeupX7 takeupX8 takeupX9
Subsidy eligIncome too highAssets too highBoth too highTotal
table 1
EmployerMedicaidMedHMOPurchaseNoneTotal
Row percent:0.3450.0740.1190.2320.2301.000
Sample n3,5008911,1322,3062,34610,175
Age in 200673.375.775.676.876.475.3
Female0.4860.7140.5570.6500.6160.579
Black0.0610.2290.0620.0870.0690.081
Other nonwhite race0.0260.0960.0330.0220.0190.029
Hispanic0.0280.2750.0970.0420.0470.062
Fair/poor health0.2160.5940.2510.2910.2710.278
Any rx conds 04?0.6760.7820.6570.6960.6150.672
Number of rx conds 041.51.91.51.61.41.6
Any ADL limitations0.9370.9800.9430.9550.9560.950
No. of ADLS if >03.86.34.14.54.34.3
mean memory score9.77.29.08.68.79.0
mem missing0.0630.1370.0600.0710.0700.072
Education < HS0.1600.6590.2270.2960.2780.263777
Education = HS0.3570.2490.3760.3690.3810.359
Some college0.2060.0610.2060.1750.1890.184
College+0.2770.0310.1910.1590.1530.193
Subsidy eligible0.1760.8210.2600.3300.3250.304
Income too high0.3040.1420.3370.2730.2730.282
Assets too high0.0460.0130.0620.0690.0610.054
Both too high0.4750.0240.3410.3270.3410.360
|0.6760.7820.6570.6960.6150.672
|1.51.91.51.61.41.5
rxcov04
EmployerMedicaidMedHMOPurchaseNoneTotal
table 2
Row percents
Coverage in 2006
Coverage in 2004EmployerMedicaidMedHMOPart DPurchaseNoneTotalMcd + MA + PDP
Employer0.6850.0090.0800.1090.0980.0191.000
Medicaid0.0260.6830.0440.1710.0550.0221.000
MedHMO0.1150.0270.7050.0690.0710.0141.0000.475
Purchase0.2740.0460.0960.3340.1960.0561.0000.629
None0.0620.0350.0710.5220.0970.2121.000
Total0.3320.0730.1530.2570.1140.0721.000
Mcdn=10,175avg:0.55195
So, estimate of takeup is about 55% overall
if you count Medicaid, MA and PDP as "takeup".
EmployerMedicaidMedHMOPart D PDPurchaseNoneTotal
Employer2,40839261387334713,500
Medicaid22629381394320891
MedHMO129387888674171,132
Purchase6151382157644411332,306
None1441011731,2152264872,346
Total3,3189451,4752,5911,11872810,175
tables 3 4
EligibleIncome toAssets toBoth tooTotalOutcomeBEligibleIncome toAssets toBoth tooTotal
Row percent0.3040.2820.0540.3611.000Row percent0.3040.2820.0540.3611.000
Employer0.2120.3450.3260.4150.329
Coverage in 2004Medicaid0.1970.0430.0170.0060.075
Employer0.2000.3720.2910.4540.345MedHMO/no0.0940.1250.1330.1100.111
Medicaid0.1990.0370.0180.0050.074MedHMO/yes subs0.0040.0020.0000.0000.002
MedHMO0.1020.1430.1360.1130.119medHMO/denied0.0020.0030.0000.0020.002
Purchase0.2530.2250.2980.2110.232medHMO/waiting0.0000.0000.0000.0000.000
None0.2460.2230.2570.2170.230HMO/dk0.0270.0550.0250.0410.040
Total1.0001.0001.0001.0001.000PDP/no su0.2370.2220.2660.2420.236
PDP/got s0.0200.0070.0060.0020.009
Coverage in 2006PDP/denie0.0130.0150.0190.0020.010
Employer0.2120.3450.3260.4150.329PDP/wait0.0040.0020.0050.0000.002
Medicaid0.1970.0430.0170.0060.075Purchase0.1170.1120.1210.1110.114
MedHMO0.1280.1850.1580.1530.155None0.0730.0700.0820.0690.071
Part D PDP0.2730.2450.2950.2470.257Sample N3,3022,9235233,42710,175
Purchase0.1170.1120.1210.1110.114
None0.0730.0700.0820.0690.071OutcomeAEligibleIncome toAssets toBoth tooTotal
Total1.0001.0001.0001.0001.000Employer0.2120.3450.3260.4150.329
Medicaid0.1970.0430.0170.0060.075
PDP or MedHMO: p(apply for subsidy)MedHMO/no0.0940.1250.1330.1100.111
Yes0.1070.0650.0650.0160.061MedHMO/ye0.0070.0050.0000.0020.004
No0.8160.8060.8800.8810.839MedHMO/dk0.0270.0550.0250.0410.040
Not asked0.0780.1280.0550.1030.100PDP/no su0.2370.2220.2660.2420.236
PDP/yes s0.0360.0230.0290.0050.021
PDP: p(apply for xh)Purchase0.1170.1120.1210.1110.114
10.1340.0940.1000.0190.081None |0.0730.0700.0820.0690.071
Total1.0001.0001.0001.0001.000
MedHMO: p(apply for subsidy)
Yes0.0520.0280.0000.0130.027
No0.7360.6760.8430.7210.716
Not asked0.2120.2960.1570.2660.257
Outcome of subsidy application, conditional on applying
PDP or MedHMO
Approved0.5660.2900.1870.3290.430
Denied0.3280.6440.6560.6030.477
Waiting0.1070.0670.1570.0680.094
PDP
Approved0.5460.2900.1870.4520.430
Denied0.3410.6420.6560.4550.470
Waiting0.1130.0680.1570.0930.101
MedHMOTotal
Approved0.6820.287-0.0000.431100.000
Denied0.2500.652-1.0000.514100.000
Waiting0.0690.062-0.0000.056100.000
100.000
Sample N3,3022,9235233,42710,175100.000
table 3 simplified
Resources relative to eligibility
EligibleIncome toAssets toBoth tooTotal
Sample n1,2591,2082211,3784,066
Row percent0.2960.2950.0600.3501.000
PDP: p(apply for subisdy)0.1340.0940.1000.0190.081
MedHMO: p(apply for subsidy)
Yes0.0520.0280.0000.0130.027
No0.7360.6760.8430.7210.716
Not asked0.2120.2960.1570.2660.257
Outcome of subsidy application, conditional on applying
PDP or MedHMO
Approved0.5660.2900.1870.3290.430
Denied0.3280.6440.6560.6030.477
Waiting0.1070.0670.1570.0680.094
table 6
Subsidy eligIncome too highAssets too highBoth too highTotalDenominator n
takeupD10.58992420.57471590.59233660.57913160.58217374,437
takeupD20.67886370.7034410.69057120.6901320.69061475,912
takeupD30.75917670.7227830.69852370.6934220.72521786,857
takeupD40.41741370.42416580.43551350.44231670.42875334,652
takeupD50.5405050.58276840.59145580.57586260.56774565,784
takeupD60.65496260.60741550.60184120.57965930.61639176,675
takeupD70.49725070.38411990.43114340.35541980.410676210,175
Subsidy eligIncome too highAssets too highBoth too highTotal
takeupX10.13435340.09367310.09959320.01870370.08100852,572
takeupX20.11570020.0750550.06860820.0182780.06718753,667
takeupX30.10669810.06543030.06484090.01639550.06046174,066
takeupX40.1845040.19366550.11975160.11939010.16056714,066
takeupX50.50037010.22824230.14949350.04284620.28972483,517
takeupX60.42304460.16954210.10479050.03500660.22435484,612
takeupX70.40097230.14976270.09924810.03145630.20535935,011
takeupX80.45314720.26642640.15213850.13287390.29002635,011
takeupX90.07791810.04674550.04329140.01182380.04385697,796
table 9
Rx coverage in 2006Rx coverage in 2006
PurchaseNoneTotalPurchaseNoneTotal
Sample n1,1187281,846Sample n1,1187281,846
(1) Already have good coverage0.6170.1130.423(1) Already have good coverage0.6170.1130.423
(2) Didn't know it was available0.0230.0140.019(2) Didn't know it was available0.0230.0140.019
(3) Heard about it too late0.0080.0190.012(3) Heard about it too late0.0080.0190.012
(4) Medicare plan too expensive0.0290.1070.059(4) Medicare plan too expensive0.0290.1070.059
(5) Medicare plan too restrictive0.0020.0050.003(5) Medicare plan too restrictive0.0020.0050.003
(6) Haven't made a decision yet0.0320.1290.069(6) Haven't made a decision yet0.0320.1290.069
(7A) Other: no additional info0.0110.0360.021(7A) Other: no additional info0.0110.0360.021
(7B) Other: text = no meds0.0620.2170.122(7B) Other: text = no meds0.0620.2170.122
(7C) Other: text = other coverage0.0450.0380.042(7C) Other: text = other coverage0.0450.0380.042
(7D) Other: text = other0.1090.2730.172(7D) Other: text = other0.1090.2730.172
Advised not to314(8A) Why not enroll = DK0.0130.0100.012
Can't afford134(8B) Why not enroll = missing0.0000.0020.001
Confusion375592(8C) Missing data on Part D enrollment0.0500.0380.046
Enrolled/ing358Total1.0001.0001.000
Family didn't allow134
Foreign Meds055
Forgot257
Free meds257
Future527
Government6410
Ineligible151631
Misc7714
No Benefit41014
No Info received235
No need101222
No reason81422
No time123
Prefers Natural Herbs044
Rip off71825
Skeptical71724
Still deciding369
Total124197321
(8A) Why not enroll = DK0.0130.010.012
(8B) Why not enroll = missing00.0020.001
(8C) Missing data on Part D enrollment0.050.0380.046
Total111
table9 simplified
Rx coverage in 2006
PurchaseNoneTotal
Sample n1,1187281,846
(1) Already have good coverage0.6170.1130.423
(2) Didn't know it was available0.0230.0140.019
(3) Heard about it too late0.0080.0190.012
(4) Medicare plan too expensive0.0290.1070.059
(5) Medicare plan too restrictive0.0020.0050.003
(6) Haven't made a decision yet0.0320.1290.069
(7A) Other: no additional info0.0110.0360.021
(7B) Other: text = no meds0.0620.2170.122
(7C) Other: text = other coverage0.0450.0380.042
(7D) Other: text = other0.1090.2730.172
(8A) Why not enroll = DK0.0130.0100.012
(8B) Why not enroll = missing0.0000.0020.001
(8C) Missing data on Part D enrollment0.0500.0380.046
Total1.0001.0001.000
table 10
All income/asset levelsSubsidy-eligible only
MedHMOPart DTotalMedHMOPart DTotal
Sample n1,4752,5914,0663848751,259
(1) Too much income0.1830.3250.2690.1140.1730.153
(2) Too much wealth0.0310.0450.040.0180.030.026
(3) Too much resources0.0240.0450.0370.0140.0260.022
(4) Didn't know about it0.1890.2910.2520.260.4140.362
(5) Too much bother/confusing0.0060.0180.0130.010.0330.025
(6) Haven't gotten around to it0.0050.0160.0120.0130.030.025
(7A) Other: no additional info0.0280.0150.020.0310.0080.016
(7B) Other: text = no meds0.0350.0410.0390.0420.0370.039
(7C) Other: text = other coverage0.1050.0390.0650.1160.050.072
(7D) Other: text = no need for it0.0590.0660.0630.0670.0670.067
(7E) Other: text = OK w/o it0.0210.020.020.0290.0170.021
(7F) Other: text = other0.0360.0480.0440.0330.0710.058
Advised not to112000
Believe Ineligible9273641216
Confusion821292810
Didn't make decision268112
Didn't want to213101
Dislike program055022
Enrolled369033
Foreign meds011000
Forgot022011
Free meds426213
Future123022
Government112000
Misc.21012077
No Social Security202000
No reason10283841519
En Español9615246
Total54119173165672
(8A) Missing all subsidy data0.26300.1030.220.0010.076
(8B) Don’t know0.0150.0280.0230.0280.0380.034
(8C) Refused0.0010.0010.0010.0050.0050.005
Total111111
table 10 simplified
All income/asset levelsSubsidy-eligible only
MedHMOPart DTotalMedHMOPart DTotal
Sample n1,4752,5914,0663848751,259
(1) Too much income0.1830.3250.2690.1140.1730.153
(2) Too much wealth0.0310.0450.0400.0180.0300.026
(3) Too much resources0.0240.0450.0370.0140.0260.022
(4) Didn't know about it0.1890.2910.2520.2600.4140.362
(5) Too much bother/confusing0.0060.0180.0130.0100.0330.025
(6) Haven't gotten around to it0.0050.0160.0120.0130.0300.025
(7A) Other: no additional info0.0280.0150.0200.0310.0080.016
(7B) Other: text = no meds0.0350.0410.0390.0420.0370.039
(7C) Other: text = other coverage0.1050.0390.0650.1160.0500.072
(7D) Other: text = no need for it0.0590.0660.0630.0670.0670.067
(7E) Other: text = OK w/o it0.0210.0200.0200.0290.0170.021
(7F) Other: text = other0.0360.0480.0440.0330.0710.058
(8A) Missing all subsidy data0.2630.0000.1030.2200.0010.076
(8B) Don’t know0.0150.0280.0230.0280.0380.034
(8C) Refused0.0010.0010.0010.0050.0050.005
Total1.0001.0001.0001.0001.0001.000
tables 11 12
Difficult?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.0280.0690.0410.1540.0440.0540.069
Somewhat0.0510.0550.0390.2170.0720.0710.096
Not very0.0970.0880.0750.1640.1190.1370.116
Not at all0.6930.2130.4010.2150.5480.4530.455
Didn't decide myself0.0260.0640.0230.0560.0380.0350.038
Auto-enrolled0.0310.3930.3480.1420.0000.0000.130
DK0.0030.0050.0060.0030.0270.0190.007
RF0.0000.0000.0000.0000.0000.0000.000
Missing0.0700.1130.0670.0490.1520.2300.089
Total1.0001.0001.0001.0001.0001.0001.000
Very or somewhat difficult
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
40.1170.1390.0850.3270.1640.1190.182
60.0930.1720.0890.3420.1470.1500.184
70.0810.1390.0500.3590.0960.1870.168
80.1150.1490.1290.4150.1320.1530.195
90.1040.1360.0730.4560.1180.1310.200
100.0510.1650.1220.4000.1120.2670.174
110.0790.1360.0780.4320.1030.1480.183
130.0710.1200.0790.4310.1850.1750.188
140.0850.0320.0730.4140.1960.1980.189
Total0.0860.1450.0880.3970.1410.1690.185
Confident?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.7520.2860.4360.4040.5820.4320.535
Somewhat0.1100.1370.1040.2900.1710.1970.171
Not very0.0130.0400.0220.0530.0350.0390.031
Not at all0.0130.0180.0100.0370.0230.0460.023
Auto-enrolled0.0310.3930.3480.1420.0000.0000.130
DK0.0070.0130.0100.0250.0310.0400.018
RF0.0010.0000.0000.0000.0010.0010.000
Missing0.0730.1130.0700.0490.1580.2450.092
Total1.0001.0001.0001.0001.0001.0001.000
Sign up next year?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.0780.5150.3300.7030.0820.1700.318
Somewhat0.0660.1480.0990.1590.1330.1760.117
Not very0.1670.0800.1480.0360.2410.2250.136
Not at all0.6560.1520.3710.0440.4520.3300.370
Missing0.0330.1060.0530.0580.0920.0990.059
Total1.0001.0001.0001.0001.0001.0001.000
chart rx cov in 04
Employer
Medicaid
MedHMO
Purchase
None
Distribution of Rx coverage in 2004Medicare beneficiaries ages 65+ in 2006HRS 2004 & 2006; n=10,175
0.3477
0.07
0.1178
0.2333
0.2312
chart rx cov in 06
Employer
Medicaid
MedHMO
Part D
Purchase
None
Distribution of Rx coverage in 2006Medicare beneficiaries ages 65+ in 2006HRS 2004 & 2006; n=10,175
0.3317
0.0729
0.1526
0.2567
0.1142
0.0718
chart rx cov in 04 & 06
200420042004200420042004
200620062006200620062006
Employer
Medicaid
MedHMO
Part D PD
Purchase
None
Rx coverage in 2004 and 2006Medicare beneficiaries ages 65+ in 2006HRS 2004 & 2006; n=10,175
0.3477
0.07
0.1178
0
0.2333
0.2312
0.3317
0.0729
0.1526
0.2567
0.1142
0.0718
chart takeup PDP
0.58992420.57471590.59233660.57913160.5821737
0.67886370.7034410.69057120.6901320.6906147
0.75917670.7227830.69852370.6934220.7252178
0.41741370.42416580.43551350.44231670.4287533
0.5405050.58276840.59145580.57586260.5677456
0.65496260.60741550.60184120.57965930.6163917
0.49725070.38411990.43114340.35541980.4106762
Subsidy elig
Income too high
Assets too high
Both too high
Total
Different definitions of Part D Takeup
chart takeup xh
takeupX1takeupX1takeupX1takeupX1takeupX1
takeupX2takeupX2takeupX2takeupX2takeupX2
takeupX3takeupX3takeupX3takeupX3takeupX3
takeupX4takeupX4takeupX4takeupX4takeupX4
takeupX5takeupX5takeupX5takeupX5takeupX5
takeupX6takeupX6takeupX6takeupX6takeupX6
takeupX7takeupX7takeupX7takeupX7takeupX7
takeupX8takeupX8takeupX8takeupX8takeupX8
takeupX9takeupX9takeupX9takeupX9takeupX9
Subsidy elig
Income too high
Assets too high
Both too high
Total
Different definitions of subsidy application
0.1343534
0.0936731
0.0995932
0.0187037
0.0810085
0.1157002
0.075055
0.0686082
0.018278
0.0671875
0.1066981
0.0654303
0.0648409
0.0163955
0.0604617
0.184504
0.1936655
0.1197516
0.1193901
0.1605671
0.5003701
0.2282423
0.1494935
0.0428462
0.2897248
0.4230446
0.1695421
0.1047905
0.0350066
0.2243548
0.4009723
0.1497627
0.0992481
0.0314563
0.2053593
0.4531472
0.2664264
0.1521385
0.1328739
0.2900263
0.0779181
0.0467455
0.0432914
0.0118238
0.0438569
response patterns by rxcov
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
"Did you sign up for Part D?"0.0790.7050.4831.0000.0000.0000.416
If yes: "Were you automatically enrolled?"0.4100.5380.6970.146--0.317
If yes: "Did you apply for Extra Help?"0.0310.0940.0550.085--0.078
"Did you apply for Extra Help?"
Yes0.0070.0680.0280.0840.0120.0060.036
No0.6870.7700.7150.9090.5660.5290.730
Missing0.3060.1620.2580.0070.4220.4660.234
pdp takeup gradient in income
Fraction of respondents with no coverage or privately purchased coverage in 2004 who took up Part D in 2006
by income and assets relative to subsidy eligibility thresholds
Taking up Part D means having rx coverage from Medicaid, a Medicare HMO, or a PDP in 2006.
Assets3x|Total
00.5880.4900.5860.6600.7440.4750.5000.5150.502
-
Average takeup
• Part D takeup is 43-73%, depending on definition
• No asset/income gradient in Part D takeup • Subsidy takeup is 4-29% overall, 8-50%
among eligibles • Both are very low if we rely only on
respondent responses to questions about takeup
-
Multivariate analysis
• How does takeup vary with respondent characteristics? – Use of prescription drugs – Self-reported health – Memory score (word recall) – Education – Income/assets – Age
-
Multivariate analysis • Estimate a separate regression for each definition of
takeup (7 for Part D, 9 for subsidy)
Y = b0 + b1 ∙(# of Rx) + b2 ∙(SR health) + b3 ∙(memory score) + b4 ∙(demographics) + b5 ∙(income) + b6 ∙(assets)
• Demographics include age, race, sex, ethnicity, marital
status • Also estimated with linear variables as vectors of
dummies
-
Summary of regression results for Part D (Table 5)
• Significant positive effect on takeup – Number of conditions with Rx (2-4 pts) – Worse self-reported health (~1 pt) – Female (3-9 pts)
• Inconsistent but generally positive effect – Better memory
• Significant negative effect – Age (~-0.5 pt/yr)
• Insignificant negative effect – Black
• Zero effect – Other nonwhite race – Education – Income – Assets
• Inconsistent effect – Hispanic
-
Summary of regression results for subsidy (Table 6)
• Whether or not Medicaid recipients are included as “taking up” matters a lot (columns 1-4 versus 5-8)
• For example, “health” variables have a big effect if Medicaid recipients are included; smaller if they are not (but still positive)
• Significant positive effect on takeup – Female (3-9 pts)
• Inconsistent but generally positive effect – Number of conditions with Rx – Worse self-reported health
• Significant negative effect – Income – Assets – Age (~-0.3 pt/yr) – Education
• Inconsistent but generally negative effect: marital status • Insignificant negative effect: Black • Inconsistent effect: memory score, other nonwhite, Hispanic, female
-
What do respondents say about why they did not sign up?
• Respondents who reported not signing up for either Part D or the subsidy were asked why.
• Multiple choice • For those who chose “Other,” interviewers
could enter text response • Text responses were coded by a research
assistant
-
Why do people say they didn’t sign up for Part D?
Rx coverage in 2006Purchase None Total
Sample n 1,118 728 1,846(1) Already have good coverage 0.617 0.113 0.423(2) Didn't know it was available 0.023 0.014 0.019(3) Heard about it too late 0.008 0.019 0.012(4) Medicare plan too expensive 0.029 0.107 0.059(5) Medicare plan too restrictive 0.002 0.005 0.003(6) Haven't made a decision yet 0.032 0.129 0.069(7A) Other: no additional info 0.011 0.036 0.021(7B) Other: text = no meds 0.062 0.217 0.122(7C) Other: text = other coverage 0.045 0.038 0.042(7D) Other: text = other 0.109 0.273 0.172(8A) Why not enroll = DK 0.013 0.010 0.012(8B) Why not enroll = missing 0.000 0.002 0.001(8C) Missing data on Part D enrollment 0.050 0.038 0.046
table 1
EmployerMedicaidMedHMOPurchaseNoneTotal
Row percent:0.3450.0740.1190.2320.2301.000
Sample n3,5008911,1322,3062,34610,175
Age in 200673.375.775.676.876.475.3
Female0.4860.7140.5570.6500.6160.579
Black0.0610.2290.0620.0870.0690.081
Other nonwhite race0.0260.0960.0330.0220.0190.029
Hispanic0.0280.2750.0970.0420.0470.062
Fair/poor health0.2160.5940.2510.2910.2710.278
Any rx conds 04?0.6760.7820.6570.6960.6150.672
Number of rx conds 041.51.91.51.61.41.6
Any ADL limitations0.9370.9800.9430.9550.9560.950
No. of ADLS if >03.86.34.14.54.34.3
mean memory score9.77.29.08.68.79.0
mem missing0.0630.1370.0600.0710.0700.072
Education < HS0.1600.6590.2270.2960.2780.263777
Education = HS0.3570.2490.3760.3690.3810.359
Some college0.2060.0610.2060.1750.1890.184
College+0.2770.0310.1910.1590.1530.193
Subsidy eligible0.1760.8210.2600.3300.3250.304
Income too high0.3040.1420.3370.2730.2730.282
Assets too high0.0460.0130.0620.0690.0610.054
Both too high0.4750.0240.3410.3270.3410.360
|0.6760.7820.6570.6960.6150.672
|1.51.91.51.61.41.5
rxcov04
EmployerMedicaidMedHMOPurchaseNoneTotal
table 2
Row percents
Coverage in 2006
Coverage in 2004EmployerMedicaidMedHMOPart DPurchaseNoneTotalMcd + MA + PDP
Employer0.6850.0090.0800.1090.0980.0191.000
Medicaid0.0260.6830.0440.1710.0550.0221.000
MedHMO0.1150.0270.7050.0690.0710.0141.0000.475
Purchase0.2740.0460.0960.3340.1960.0561.0000.629
None0.0620.0350.0710.5220.0970.2121.000
Total0.3320.0730.1530.2570.1140.0721.000
Mcdn=10,175avg:0.55195
So, estimate of takeup is about 55% overall
if you count Medicaid, MA and PDP as "takeup".
EmployerMedicaidMedHMOPart D PDPurchaseNoneTotal
Employer2,40839261387334713,500
Medicaid22629381394320891
MedHMO129387888674171,132
Purchase6151382157644411332,306
None1441011731,2152264872,346
Total3,3189451,4752,5911,11872810,175
tables 3 4
EligibleIncome toAssets toBoth tooTotalOutcomeBEligibleIncome toAssets toBoth tooTotal
Row percent0.3040.2820.0540.3611.000Row percent0.3040.2820.0540.3611.000
Employer0.2120.3450.3260.4150.329
Coverage in 2004Medicaid0.1970.0430.0170.0060.075
Employer0.2000.3720.2910.4540.345MedHMO/no0.0940.1250.1330.1100.111
Medicaid0.1990.0370.0180.0050.074MedHMO/yes subs0.0040.0020.0000.0000.002
MedHMO0.1020.1430.1360.1130.119medHMO/denied0.0020.0030.0000.0020.002
Purchase0.2530.2250.2980.2110.232medHMO/waiting0.0000.0000.0000.0000.000
None0.2460.2230.2570.2170.230HMO/dk0.0270.0550.0250.0410.040
Total1.0001.0001.0001.0001.000PDP/no su0.2370.2220.2660.2420.236
PDP/got s0.0200.0070.0060.0020.009
Coverage in 2006PDP/denie0.0130.0150.0190.0020.010
Employer0.2120.3450.3260.4150.329PDP/wait0.0040.0020.0050.0000.002
Medicaid0.1970.0430.0170.0060.075Purchase0.1170.1120.1210.1110.114
MedHMO0.1280.1850.1580.1530.155None0.0730.0700.0820.0690.071
Part D PDP0.2730.2450.2950.2470.257Sample N3,3022,9235233,42710,175
Purchase0.1170.1120.1210.1110.114
None0.0730.0700.0820.0690.071OutcomeAEligibleIncome toAssets toBoth tooTotal
Total1.0001.0001.0001.0001.000Employer0.2120.3450.3260.4150.329
Medicaid0.1970.0430.0170.0060.075
PDP or MedHMO: p(apply for subsidy)MedHMO/no0.0940.1250.1330.1100.111
Yes0.1070.0650.0650.0160.061MedHMO/ye0.0070.0050.0000.0020.004
No0.8160.8060.8800.8810.839MedHMO/dk0.0270.0550.0250.0410.040
Not asked0.0780.1280.0550.1030.100PDP/no su0.2370.2220.2660.2420.236
PDP/yes s0.0360.0230.0290.0050.021
PDP: p(apply for xh)Purchase0.1170.1120.1210.1110.114
10.1340.0940.1000.0190.081None |0.0730.0700.0820.0690.071
Total1.0001.0001.0001.0001.000
MedHMO: p(apply for subsidy)
Yes0.0520.0280.0000.0130.027
No0.7360.6760.8430.7210.716
Not asked0.2120.2960.1570.2660.257
Outcome of subsidy application, conditional on applying
PDP or MedHMO
Approved0.5660.2900.1870.3290.430
Denied0.3280.6440.6560.6030.477
Waiting0.1070.0670.1570.0680.094
PDP
Approved0.5460.2900.1870.4520.430
Denied0.3410.6420.6560.4550.470
Waiting0.1130.0680.1570.0930.101
MedHMOTotal
Approved0.6820.287-0.0000.431100.000
Denied0.2500.652-1.0000.514100.000
Waiting0.0690.062-0.0000.056100.000
100.000
Sample N3,3022,9235233,42710,175100.000
table 6
Subsidy eligIncome too highAssets too highBoth too highTotalDenominator n
takeupD10.5820.5900.5750.5920.5794,437
takeupD20.6910.6790.7030.6910.6905,912
takeupD30.7250.7590.7230.6990.6936,857
takeupD40.4290.4170.4240.4360.4424,652
takeupD50.5680.5410.5830.5910.5765,784
takeupD60.6160.6550.6070.6020.5806,675
takeupD70.4110.4970.3840.4310.35510,175
Subsidy eligIncome too highAssets too highBoth too highTotal
takeupX10.0810.1340.0940.1000.0192,572
takeupX20.0670.1160.0750.0690.0183,667
takeupX30.0600.1070.0650.0650.0164,066
takeupX40.1610.1850.1940.1200.1194,066
takeupX50.2900.5000.2280.1490.0433,517
takeupX60.2240.4230.1700.1050.0354,612
takeupX70.2050.4010.1500.0990.0315,011
takeupX80.2900.4530.2660.1520.1335,011
takeupX90.0440.0780.0470.0430.0127,796
table 9
Rx coverage in 2006Rx coverage in 2006
PurchaseNoneTotalPurchaseNoneTotal
Sample n1,1187281,846Sample n1,1187281,846
(1) Already have good coverage0.6170.1130.423(1) Already have good coverage0.6170.1130.423
(2) Didn't know it was available0.0230.0140.019(2) Didn't know it was available0.0230.0140.019
(3) Heard about it too late0.0080.0190.012(3) Heard about it too late0.0080.0190.012
(4) Medicare plan too expensive0.0290.1070.059(4) Medicare plan too expensive0.0290.1070.059
(5) Medicare plan too restrictive0.0020.0050.003(5) Medicare plan too restrictive0.0020.0050.003
(6) Haven't made a decision yet0.0320.1290.069(6) Haven't made a decision yet0.0320.1290.069
(7A) Other: no additional info0.0110.0360.021(7A) Other: no additional info0.0110.0360.021
(7B) Other: text = no meds0.0620.2170.122(7B) Other: text = no meds0.0620.2170.122
(7C) Other: text = other coverage0.0450.0380.042(7C) Other: text = other coverage0.0450.0380.042
(7D) Other: text = other0.1090.2730.172(7D) Other: text = other0.1090.2730.172
Advised not to314(8A) Why not enroll = DK0.0130.0100.012
Can't afford134(8B) Why not enroll = missing0.0000.0020.001
Confusion375592(8C) Missing data on Part D enrollment0.0500.0380.046
Enrolled/ing358Total1.0001.0001.000
Family didn't allow134
Foreign Meds055
Forgot257
Free meds257
Future527
Government6410
Ineligible151631
Misc7714
No Benefit41014
No Info received235
No need101222
No reason81422
No time123
Prefers Natural Herbs044
Rip off71825
Skeptical71724
Still deciding369
Total124197321
(8A) Why not enroll = DK0.0130.010.012
(8B) Why not enroll = missing00.0020.001
(8C) Missing data on Part D enrollment0.050.0380.046
Total111
table9 simplified
Rx coverage in 2006
PurchaseNoneTotal
Sample n1,1187281,846
(1) Already have good coverage0.6170.1130.423
(2) Didn't know it was available0.0230.0140.019
(3) Heard about it too late0.0080.0190.012
(4) Medicare plan too expensive0.0290.1070.059
(5) Medicare plan too restrictive0.0020.0050.003
(6) Haven't made a decision yet0.0320.1290.069
(7A) Other: no additional info0.0110.0360.021
(7B) Other: text = no meds0.0620.2170.122
(7C) Other: text = other coverage0.0450.0380.042
(7D) Other: text = other0.1090.2730.172
(8A) Why not enroll = DK0.0130.0100.012
(8B) Why not enroll = missing0.0000.0020.001
(8C) Missing data on Part D enrollment0.0500.0380.046
Total1.0001.0001.000
table 10
Reasons for not applying for the subsidysubs elig
MedHMOPart D PDTotalMedHMOPart D PDTotal
too much income0.0000.0000.0000.0000.0000.000
too much wealth0.0000.0000.0000.0000.0000.000
too much resources0.0000.0000.0000.0000.0000.000
didn't know about it0.0000.0000.0000.0000.0000.000
too much bother0.0000.0000.0000.0000.0000.000
haven't gotten around0.0000.0000.0000.0000.0000.000
other, no text0.0000.0000.0000.0000.0000.000
no meds0.0000.0000.0000.0000.0000.000
Other coverage0.0000.0000.0000.0000.0000.000
No need for it0.0000.0000.0000.0000.0000.000
Financially OK w/o it0.0000.0000.0000.0000.0000.000
Other text reason0.0000.0000.0000.0000.0000.000
no Part D, missing xh0.0000.0000.0000.0000.0000.000
DK0.0000.0000.0000.0000.0000.000
RF0.0000.0000.0000.0000.0000.000
Total0.0000.0000.0000.0000.0000.000
Subs eligSubs eligSubs elig
MedHMOPart D PDTotalMedHMOPart D PDTotal
Advised not to112000
Believe Ineligible9273641216
Confusion821292810
Didn't make decision268112
Didn't want to213101
Dislike program055022
Enrolled369033
Foreign meds011000
Forgot022011
Free meds426213
Future123022
Government112000
Misc21012077
No SS202000
No reason10283841519
En Espanol9615246
Total54119173165672
tables 11 12
Difficult?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.0280.0690.0410.1540.0440.0540.069
Somewhat0.0510.0550.0390.2170.0720.0710.096
Not very0.0970.0880.0750.1640.1190.1370.116
Not at all0.6930.2130.4010.2150.5480.4530.455
Didn't decide myself0.0260.0640.0230.0560.0380.0350.038
Auto-enrolled0.0310.3930.3480.1420.0000.0000.130
DK0.0030.0050.0060.0030.0270.0190.007
RF0.0000.0000.0000.0000.0000.0000.000
Missing0.0700.1130.0670.0490.1520.2300.089
Total1.0001.0001.0001.0001.0001.0001.000
Very or somewhat difficult
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
40.1170.1390.0850.3270.1640.1190.182
60.0930.1720.0890.3420.1470.1500.184
70.0810.1390.0500.3590.0960.1870.168
80.1150.1490.1290.4150.1320.1530.195
90.1040.1360.0730.4560.1180.1310.200
100.0510.1650.1220.4000.1120.2670.174
110.0790.1360.0780.4320.1030.1480.183
130.0710.1200.0790.4310.1850.1750.188
140.0850.0320.0730.4140.1960.1980.189
Total0.0860.1450.0880.3970.1410.1690.185
Confident?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.7520.2860.4360.4040.5820.4320.535
Somewhat0.1100.1370.1040.2900.1710.1970.171
Not very0.0130.0400.0220.0530.0350.0390.031
Not at all0.0130.0180.0100.0370.0230.0460.023
Auto-enrolled0.0310.3930.3480.1420.0000.0000.130
DK0.0070.0130.0100.0250.0310.0400.018
RF0.0010.0000.0000.0000.0010.0010.000
Missing0.0730.1130.0700.0490.1580.2450.092
Total1.0001.0001.0001.0001.0001.0001.000
Sign up next year?
EmployerMedicaidMedHMOPart DPurchaseNoneTotal
Very0.0780.5150.3300.7030.0820.1700.318
Somewhat0.0660.1480.0990.1590.1330.1760.117
Not very0.1670.0800.1480.0360.2410.2250.136
Not at all0.6560.1520.3710.0440.4520.3300.370
Missing0.0330.1060.0530.0580.0920.0990.059
Total1.0001.0001.0001.0001.0001.0001.000
chart rx cov in 04
Employer
Medicaid
MedHMO
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