take-up of medicare part d and the ssa subsidy: early ... · • the medicare modernization act of...

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

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?

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.

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

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

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

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

Assets

• Does not include primary residence or vehicles

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

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

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?

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.)

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?

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

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?

Caveats

These analyses are preliminary! • Weight is preliminary weight. • No imputation of income and asset data.

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


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


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


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?


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?


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


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









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)


0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

1 2 3 4 5 6 7


table 1


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


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



No. of ADLS if >03.86.34.14.54.34.3


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


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


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




Employer2,40839261387334713,500

Medicaid22629381394320891

MedHMO129387888674171,132

Purchase6151382157644411332,306

None1441011731,2152264872,346

Total3,3189451,4752,5911,11872810,175

tables 3 4



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


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


Yes0.0520.0280.0000.0130.027

No0.7360.6760.8430.7210.716

Not asked0.2120.2960.1570.2660.257


PDP or MedHMO

Approved0.5660.2900.1870.3290.430

Denied0.3280.6440.6560.6030.477

Waiting0.1070.0670.1570.0680.094

table 6


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


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


(8B) Why not enroll = missing0.0000.0020.001


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



Confusion821292810




Enrolled369033

Foreign meds011000

Forgot022011

Free meds426213

Future123022

Government112000

Misc.21012077

No Social Security202000


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



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











(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?


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


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



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?


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?


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


0.3477

0.07

0.1178

0.2333

0.2312

chart rx cov in 06

Employer

Medicaid

MedHMO

Part D

Purchase

None


0.3317

0.0729

0.1526

0.2567

0.1142

0.0718


200420042004200420042004

200620062006200620062006

Employer

Medicaid

MedHMO

Part D PD

Purchase

None


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


chart takeup xh










Subsidy elig

Income too high

Assets too high

Both too high

Total


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



"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





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


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


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



No. of ADLS if >03.86.34.14.54.34.3


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


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


table 2

Row percents

Coverage in 2006


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




Employer2,40839261387334713,500

Medicaid22629381394320891

MedHMO129387888674171,132

Purchase6151382157644411332,306

None1441011731,2152264872,346

Total3,3189451,4752,5911,11872810,175

tables 3 4



Employer0.2120.3450.3260.4150.329






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




MedHMO0.1280.1850.1580.1530.155None0.0730.0700.0820.0690.071


Purchase0.1170.1120.1210.1110.114


Total1.0001.0001.0001.0001.000Employer0.2120.3450.3260.4150.329

Medicaid0.1970.0430.0170.0060.075


Yes0.1070.0650.0650.0160.061MedHMO/ye0.0070.0050.0000.0020.004

No0.8160.8060.8800.8810.839MedHMO/dk0.0270.0550.0250.0410.040


PDP/yes s0.0360.0230.0290.0050.021


10.1340.0940.1000.0190.081None |0.0730.0700.0820.0690.071

Total1.0001.0001.0001.0001.000


Yes0.0520.0280.0000.0130.027

No0.7360.6760.8430.7210.716

Not asked0.2120.2960.1570.2660.257


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


EligibleIncome too highAssets too highBoth too highTotal

Sample n1,2591,2082211,3784,066

Row percent0.2960.2950.0600.3501.000



Yes0.0520.0280.0000.0130.027

No0.7360.6760.8430.7210.716

Not asked0.2120.2960.1570.2660.257


PDP or MedHMO

Approved0.5660.2900.1870.3290.430

Denied0.3280.6440.6560.6030.477

Waiting0.1070.0670.1570.0680.094

table 6


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


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



Sample n1,1187281,846Sample n1,1187281,846
















Foreign Meds055

Forgot257

Free meds257

Future527

Government6410

Ineligible151631

Misc7714

No Benefit41014

No Info received235

No need101222

No reason81422

No time123


Rip off71825

Skeptical71724

Still deciding369

Total124197321




Total111

table9 simplified

Rx coverage in 2006

PurchaseNoneTotal

Sample n1,1187281,846














Total1.0001.0001.000

table 10



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













Confusion821292810




Enrolled369033

Foreign meds011000

Forgot022011

Free meds426213

Future123022

Government112000

Misc.21012077



En Español9615246

Total54119173165672


(8B) Don’t know0.0150.0280.0230.0280.0380.034

(8C) Refused0.0010.0010.0010.0050.0050.005

Total111111

table 10 simplified



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












(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?


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


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



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?


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?


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


0.3477

0.07

0.1178

0.2333

0.2312

chart rx cov in 06

Employer

Medicaid

MedHMO

Part D

Purchase

None


0.3317

0.0729

0.1526

0.2567

0.1142

0.0718


200420042004200420042004

200620062006200620062006

Employer

Medicaid

MedHMO

Part D PD

Purchase

None


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


chart takeup xh










Subsidy elig

Income too high

Assets too high

Both too high

Total


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







Yes0.0070.0680.0280.0840.0120.0060.036

No0.6870.7700.7150.9090.5660.5290.730

Missing0.3060.1620.2580.0070.4220.4660.234





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)


0

0.1

0.2

0.3

0.4

0.5

0.6

takeupX1 takeupX2 takeupX3 takeupX4 takeupX5 takeupX6 takeupX7 takeupX8 takeupX9


table 1


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


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



No. of ADLS if >03.86.34.14.54.34.3


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


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


table 2

Row percents

Coverage in 2006


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




Employer2,40839261387334713,500

Medicaid22629381394320891

MedHMO129387888674171,132

Purchase6151382157644411332,306

None1441011731,2152264872,346

Total3,3189451,4752,5911,11872810,175

tables 3 4



Employer0.2120.3450.3260.4150.329






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




MedHMO0.1280.1850.1580.1530.155None0.0730.0700.0820.0690.071


Purchase0.1170.1120.1210.1110.114


Total1.0001.0001.0001.0001.000Employer0.2120.3450.3260.4150.329

Medicaid0.1970.0430.0170.0060.075


Yes0.1070.0650.0650.0160.061MedHMO/ye0.0070.0050.0000.0020.004

No0.8160.8060.8800.8810.839MedHMO/dk0.0270.0550.0250.0410.040


PDP/yes s0.0360.0230.0290.0050.021


10.1340.0940.1000.0190.081None |0.0730.0700.0820.0690.071

Total1.0001.0001.0001.0001.000


Yes0.0520.0280.0000.0130.027

No0.7360.6760.8430.7210.716

Not asked0.2120.2960.1570.2660.257


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


EligibleIncome toAssets toBoth tooTotal

Sample n1,2591,2082211,3784,066

Row percent0.2960.2950.0600.3501.000



Yes0.0520.0280.0000.0130.027

No0.7360.6760.8430.7210.716

Not asked0.2120.2960.1570.2660.257


PDP or MedHMO

Approved0.5660.2900.1870.3290.430

Denied0.3280.6440.6560.6030.477

Waiting0.1070.0670.1570.0680.094

table 6


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


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



Sample n1,1187281,846Sample n1,1187281,846
















Foreign Meds055

Forgot257

Free meds257

Future527

Government6410

Ineligible151631

Misc7714

No Benefit41014

No Info received235

No need101222

No reason81422

No time123


Rip off71825

Skeptical71724

Still deciding369

Total124197321




Total111

table9 simplified

Rx coverage in 2006

PurchaseNoneTotal

Sample n1,1187281,846














Total1.0001.0001.000

table 10



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













Confusion821292810




Enrolled369033

Foreign meds011000

Forgot022011

Free meds426213

Future123022

Government112000

Misc.21012077



En Español9615246

Total54119173165672


(8B) Don’t know0.0150.0280.0230.0280.0380.034

(8C) Refused0.0010.0010.0010.0050.0050.005

Total111111

table 10 simplified



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












(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?


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


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



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?


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?


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


0.3477

0.07

0.1178

0.2333

0.2312

chart rx cov in 06

Employer

Medicaid

MedHMO

Part D

Purchase

None


0.3317

0.0729

0.1526

0.2567

0.1142

0.0718


200420042004200420042004

200620062006200620062006

Employer

Medicaid

MedHMO

Part D PD

Purchase

None


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


chart takeup xh










Subsidy elig

Income too high

Assets too high

Both too high

Total


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







Yes0.0070.0680.0280.0840.0120.0060.036

No0.6870.7700.7150.9090.5660.5290.730

Missing0.3060.1620.2580.0070.4220.4660.234





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


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


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



No. of ADLS if >03.86.34.14.54.34.3


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


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


table 2

Row percents

Coverage in 2006


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




Employer2,40839261387334713,500

Medicaid22629381394320891

MedHMO129387888674171,132

Purchase6151382157644411332,306

None1441011731,2152264872,346

Total3,3189451,4752,5911,11872810,175

tables 3 4



Employer0.2120.3450.3260.4150.329






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




MedHMO0.1280.1850.1580.1530.155None0.0730.0700.0820.0690.071


Purchase0.1170.1120.1210.1110.114


Total1.0001.0001.0001.0001.000Employer0.2120.3450.3260.4150.329

Medicaid0.1970.0430.0170.0060.075


Yes0.1070.0650.0650.0160.061MedHMO/ye0.0070.0050.0000.0020.004

No0.8160.8060.8800.8810.839MedHMO/dk0.0270.0550.0250.0410.040


PDP/yes s0.0360.0230.0290.0050.021


10.1340.0940.1000.0190.081None |0.0730.0700.0820.0690.071

Total1.0001.0001.0001.0001.000


Yes0.0520.0280.0000.0130.027

No0.7360.6760.8430.7210.716

Not asked0.2120.2960.1570.2660.257


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


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


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



Sample n1,1187281,846Sample n1,1187281,846
















Foreign Meds055

Forgot257

Free meds257

Future527

Government6410

Ineligible151631

Misc7714

No Benefit41014

No Info received235

No need101222

No reason81422

No time123


Rip off71825

Skeptical71724

Still deciding369

Total124197321




Total111

table9 simplified

Rx coverage in 2006

PurchaseNoneTotal

Sample n1,1187281,846














Total1.0001.0001.000

table 10

Reasons for not applying for the subsidysubs elig


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




Confusion821292810




Enrolled369033

Foreign meds011000

Forgot022011

Free meds426213

Future123022

Government112000

Misc21012077

No SS202000


En Espanol9615246

Total54119173165672

tables 11 12

Difficult?


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


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



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?


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?


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

take-up of medicare part d and the ssa subsidy: early ... · • the medicare modernization act of...

Documents