Report to the President: Prescription Drug Coverage, Spending, Utilization, and Prices.. Non-Medicare Population

04/01/2000

To put drug coverage for Medicare beneficiaries in perspective, Table 1-13 and Figure 11-6 show sources of drug coverage for the non-Medicare population in 1996.46 Nearly one in four people had no drug coverage during the year.


Figure 1-6. Sources of Drug Coverage for Non-Medicare Population, 1996

Figure 1-6. Sources of Drug Coverage for Non-Medicare Population, 1996

Source: Center for Cost and Financing Studies, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component


Source of coverage Number (000s) Percent
Table 1-13. Percent of Non-Medicare Population with Drug Coverage at Any Time During the Year, by Source of Coverage, 1996
Employer 140,303 60.7%
Private nongroup and other private 8,268 3.6%
Medicaid 26,291 11.4%
All other 2,991 1.3%
Total with coverage 177,853 77.0%
     
No drug coverage 53,109 23.0%
     
Total 230,962 100.0%
Source: Center for Cost and Financing Studies, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1996.

The sources of coverage are very different for the non-Medicare population. Three- fifths of the nonelderly, or about 80 percent of those with coverage, have drug coverage through employer groups, compared to a third of the elderly. Many fewer non- Medicare individuals purchase individual coverage. The non-Medicare population is slightly more likely to have drug coverage through Medicaid. While Medicaid benefits for Medicare beneficiaries (specifically QMBs and SLMBs) may or may not include drug coverage, all states provide drug benefits to the non-Medicare classes of Medicaid eligibles, such as pregnant women and children, certain families, and disabled people who do not receive Medicare. Of those without drug coverage, the majority lacked any form of health insurance that covered physician and hospitalization expenses.

Table 1-14 shows coverage rates by ratio of family income to the federal poverty threshold. The near-poor, those between 100 and 200 percent of FPL, have the lowest coverage rate; over a third are without drug coverage. This is the same income range with lowest coverage rates in the MCBS data for Medicare beneficiaries. As with the latter group, individuals at this income threshold may earn too much to qualify for Medicaid but lack the means to obtain their own coverage. However, there is more of a correlation between income and drug coverage in the non-Medicare population compared to the Medicare population. Thus, about 23 percent of Medicare beneficiaries with incomes above 400 percent of poverty lack drug coverage, compared to 14 percent of the non-Medicare population. This probably is in part a result of the types of jobs held by those at different income levels: low-wage workers are less likely to be offered health insurance by their employers.

Income as a percent of poverty With drug coverage (000) Without drug coverage (000) Percent without coverage
Table 1-14. Drug Coverage of Non-Medicare Population, by Income, 1996
< 100 22,425 9,987 30.8%
100-199 26,797 15,371 36.5%
200-399 59,563 16,459 21.9%
> 400 68,796 11,229 14.0%
Total 177,853 53,109 23.0%

Note: The total includes 335,000 people with negative family income; the sample size for this group is too small for reliable coverage estimates.

Source: Center for Cost and Financing Studies, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1996.

Finally, coverage in the non-Medicare population varies by individual health status. Table 1-15 shows rates of drug coverage by self-reported health status. Those reporting poor health have the highest rate of coverage, but those in excellent or very good health have higher coverage rates than those in good or fair health.47 Further research would be needed to determine whether confounding variables, such as employment status or income, are affecting the results.

Health status Percent without drug coverage
Table 1-15. Percent of Non-Medicare Population with Drug Coverage, by Self-Reported Health Status, 1996
Total 23.0%
Excellent 22.7%
Very good 21.9%
Good 24.6%
Fair 25.0%
Poor 16.4%

Note: Total row includes persons with unknown perceived health status.

Source: Center for Cost and Financing Studies, Agency for Healthcare Research and Quality: Medical Expenditure Panel Survey Household Component, 1996.

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