Report to the President: Prescription Drug Coverage, Spending, Utilization, and Prices.. Sources and Nature of Coverage

04/01/2000

Most people who have medical insurance obtain drug coverage through the same source that provides their overall insurance: most commonly an employer or union plan, private nongroup coverage, or Medicaid. Nearly all employer plans include drug benefits for active workers (although not necessarily retirees). Coverage of prescription drugs by Medicaid is optional under federal law, but every state’s program includes this benefit.1

Because Medicare generally does not cover outpatient prescription drugs, beneficiaries who have drug coverage obtain it as part of a supplemental plan, which usually also covers Medicare’s deductibles and coinsurance and may include benefits for other services excluded from Medicare. There are several ways for beneficiaries to obtain supplemental coverage: retiree health benefits, private Medigap policies, Medicare+Choice plans,2 Medicaid, and other federal and state programs.

Different sources of prescription drug coverage vary in the extent of coverage, the amount participants must contribute toward the cost of their drug spending, and how a participant obtains the benefits.

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