CMS's Beneficiary Education and Outreach Efforts for the Medicare Prescription Drug Discount Card and Transitional Assistance Program
GAO-06-139R: Published: Nov 18, 2005. Publicly Released: Nov 30, 2005.
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The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 required the Centers for Medicare & Medicaid Services (CMS) in the Department of Health and Human Services (HHS) to broadly disseminate information on the program to the millions of Medicare beneficiaries--seniors and people under age 65 with permanent disabilities--who are eligible for a drug discount card. In response, CMS began education and outreach efforts designed to publicize the availability and features of the drug discount cards, provide information to facilitate beneficiary choice, and assist beneficiaries with the enrollment process. Congress asked us to provide information on CMS's efforts because the agency's experience in supporting the drug card program may yield important insights relevant to implementing the new prescription drug benefit that becomes effective in 2006. In this report, we (1) describe CMS's education and outreach efforts in support of the drug card program and review assessments of these efforts by public and private health care research organizations and (2) provide data on enrollment in the drug card program and identify factors that may have limited this enrollment.
CMS implemented a variety of education and outreach efforts that included the use of mass media and individualized counseling to inform beneficiaries about the drug card program and to assist in enrollment. Assessments we reviewed showed that CMS was effective in raising awareness of the drug card program, but was less effective in its efforts to inform and assist beneficiaries. In general, studies found that CMS's efforts did not consistently provide information that was clear, accurate, and accessible, and they collectively fell short of conveying program features. At the same time, these assessments acknowledge the actions taken by CMS to address some of these problems. Studies we examined indicated that disseminating information via mass media and direct mail may not have been effective in reaching beneficiaries, particularly those with low incomes. Studies also found that CMS's telephone help line and Web site did not always provide the information beneficiaries needed to choose a card that was best for them. Assessments also showed that CMS-funded State Health Insurance Assistance Programs offering one-on-one counseling provided valuable assistance to beneficiaries but were limited in the number of people they could serve. An analysis of CMS partnerships with community-based organizations showed that these organizations could have been utilized more effectively in promoting the drug card program. As of September 1, 2005, about 6.4 million Medicare beneficiaries were enrolled in the drug card program, including 1.9 million who received transitional assistance. Many more beneficiaries were automatically enrolled than enrolled on their own. A variety of factors may have limited enrollment in the program. CMS attributed the extent of enrollment to confusion and misperceptions about the drug cards among Medicare beneficiaries. In addition, other assessments noted that the drug card program's unfamiliar design, abundance of choices, and uncertain value may have discouraged some beneficiaries from enrolling.