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Improve access to health care for Vermont's older adults

Percent of adults age 65 and older with prescription drug coverage

84%2016

Story Behind the Curve

Prescription drug coverage decreases financial strain and increases access to medications. Medicare beneficiaries can obtain Medicare Part D, a voluntary Medicare drug benefit, through two types of private plans, a standalone prescription drug plan or a Medicare Advantage (Part C) plan that covers prescription drugs. Medicare Part D plans vary by state in cost and coverage. Medicare beneficiaries in 2010 spent $4,734 out-of-pocket for health care, on average, and over $520 of that was spent on prescription drugs. Those with prescription drug coverage under Medicare Part D are 10% more likely to buy the medications they are prescribed and take them when and how they should.

What Works

Medicare can be complicated and confusing for older Vermonters.Many do not understand that basic Medicare does not pay for prescriptions, nor do they have information about options for prescription drug coverage including which plans they may be eligible for, what will be covered, and what the costs will be.Thus the first step to increasing coverage is education and awareness for Vermonters as they become eligible for Medicare.Also critical is access and assistance – having many touch points in the community where older Vermonters can learn about options and receive assistance in accessing appropriate drug plans.Finally, once enrolled in various coverage plans, it is just as important that older Vermonters understand the importance of taking their medications as directed by their healthcare provider.

Strategy

Vermont’s community provider network is the primary mechanism for educating older Vermonters about prescription drug plans.Vermont’s five Area Agencies on Aging all have educational programs, funded through the State Health Insurance Assistance Program (SHIP) often called “Medicare Boot Camp,” to educate older Vermonters about the various Medicare options, including eligibility and costs, providing them with the information and knowledge needed to make educated choices about their healthcare needs.SHIP Counselors also provide one-on-one education and support to help older Vermonters choose the best Medicare plan for their individual needs and answer any questions they may have.

Notes on Methodology

This data comes from the United Health Foundation’s annual report entitled, America’s Health Rankings Senior Report.Reports can be found here:

Additional information about medication adherence and hospital admissions is found here: https://www.ncbi.nlm.nih.gov/books/NBK2670/ (Approximately 30 percent of hospital admissions of older adults are drug related, with more than 11 percent attributed to medication nonadherence and 10–17 percent related to adverse drug reactions).

Why Is This Important?

Medication adherence (taking the right doses of the right medications at the right time) is critical to many older Vermonters’ health. Nonadherence (failing to take the right doses of the right medications at the right time) can lead to decreased health outcomes and increased visits to the hospital.A large percentage of hospital admissions are associated with medications, either due to nonadherence or adverse drug reactions.When older Vermonters on fixed incomes do not have enough money to pay their healthcare costs, they make difficult choices between food, heat, and medicine, all of which can be detrimental to their health, well-being and ability to remain living in their homes.Increasing the percentage of older Vermonters who have prescription drug coverage increases their ability to manage both their finances and their health. Given Vermont’s rapidly aging population, with one in three Vermonters expected to be over 60 by 2030, increasing prescription drug coverage will not only better support individual Vermonters but help to avoid unnecessary healthcare costs.

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