title: Elderly patients' knowledge of drug benefit caps and communication with providers about exceeding caps.
abstract: OBJECTIVE
  Many elderly persons have drug benefits with coverage gaps, such as in Medicare Part D. Because beneficiaries who have such gaps must pay all drug costs, an accurate knowledge of gap thresholds and communication with providers about exceeding caps is important for elderly persons to manage out-of-pocket drug costs.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Health plan.
  
  
  METHODS
  One thousand three hundred eight health plan members aged 65 and older. The study was a 2002 cross-sectional survey of elderly persons with capped drug benefits in a managed care plan in one state. Participants were sampled so that half reached coverage caps and half did not.
  
  
  METHODS
  Participants reported cap levels, communication with providers about exceeding caps, and decreased medication use due to cost.
  
  
  RESULTS
  Of the 1,308 participants (65.4%response rate), 68.6%did not know their correct cap level. Rates were similar in those who exceeded caps (66.2%), reported difficulty paying for medications (63.9%), or decreased medication use (66%). For participants who exceeded caps, 59.1% did not know beforehand that they were close to exceeding caps and 50.2% did not tell providers afterward. In multivariate analyses accounting for demographics and health, the oldest participants (> or =85 vs 65-74) were at greater risk for not knowing cap levels (odds ratio (OR)=2.0, 95% confidence interval (CI)=1.2-3.4) and not telling providers about exceeding caps (OR=2.2, 95% CI=1.1-4.5).
  
  
  CONCLUSIONS
  Elderly patients often did not know correct cap levels and did not tell providers about exceeding caps. Providers, plans, and policymakers should actively assess and improve Medicare beneficiaries' knowledge of Part D coverage gaps.
authors.affiliation: Department of Family Medicine and Community Health, University of Hawaii, Pacific Health Research Institute, 700 Bishop St., Ste. 900, Honolulu, HI 96813, USA. cwtseng@hawaii.edu
authors.forename: Chien-Wen
authors.initials: CW
authors.lastname: Tseng
authors.forename: R Adams
authors.initials: RA
authors.lastname: Dudley
authors.forename: Robert H
authors.initials: RH
authors.lastname: Brook
authors.forename: Emmett
authors.initials: E
authors.lastname: Keeler
authors.forename: Allen L
authors.initials: AL
authors.lastname: Hixon
authors.forename: Luella R
authors.initials: LR
authors.lastname: Manlucu
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003430:Cross-Sectional Studies; D016527:Drug Costs; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D054524:Medicare Part D; D015999:Multivariate Analysis; D010817:Physician-Patient Relations; D014481:United States