The Medicare Part D Coverage Gap: Implications for Non-Dually Eligible Older Adults With a Mental Illness

This study examines how the Medicare Part D coverage gap impacts non-dually eligible older adults with a mental illness. Qualitative, semistructured interviews were conducted with 11 case managers from community-based agencies serving persons, age 55 and over, with a mental disorder. Five themes illustrating the central difficulties associated with the Part D gap emerged: medication affordability, beneficiary understanding, administrative barriers, Low-Income Subsidy income and asset guidelines, and medication compliance. Although the Patient Protection and Affordable Care Act gradually reduces cost sharing within the gap, findings suggest that medication access and adherence may continue to be impacted by the benefit's structure.