Low-income beneficiaries in Medicare's prescription drug program have fewer plans to choose from next year in every state except Wisconsin, raising concerns among advocates that millions will be forced to change plans - and may find skimpier coverage.

    An analysis out this week by Avalere Health, a for-profit research firm in Washington, found 308 stand-alone drug plans nationwide next year eligible to serve low-income residents, down about 200 from this year. Those beneficiaries are subsidized by the government. They pay little or no monthly premiums and generally have lower out-of-pocket costs, called deductibles, for drugs than do higher-income policyholders.

    Avalere estimates 1.3 million low-income beneficiaries will be reassigned to new coverage, up from 1.2 million in 2008 and 250,000 in 2007.

    "This continues the incredible disruption and access to benefits that low-income folks face in Medicare," says David Lipschutz, a staff attorney with California Health Advocates, a non-profit that advocates for Medicare beneficiaries. The changes could mean some beneficiaries may have to switch prescriptions if their medications are not covered by their new plans, or face other changes, he says.

    To serve low-income Medicare members, insurers must keep their premiums below a government-set median benchmark. Many insurers raised their premiums overall for next year, so they no longer qualify to offer the low-income coverage but will still offer policies to higher-income Medicare members.

    One large insurer, Humana, which this year offered low-income coverage in 43 states, won't have any eligible low-income plans next year. Cigna, another large insurer, will drop from low-income coverage in 29 states to 14, according to the analysis.

    Bucking the trend: UnitedHealth, whose partner is AARP. Next year United will boost low-income coverage to 42 states, up from 30.

    The changes mean low-income residents of Nevada will have only one stand-alone drug plan. Arizona residents will have two. Four other states - Florida, Hawaii, Maine and New Hampshire - will have five or fewer.