Health Under Medicare

>> Berwick is an admirer of Britain’s National Health Service and its National Institute for Clinical Excellence, with the Orwellian-acronym NICE.
>>
>> “NICE,” Berwick has said, “is extremely effective and a conscientious, valuable and — importantly — knowledge-building system.”

Last week, the U.S. Department of Health and Human Services debuted a new website that offers comprehensive information on the health insurance options available to Americans. The site, www.healthcare.gov, includes sections that are tailored to the needs of older adults and people with disabilities. The site also explains how and when health reform provisions will affect consumers.

Although the website was unveiled as a fully functional tool, more features and information will be added in the coming months. Just yesterday, the Centers for Medicare & Medicaid Services added data on care quality to Hospital Compare, a tool available through the website. The new data will help consumers evaluate the quality of outpatient and inpatient care at hospitals across the country.

Use the Hospital Compare tool.

Visit www.healthcare.gov.

June 10, 2010    Volume 1, Issue 15

Today, the Department of Health and Human Services (HHS) will begin sending the $250 rebate checks to consumers in the Medicare drug coverage gap, also known as the “doughnut hole.” This rebate is a result of provisions included in the health reform law. HHS will send an estimated 80,000 checks today to people who have entered the coverage gap since the start of 2010, and will continue to send the rebates on a rolling basis approximately every month to people who newly enter the doughnut hole.

The rebate checks will be sent automatically and there are no forms to fill out. Consumers should protect themselves from fraud, and should not provide personal information, such as Social Security numbers or bank account numbers, to anyone who contacts them about the rebate. People should report potential fraud by calling 1-800-MEDICARE.

The health reform law gradually phases out the doughnut hole. This year, people who enter the coverage gap will receive the one-time $250 rebate check. Beginning next year, consumers in the doughnut hole will receive a 50 percent discount on brand-name drugs and a 7 percent discount on generics. The share consumers pay for both brand-name and generic drugs will decrease until the gap is eliminated in 2020, when consumers will pay the standard 25 percent of the costs for drugs while in the doughnut hole.

                                from: Medicarerights.org
       

May 6, 2010    Volume 1, Issue 10

People with Medicare who hit the coverage gap or “doughnut hole” in the Medicare drug benefit next year will receive a 50 percent discount at the pharmacy—without having to send in receipts or request a refund—according to draft guidance implementing the recently passed health reform law.

The guidelines from the Centers for Medicare and Medicaid Services (CMS) also state that the insurance companies offering Part D plans will inform pharmacies through their electronic claims systems when consumers are eligible for the discount, although the discounts will come from drug manufacturers.

State pharmaceutical assistance programs (SPAP) that provide coverage through the doughnut hole will also benefit from the discounts, while consumers enrolled in these programs will continue to pay the copays charged by their SPAP. Consumers enrolled in Part D plans offered by their employers, which often provide coverage through the doughnut hole, will not be eligible for the discount, according to CMS’s proposed guidance. The guidance is open for public comment until May 14, 2010.

Read the CMS draft guidance.       

The new health care reform law includes provisions that will help older Americans who are not yet eligible for Medicare have access to affordable health insurance coverage. In addition, it includes provisions to help employers with the costs of providing coverage to early-retirees and older workers.
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The new health care reform law includes substantial improvements and protections that are very important for Medicare beneficiaries. Some of the major provisions that will enhance benefits and limit out-of-pocket costs for Medicare beneficiaries are described below.
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http://www.medicarerights.org/pdf/Health-Reform-Implementation-Timeline.pdf

http://www.medicarerights.org/pdf/Health-Reform-Implementation-Timeline.pdf

The Patient Protection and Affordable Care Act and accompanying health care reform legislation add important improvements to Medicare prescription drug coverage for seniors. In 2010, the new health reform law helps cover expenses for victims of the “donut hole” coverage gap, and the hole in coverage is eliminated altogether by 2020. The law also provides for additional assistance for low-income beneficiaries.

The Donut Hole: Relief for Seniors Now and Closure by 2020

 Currently, the standard Part D drug benefit contains a “donut hole,” a gap in coverage where beneficiaries must cover the full cost of their medications even while they continue to pay premiums. In 2010, this occurs when the total costs of a beneficiary’s prescription drugs reaches $2,830 - requiring the beneficiary to cover the next $3,610 in drug costs.

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n addition to slowing costs, health care reform will provide a wide range of benefit improvements for seniors.

In a key improvement designed to help keep seniors
healthy, preventive care will no longer require co-payments, the number
of covered preventive services will be expanded, and for the first
time, Medicare will cover an annual wellness visit and personalized
prevention plan for every beneficiary. In addition, health reform will
protect seniors’ access to doctors by making bonus payments to primary
care providers and making new investments in training programs,
scholarships and tax incentives for doctors, nurses and public health
professionals who provide primary health services.

In a dramatic reform to the Part D prescription drug
program, seniors will no longer experience the coverage gap known as
the donut hole. As a downpayment on this important reform, any senior
who enters the donut hole in 2010 will receive a payment of $250 to
help cover the cost of his or her prescription drugs. Seniors will
receive this rebate even if they have only entered the donut hole by a
single dollar. Beginning in 2011, all seniors in the donut hole will
receive a 50 percent discount on their brand-name drugs - a discount
which will expand to 75 percent and will cover both brand-name drugs
and generics by the end of the decade. This discount expansion
effectively closes the donut hole for all beneficiaries. For a typical
senior in the donut hole, this represents a savings of $250 in 2010,
$700 in 2011, and over $3,000 by 2020.

As a further improvement to the drug program, both
the discount amounts and seniors’ out-of-pocket drug costs will count
toward reaching the threshold for catastrophic coverage. The dollar
amount of the threshold will also grow more slowly in the future. These
two changes will allow seniors with high prescription drug expenses to
more quickly reach the point at which the federal government picks up
95 percent of their drug costs.

Health reform also makes it easier for low-income
seniors to enroll in plans without any premiums, and reduces the number
of low-income seniors who are required to change plans each year to
maintain their zero premiums. In addition, it will become easier for
widows and widowers to keep their low-income eligibility after the
death of a spouse.

To protect seniors who become hospitalized, health
reform rewards hospitals that reduce preventable readmissions. This
change will help ensure that seniors are not released from the hospital
before they are healthy enough to leave, and will create incentives for
hospitals to provide outpatient support once seniors have been
released.

The current fee-for-service payment system rewards
providers who order the most tests and procedures, not necessarily
those who provide the best quality health care. We all know of seniors
who have been subjected to unnecessary and potentially dangerous tests,
not because they were needed but because they were profitable for the
providers. This system not only puts seniors’ health at risk from
unneeded tests and procedures, it makes it hard to clamp down on rising
costs. As Medicare reduces the amount it pays for each test, many
providers simply increase the number of tests they order to maintain
their profit margins, thus undermining previous efforts at cost
containment. 

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Government Relations and Policy, March 2010

The National Committee is a nonprofit, nonpartisan organization that acts in the interests of its membership through advocacy, education, services, grassroots efforts and the leadership of the board of directors and professional staff. The work of the National Committee is directed toward developing a secure retirement for all Americans.