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.
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.
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.
Under current law, the Medicare Part D coverage gap, or “doughnut hole,” is projected to double in size by 2021, exposing seniors to drastically increased liability for the costs of their medications. This characteristic of the coverage gap makes it exceedingly expensive to correct – Congress must dedicate significant resources simply to keep the gap from becoming larger every year; reversing the momentum takes an even greater commitment of funds. The House of Representatives has proposed to provide additional protection to seniors from the cost of prescription drugs by closing the doughnut hole completely, though the high cost requires this closure to be phased- in over time. According to a recent analysis by the National Committee to Preserve Social Security and Medicare, the provisions to close the coverage gap in the House’s America’s Affordable Health Choices Act (H.R. 3200) would close the gap by 2023. The financial protection afforded by the bill becomes progressively stronger beginning in 2011, providing increasing relief to seniors experiencing the coverage gap throughout the phase-out period. from: National Committee to Preserve Social Security and Medicare
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Much has been written about the offer by Walmart and Target to fill generic prescriptions for $4 for 30 days supply and $10 for 90 days supply. However be informed and aware before transfering prescriptions there. They publish a list of the medications covered under the plan - and you can check to see that your medications are on the list by going to their web page or calling them in advance. But also check carefully the dosage and size of the prescription. If you have a 180 MG prescription and they only list a 50 MG prescription you will be charged the regular cost of the drug. Also for some prescriptions they will charge more because of “extra import taxes” or other expense they have to pay. Consider that if your medication is not listed in the exact dosage that you are prescribed you will be charged the regular market rate - in which case you need to determine if you are better off staying with your original pharmacy and plan.
For all the complexity of health insurance, the idea behind it is pretty simple. You and millions of other people pay premiums so that those who get sick will be protected, particularly if the illness is severe or debilitating. But increasingly — and to policyholders’ surprise — that’s not the case when someone needs the most expensive drugs.
Policyholders might find out only when they or a family member suffer a serious illness — such as multiple sclerosis, rheumatoid arthritis or many types of cancer. Then they are faced with a financial catastrophe on top of a health crisis: Costs can run as high as $100,000 a year for some medicine needed to cope with a serious disease.
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