Health Under Medicare

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
       

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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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

Under the current Part D program, however, seniors
are given only six weeks each year to make difficult decisions about
their prescription drug coverage, and they are then locked into the
plans they select for an entire year. This year’s Annual Coordinated
Election Period (ACEP) begins on November 15, 2008 and lasts until
December 31, 2008 . It is only d uring this open enrollment period that
most seniors are permitted to enroll in a Part D plan, drop Part D
coverage, or switch to a different plan. While most seniors will be
locked into the plans they select for all of 2009, plans are allowed to
make significant changes to their prices, formulary, and benefits
throughout the year. In addition, many plans have already announced
significant changes to their coverage for next year. We strongly
encourage you to closely examine how your current coverage will change
in 2009. It might be to your advantage to choose another plan that
better matches your prescription needs and your cost expectations.

Check the new handbook

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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LITTLE ROCK, Ark. - Wal-Mart Stores Inc., the world’s largest retailer, announced Monday it would expand its discounted prescription drug program to offer 90-day supplies for $10 and add several women’s medications at a discount. It also said it would lower the price of more than 1,000 over-the-counter drugs.

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A Medicare Interactive article 

Medicare and Prescription Help
Medicare beneficiaries are eligible for the extra help if they have limited income and resources. The extra help can increase their cost savings by paying for part of the monthly premiums, annual deductibles and prescription co-payments under the new prescription drug program. The extra help could be worth more than $3,300 per year.

NCPSSM: Special Report