>> 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.”

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.

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
       

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will receive a 50 percent discount at the pharmacy—without having to send in receipts or request a refund—according to draft guidance implementing the recently passed health reform law.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.       

Limiting Age Rating of Health Insurance Premiums

The health care reform law establishes a 3:1 ratio for setting health insurance premiums based on age. Currently, older Americans buying health insurance in the individual or small group markets are likely to be charged much more than three times the cost for a younger person.

Reforming Private Insurance for All

The health care reform law includes many reforms to private health insurance that will benefit Americans of all ages, including older Americans. These reforms include prohibiting coverage denials for pre-existing conditions, banning caps on lifetime coverage, ending annual limits on coverage, and prohibiting insurers from dropping coverage when someone is sick. In addition, the law requires that parents be allowed to keep their unmarried adult children on their family health insurance plan until age 26.

Providing Immediate Assistance through a High - Risk Pool

The law establishes a temporary national high-risk pool to provide health coverage to individuals with pre-existing medical conditions who have been uninsured for at least six months. Premiums will be subsidized and cost-sharing will be limited. The high-risk pool will be available until state exchanges begin operating in 2014.

Providing Affordable Private Insurance Choices through Exchanges

A major provision of the health care reform law is to create state-based American Health Benefit Exchanges through which individuals can purchase coverage. Subsidies will be available to help individuals and families with income between 133-400 percent of the federal poverty level afford insurance. U. S. citizens and legal residents will be required to have qualifying health coverage individually or through an employer.

Creating a Program to Help Employers Cover Retirees Age 55-64

The health care reform law creates a temporary $5 billion reinsurance program for employers providing health insurance coverage to retirees over age 55 who are not eligible for Medicare. The program, which is designed to encourage former employers to maintain retiree health care coverage, will reimburse employers or insurers for 80 percent of retiree claims between $15,000 and $90,000. Payments from the reinsurance program will be used to lower the costs for enrollees in the employer plan.

Increasing the Thresholds for the Excise Tax Based on Age

The health care reform law imposes an excise tax on high-cost insurance plans beginning in 2018. However, the threshold amounts for imposing the tax will be increased for retired individuals age 55 and older who are not eligible for Medicare, and they will also be increased for employers who may have higher health care costs because of the age or gender of their workers.

Government Relations and Policy, April 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.

Providing Immediate Relief from the Prescription Drug Donut Hole

The health care reform law provides assistance to help seniors bridge the current “donut hole,” a gap in coverage where beneficiaries must cover the full cost of their medications even while they continue to pay premiums. Under the new law, any senior who falls into the donut hole in 2010 will receive a $250 rebate. Beginning in 2011, a 50 percent rebate will be applied at the pharmacy for brand name medications purchased while in the donut hole.

Closing the Part D Prescription Drug Donut Hole

The law also phases out the donut hole by 2020 for brand-name and generic drugs. At that time, copayments for all drugs will be the standard 25 percent. Also, between 2014 and 2020, the law will help seniors get out of the donut hole sooner - as a lower level of spending will qualify beneficiaries for “catastrophic” coverage where Medicare covers 95 percent of their costs. Altogether, a typical senior who falls into the donut hole will save $250 this year, over $700 in 2011, and over $3,000 by 2020.

Assisting Low-Income Seniors with Part D Prescription Drug Costs

The health reform law improves eligibility and coverage for low-income Medicare beneficiaries by eliminating copayments for many beneficiaries receiving home- and community-based services who are eligible for both Medicare and Medicaid. The new law will reduce the number of low-income beneficiaries who are required to change plans each year to maintain zero premiums; and it allows widows and widowers to more easily retain their low-income eligibility. In addition, outreach programs are enhanced to ensure that more beneficiaries who are eligible for a Low-Income Subsidy are able to enroll.

Improving Preventive Health Care Services

The health care reform law includes improvements designed to help keep seniors healthy. Beginning in January 2011, preventive services such as cancer, cardiovascular, and diabetes screenings will no longer require any out-of-pocket payments for deductibles or coinsurance; 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.

Limiting Out-of-Pocket Costs for Medicare Advantage Enrollees

Although the health care reform law gradually reduces overpayments to private Medicare Advantage plans, it does NOT eliminate the plans or reduce the extra benefits they provide. It is up to each private insurer to decide what extra benefits to offer; they are required to offer all benefits covered by traditional Medicare. The health care reform legislation prohibits Medicare Advantage plans from charging seniors more than traditional Medicare for chemotherapy, skilled nursing facility care and renal dialysis. Decisions about limiting charges for other high-cost services can be made in the future. Often beneficiaries do not realize what their costs will be for these services until the need for them arises.

Requiring Medicare Advantage Plans to Spend on Care over Profits

The health care reform law requires Medicare Advantage plans to spend at least 85 percent of their revenue on senior care rather than profits or overhead. Plans that do not spend at least 85 percent of their revenue on patient care would be required to return money to the government and could be suspended or terminated from the program if their spending on patient care remains below 85 percent for two or more years.

Government Relations and Policy, April 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.

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.

The new law provides assistance to help seniors bridge this donut hole.

• $250 rebate in 2010. Any senior that falls into the donut hole in 2010 will receive a $250 rebate.

• 50 percent rebate on brand-name drugs in 2011. Beginning in 2011, a 50 percent rebate will be applied at the pharmacy for brand name medications.

• Closure of the donut hole by 2020 for brand-name and generic drugs. The co-payments required for brand-name and generic drugs will be phased down to the standard 25 percent by 2020, eliminating the donut hole. For brand-name drugs, manufacturers will increase their discounts each year to negate the coverage gap. Beginning in 2011, co-payments required by Part D law for generic drugs will be reduced by seven percentage points each year until the coverage gap is eliminated for these drugs as well.

• Immediate assistance for seniors. A typical senior that falls into the donut hole will save $250 this year, over $700 in 2011, and over $3,000 by 2020.

• Provides catastrophic coverage sooner to protect seniors. The legislation will help seniors get out of the donut hole sooner beginning in 2014. The dollar amount of the catastrophic threshold, where seniors’ co-payments are dropped to 5 percent of drug costs, will be more slowly increased from year to year at this point.
  

Assistance for Low-Income Seniors

The health reform legislation also provides improves eligibility and coverage for low-income Medicare beneficiaries:

• Co-payments are eliminated for many beneficiaries receiving home- and community-based services who are eligible for both Medicare and Medicaid.

• The new law will reduce the number of low-income beneficiaries that are required to change plans each year to maintain zero premiums.
• It allows widows and widowers to more easily retain their low-income eligibility.
• Outreach programs are enhanced to ensure that more beneficiaries who are eligible for a Low-Income Subsidy are able to enroll.

Government Relations and Policy, March 2010

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.