Category: Part D
While the nation waits for the Supreme Court’s decision on the Affordable Care Act, we think it’s important that the real-world implications of this decision for millions of American seniors not get lost in the shuffle.
Here is an analysis of the impact on seniors’ Medicare and Medicaid benefits if the ACA is completely overturned:
If the individual mandate is declared unconstitutional and is not severed from the rest of the law the whole ACA would be struck down.
All of the provisions which positively impact senior’s health would be stripped away.
The Part D Donut Hole will return. Prescription drug costs will rise because discounts provided by ACA will be revoked.
Beginning in 2011, brand-name drug manufacturers provided a 50% discount on brand-name and biologic drugs for Part D enrollees in the donut hole. By 2013, Medicare would have begun to provide an additional discount on brand-name and biologic drugs for enrollees in the donut hole. By 2020, Part D enrollees would have been responsible for only 25% of donut hole drug costs. All of these savings will be gone if the ACA is repealed
New Preventive Services provided with the ACA will disappear.
Savings for Chemotherapy and Dialysis patients in Medicare Advantage plans lost
- Prior to the ACA, Medicare beneficiaries were required to pay a deductible and 20% co-pay for many preventive health services.
- The ACA eliminated cost-sharing for many preventive services and introduced an annual wellness visit for beneficiaries.
- The ACA also eliminated cost-sharing for screening services, like mammograms, Pap smears, bone mass measurements, depression screening, diabetes screening, HIV screening and obesity screenings.
Improvements in care for individuals with chronic conditions gone
- In the past, Medicare Advantage plans have had flexibility to impose cost-sharing structures that differ from traditional Medicare. Prior to the ACA, plans increased co-insurance for some services, like chemotherapy and dialysis. Beneficiaries who were enrolled in MA plans that needed those services were left worse off than if they had the same conditions and were in traditional Medicare. Many beneficiaries enrolled in these plans did not understand the differences in cost sharing.
- The ACA attempts to remedy this by preventing Medicare Advantage plans from imposing higher cost-sharing for chemotherapy and dialysis than is permitted under Medicare Parts A and B.
- The Centers for Medicare and Medicaid Services (CMS) issued final regulations on these improvements in 2011, and many became effective January 1 of this year.
Improvements to help seniors transition from the hospital back home repealed
- The ACA has several provisions targeted to improving the quality of care for patients with chronic illness and reducing the costs to Medicare and Medicaid for serving those beneficiaries.
Improvements in seniors’ access to primary care physicians lost
- The ACA established the Community-Based Care Transition Program which targets individuals who are in traditional fee-for-service Medicare and are hospitalized and at risk for readmission. The program provides grants to hospitals to work with community-based organizations to provide transitional care interventions.
- 30 community-based organizations across the country have already partnered with local hospital systems and are committed to reducing readmissions by 20% and hospital acquired conditions by 40%.
Medicare’s Trust Fund will face insolvency 8 years (or even more) sooner than expected
- Through the Independence at Home demonstration, that ACA will pay physicians and nurse practitioners to provide home-based primary care to targeted chronically ill individuals for a three-year period.
- CMS recently launched this primary care initiative with 16 practices across the country.
- The Affordable Care Act includes many measures to control costs as well as models for reform that will increase the solvency of the Medicare. If the ACA is repealed those cost saving measures will be lost and Medicare’s solvency threatened.
The National Committee
has partnered with the highly respected National Senior Citizens Law Center
to provide detailed analysis of the various Affordable Care Act rulings that could come from the Supreme Court. Our full analysis will be available immediately following the Court’s ruling, expected soon.
CATEGORY: [entitlement reform], [healthcare], [Medicare], [Medicare Advantage], [Part D], [Retirement]
Confused by what health care reform really means for seniors? Join the crowd. Take a few minutes and let this video help break it all down for you...
The Patients Aware
campaign, created by the National Committee to Preserve Social Security and Medicare Foundation, the Herndon Alliance, and the National Physicians Alliance
, has released a new video
to help America’s seniors understand the new Medicare benefits available to them thanks to the Affordable Care Act. The video, “Did You Know?”
, highlights new preventive benefits for seniors, Part D coverage improvements like closing the donut hole, and describes how savings have already reduced Part B premiums for seniors. The video can be seen on the Patients Aware website at: www. Patientsaware.org.
has assembled a national network of doctors, nurses, and other healthcare experts to give Medicare presentations during educational meetings and town halls beginning in March. Medical professionals are among the most trusted sources of health care information for seniors and their families. They understand how vital Medicare is to the health and wellbeing of their older patients which is why they have agreed to donate their free time to provide information and answer questions for seniors in cities throughout the country.
“America’s seniors want and deserve the facts about Medicare, prescription drug policy, and what federal health reform will mean for them. Most Americans know very little about the important new benefits and protections provided by the Patient Protection and Affordable Care Act. The National Physicians Alliance has found that providing non-partisan, factual information about the law is the best antidote to widespread confusion and anxiety.” Dr. Valerie Arkoosh, NPA President
The video release and town hall tour follows a successful December 2011 campaign kick off in which more than sixty thousand Americans participated in a Patients Aware
tele-town hall with Assistant Secretary for Aging Kathy Greenlee, and a panel of doctors, nurses, and healthcare policy experts. Seniors and their families dialed in to this national forum to ask questions about the Affordable Care Act and what it means for millions of Medicare beneficiaries. The hour-long event kicked-off one of the most effective education efforts to date since the law was passed in March 2010.
CATEGORY: [healthcare], [Medicare], [Medicare Advantage], [Part D], [privatization]
Online “Plan Finder reviews 2012 plan options
In advance of the new, earlier annual enrollment period, CMS has opened up it's plan finder earlier too...people with Medicare coould begin reviewing plan benefit and cost information on Saturday, October 1st, 2011. The Centers for Medicare & Medicaid Services (CMS) will launch access to its popular web-based Medicare Plan Finder
that allows beneficiaries, their families, trusted representatives, and senior program advocates to look at all local drug and Medicare Advantage (Part C) plan options that are available for the 2012 benefit year. From the CMS news release:
“With Open Enrollment coming early this year, it is important that people with Medicare take advantage of the next couple weeks to review their current coverage and compare it with the options that are available for next year,” said CMS Administrator Donald M. Berwick, M.D. “The information that’s available now on the Plan Finder will also help caregivers, health providers, and partners that support and counsel seniors and people with disabilities in selecting the best plan for their needs.”
The annual enrollment period begins earlier this year, on October 15th, and runs through December 7th. People with Medicare will have seven weeks to review Medicare Advantage and Part D prescription drug coverage benefits and plan options, and choose the option that best meets their unique needs. The earlier open enrollment period also ensures that Medicare has enough time to process plan choices so that coverage begins without interruption on January 1, 2012.
People can use the Plan Finder – available at Medicare.gov
–by inserting their home zip code to find out which Medicare Advantage (Part C) and Prescription Drug (Part D) plans are available in their areas.
CATEGORY: [Medicare], [Medicare Advantage], [Part D]
Max Richtman, NCPSSM Executive VP/Acting CEO
Sometimes the “good old days” really weren’t all that good and turning back the clock actually means turning our back on progress. This is especially important to remember as we celebrate Medicare’s 46th
birthday. When President Johnson signed Medicare into law on July 30th
, 1965, 51% of America’s seniors were uninsured and 30% lived in poverty. Healthcare was unavailable for millions of retirees who private insurers wouldn’t cover because they were considered too big a risk. Today, the senior poverty rate is at 7.5% thanks to Social Security and the Medicare program which American retirees can count on to help keep them healthy. Unfortunately, these simple facts are largely ignored in Washington’s current race to gut our social safety net in the name of deficit reduction. As we celebrate Medicare’s 46 years of success, the threat to the program’s future has never been as serious as it is today.
The current atmosphere in Washington is one in which decimating programs like Medicare has become a fiscal litmus test for being considered an “adult”, “serious” or even a political badge of honor. However, once you step outside Washington it is clear Americans of all ages understand we don’t have to destroy vital programs like Medicare to be fiscally responsible. That message has been delivered loud and clear in town halls nationwide and in poll after poll. Politicians who ignore the real-life impact these cuts, caps and coupon proposals will have on beneficiaries and their families will certainly find they will not be rewarded for their supposed “political courage” come Election Day.
The fact is Medicare isn't broken but it is plagued by the same problems confronting our healthcare system nationwide. Rising health care costs are eroding family resources, undermining our ability to compete in the global economy and creating fiscal burdens that crowd out other important investments of social capital. That's not a Medicare problem, that's a healthcare problem. Yet, many conservatives in Congress continue to urge repeal of the only law to reform our healthcare system in a generation. They’d prefer "reforms" that shift the burden to seniors rather than address the real issues of cost-containment. The GOP/Ryan budget plan would replace the current Medicare program with vouchers and leave seniors and the disabled – some of our most vulnerable Americans – hostage to the whims of the private marketplace. Over time, this will destroy the only health insurance program available to 47 million Americans. Vouchers are strategically designed not
to keep up with the increasing cost of health insurance -- that is why they save money.
Rather than destroying Medicare and replacing it with vouchers, raising the eligibility age and barring a growing number of retirees from enrolling in the program, or shifting even more costs directly to seniors, Washington’s goal should be to provide the healthcare retirees need at a cost we can afford. We should continue the course laid out in healthcare reform legislation, which adds 8 years of solvency to Medicare by reducing massive overpayments to private insurers, while also eliminating the doughnut hole in the prescription drug program, and providing other valuable improvements for beneficiaries. Medicare is already far more efficient than private insurance and without it millions of America’s seniors simply could not afford health coverage. Some might die prematurely and many more would suffer needlessly due to a lack of health insurance.
Medicare is truly an American success story and one we should be celebrating this July. Unfortunately, these facts are seldom voiced by those in Washington all too eager to make this year Medicare’s final birthday.
CATEGORY: [Budget], [healthcare], [Medicare], [Part D], [Retirement]
The ongoing quest to balance the budget on the backs of America’s seniors continues with the latest Medicare plan
offered by Senator Joe Lieberman and Senator Tom Coburn (who left the Gang of 6 negotiations because that bipartisan group wouldn’t slash seniors’ programs enough).
Rather than reigning in the skyrocketing costs of healthcare system wide (not just in Medicare), increasing efficiencies or even rooting out inefficiencies this plan puts the burden of a nationwide healthcare crisis directly on America’s seniors:
“Most of the plan's savings would come from some form of benefit reductions or cost-shifting to seniors — a stark contrast to the Medicare cuts believed to be on the table in talks over the debt ceiling. Negotiators there are looking at cuts to healthcare industries after Democrats drew a line in the sand over benefit cuts.
But Lieberman and Coburn's proposal includes several politically risky benefit changes, such as making seniors pay more for their prescription drugs. It also would raise the eligibility age for Medicare.
The proposal would cap seniors' out-of-pocket costs depending on their income. The maximum would be set at $7,500 for people making less than $85,000 per year. Seniors with twice as much income would pay three times more in out-of-pocket Medicare costs.
Seniors also would pay more for their prescription drugs. Premiums only cover about 11 percent of the total costs for Medicare Part D, the senators said. They would require seniors to pay the full cost of their drug coverage. They said the change would free up between $5 billion and $10 billion in tax money.
The plan also would increase premiums for Medicare Part B, which covers drugs that are administered by a doctor. Part B premiums are more than $400 per year, and taxes currently cover only about a quarter of that cost. High-income seniors would have to pay the full cost of their Part B premiums under the Lieberman plan.” The Hill
Not so surprisingly, this proposal is all pain for seniors with absolutely no attempt to raise revenues.
“Lieberman gave up an income tax hike that he previously said would be part of his proposal. ‘The sooner you take the strong medicine, the sooner you will get healthy again,’ [he] said.”
In other words, America’s seniors must continue to take Washington’s version of “strong medicine” so the nation’s largest corporations and wealthiest citizens can continue to stay healthy.
CATEGORY: [Budget], [entitlement reform], [healthcare], [Medicare], [Part D]
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