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Articles: Medicare expansion similar to Medigap

Posted by admin on Tuesday, April 20, 2004 - 02:22 AM

The first step in the expansion of Medicare to cover prescription drugs begins in less than two weeks with registration in May for drug discount cards that will be issued in June. In an information session for senior citizens here last week, Rep. Ginny Brown-Waite and Leslie Norwalk, acting deputy administrator of the Centers for Medicare and Medicaid Services, explained how the system is expected to work. Most older residents also received a letter from Tommy G. Thompson, the secretary of Health and Human Services, giving the highlights of the Medicare Modernization Act of 2003.
Norwalk estimated that seniors will have at least 30 drug discount cards -- approved by but not provided by the government -- to choose from. Each, which may cost $30 a year for an enrollment fee, is expected to provide anywhere from 10 to 25 percent discounts on a variety of drugs. Some cards not connected with the Medicare Prescription Drug Plan already are available through some Medigap insurance companies or through associations such as the American Association of Retired Persons, which have negotiated discounted prices with certain pharmacy chains. Brown-Waite noted that about a third of all retired persons have medical benefit plans from their former employers. Many of those people have some sort of coverage for prescription drugs and would have little or no need for the Medicare Prescription Drug Plan (PDP). In fact, companies will be given subsidies to encourage them to retain those benefit programs. When the drug coverage addition to Medicare takes full effect beginning Jan. 1, 2006, the prescription discount cards no longer will be needed by those who sign up for the PDP. The plan will work something like private Medigap policies that include prescription drug coverage work now. After paying a premium of $35 a month, you will pay the first $250 (a deductible) of the cost of drugs. Medicare will pay 75 percent of the next $2,250 of the cost of drugs. You will pay the other 25 percent. You will pay 100 percent of the cost of drugs beyond $2,250 up to $3,600. Then Medicare will step in and pay 95 percent of any cost above $3,600. Further savings will be offered to those who join a Medicare Advantage plan. (Those are preferred provider organizations (PPOs) which limit your choice of doctors or hospitals to those participating in the program.) More help is available to individuals or couples with low income who, according to Brown-Waite, account for 30 percent of her constituents in this area. Individuals with incomes of $12,569 or less and married couples with incomes of $15,862 or less may be eligible for $600 of credit on their drug discount card if they are not receiving drug coverage from Medicaid, TRICARE for Life (military), or an employer group health plan. They also will pay no premium or deductible and only a small co-pay. The Medicare Modernization Act already has eliminated the cap on physical and occupational therapy, and the co-payment for some home health care, notes Thompson. And next year Medicare will cover an initial physical exam, screening blood tests for early detection of cardiovascular diseases, and diabetes screening tests. And by increasing Medicare payments to doctors and segments of the health care system, the new act assures that more doctors and hospitals will remain in the Medicare program, Thompson said. For more information about changes in Medicare, visit the Web site at www.medicare.gov or phone (800) MEDICARE; contact Brown-Waite at www.house.gov/brown-waite or phone (866) GWAITE-5.

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