Menstuff® has compiled the following 2005 update on the
medicare drug benefits.
Medicare Update 2005: Drug Benefits
Also:
Medicare and
You: Marisa Scala-Foley
Medicare
Update 2005: Part One
Medicare
Update 2005: Part Two
Medicare
Rx Benefits Center
Medicare
Drug Card Q & A
On Jan. 1, 2006, a new Medicare drug benefit will begin: "Part D" (as in "Drug"). Sign up for Part D coverage begins on Nov. 15, 2005. How is Part D different than the discount card you may have now? Why should you sign up? What will be covered? What will it cost and what can you save? Medicare & Medicaid Services Administrator Mark B. McClellan, MD, PhD, joined us on Sept. 19, 2005 and answered your questions about this new Medicare drug coverage and more.
If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
MODERATOR:
Welcome to WebMD Live. Today our guest is Medicare & Medicaid Services Administrator Mark B. McClellan, MD, PhD.
Welcome back to WebMD Live, Dr. McClellan. Thank you for joining us today.
MCCLELLAN:
It's great to be back with WebMD again. This is a wonderful opportunity to answer questions and share new information about our nation's health care programs.
MODERATOR:
Let's start today by talking about the new Medicare Part D program. This is the program designed to help participants pay for prescription drugs. Who will be eligible for these benefits?
MCCLELLAN:
Everyone in Medicare is eligible for the new prescription drug coverage. There is extra help available for people with limited means, about one-third of all of our beneficiaries, and people who have good coverage now from a retiree plan can get new help in supporting that coverage.
MODERATOR:
What will be covered under the new benefit?
MCCLELLAN:
The drug benefit will cover all medically necessary drugs, including both brand name and generic medicines. You will be able to get your medicines at a convenient pharmacy or by mail order.
MODERATOR:
When will this program go into effect?
MCCLELLAN:
There are some important dates coming up. The drug benefit goes into effect on Jan. 1, 2006, and we will be providing this drug benefit on schedule nationwide.
In early October people with Medicare will get their Medicare and You handbook, which will provide more information about how to take advantage of this new voluntary coverage. People will also start seeing information from the prescription drug plan about the coverage they offer.
"We're going to provide lots of help for people to take advantage of the new benefits."
Two other important dates: in mid-October people will be able to go to medicare.org or to our link through WebMD to get specific information about the drug plan option that is best for them, based on their own needs and preferences. This is a much more personal approach to keeping Medicare coverage up to date that builds on new information technology.
Another important date is Nov. 15. That's when people can start enrolling in the drug coverage. If you already have coverage from a former employer, you should also be hearing very soon from your former employer about how your coverage will work with the new Medicare coverage.
All of this is right around the corner, and we're going to provide lots of help for people to take advantage of the new benefits.
MEMBER QUESTION:
Is there any truth to the rumor that changes to Medicare might be delayed because of the crisis with Hurricane Katrina?
MCCLELLAN:
We will implement the drug benefit on schedule nationwide. In fact, it's particularly important for people from the Gulf Coast who have lost their income and in many cases are no longer in the state where they got drug coverage before. We are taking extra steps to help evacuees take advantage of this drug coverage on schedule.
MODERATOR:
What do those affected by Katrina need to do to get signed up for Part D?
MCCLELLAN:
They can call 1-800-MEDICARE anytime. We will make sure they can get the drug coverage on schedule, even if they do not call us, because they are having trouble with a phone connection or other connections, we will be making sure people still can get access to the coverage.
For example, people from Louisiana with limited income who have Medicaid drug coverage now will be automatically enrolled in the Medicare coverage at no cost so that they can get benefits at a local pharmacy wherever they are on Jan. 1. Medicare will pay about $3 for every $1 that a beneficiary spends on drug coverage. In other words, 75% of the cost.
We have recent good news about the cost of the drug coverage. Because of the strong competition among drug plans, the actual cost of this coverage will be about 15% less than people had predicted. In addition, in every state in the country, there will be low-cost drug benefit options available. Premiums will often be under $20 a month and in some cases, even less. Previously people had expected the premiums to be around $37 a month for this coverage.
MEMBER QUESTION:
Will this replace the cards we have now? They only cover some drugs.
MCCLELLAN:
The Medicare program implemented a drug discount card in mid-2023 as a bridge for temporary help with drug costs before the prescription drug benefit begins in January 2006. That temporary program was designed for people who were getting no help with their drug costs.
The new Medicare drug benefit will provide more help through discounts and drug coverage, and in addition, it's designed to work with employer coverage and coverage from Medicare advantage plans that many people rely on today.
Will there be a list of covered drugs, or will coverage be for what the doctor orders?
MEMBER QUESTION:
Will there be a list of covered drugs, or will coverage be for what the doctor orders?
MCCLELLAN:
Every prescription drug plan today has a formulary or preferred drug list, and that will be true for the Medicare plan, as well. Medicare is closely overseeing the formularies of the drug plan. As a result, we will make sure that the drug plans provide access to all medically necessary treatments.
For example, every drug plan will cover essentially every medicine for mental illness, HIV/AIDS, cancer and immune conditions. For other conditions, such as allergies, where several drugs in a class may generally work in a similar way, the drug plan will typically have better coverage for certain drugs.
That enables the plan to negotiate lower prices from the drug manufacturers, but they are not allowed to do so at the expense of limiting access to medically necessary drugs.
MODERATOR:
What factors should be considered when choosing a plan?
MCCLELLAN:
That's a good question. Medicare and our many partners will be helping people consider their plan choices in the weeks ahead. I think many people will consider cost, coverage, and convenience.
In terms of cost, we will use the drug plan tools that I mentioned earlier to let people know just how much they will pay for the medicines they need in the drug plan.
In terms of coverage, many drug plan options are offering additional coverage beyond the standard drug benefit. That means people who prefer coverage with no deductibles or who prefer more comprehensive coverage with less or no coverage gap, will have those options.
In terms of convenience, if you have preferred pharmacies or other preferences about how you get your medicines, we can help you find a plan that is a good fit in those areas, as well.
"People with limited incomes get extra help from the Medicare drug benefit."
Beginning in mid-October, people can go online to medicare.gov or through our link at WebMD, or they can call us at 1-800-MEDICARE. If they are ready with information on their medicines and how they prefer to get their coverage, we will help them find the two or three plans that are the best fit for their own circumstances. Then they can choose the plan that they prefer based on this help from us.
I would like to add that we are providing help to choose a plan not only for those with Medicare, but for the millions who care for or who care about people with Medicare. I would encourage all of you to have a conversation with a parent or loved one who has Medicare to make sure they know how to get the most help from the new coverage.
MEMBER QUESTION:
Can people with low income get coverage also?
MCCLELLAN:
People with limited incomes get extra help from the Medicare drug benefit.
If their incomes are low enough to qualify for Medicaid, we will help them enroll in the extra help automatically. That means starting in January, they will get drug coverage for zero premium that gives them access to the medicines they need for at most, several dollars per prescription. This extra help will cover over 95% of their drug costs, and that's a benefit worth close to $4,000.
This extra help is available to millions more seniors and people with a disability who may not think of themselves as poor, but who are struggling between paying for their drugs and paying for other necessities like food or rent.
One out of three Medicare beneficiaries are eligible for this extra help. This includes couples with incomes of close to $20,000 and limited financial assets. There is a straightforward application available right now to enroll.
Again, it costs nothing and provides comprehensive drug coverage. If you or someone you know is living on a fixed income and struggling with their drug costs, it's very important for them to sign up for a benefit that independent experts have called the most important new benefit for low income seniors in 40 years.
The application is available online through medicare.gov or our partners at social security, ssa.gov. You can also find out about enrolling in the extra help by calling Social Security at 1-800-SSA-1213.
MODERATOR:
Some low-income people may receive lump sum payments to assist them in rebuilding their lives in the wake of Hurricane Katrina. Will this posthurricane assistance affect their income eligibility for Medicare programs like Part D?
MCCLELLAN:
No. The income determinations are based on their incomes for the past year.
In addition, we are working with the states to create a new type of temporary eligibility for Medicaid for people including seniors, who have lost income or financial resources because of the storm. Those people will be automatically eligible for the extra help from Medicare.
MODERATOR:
How will Medicare help those who have lost records of income and expenses?
MCCLELLAN:
It's a special kind of Medicaid eligibility that recognizes that many evacuees have not only lost their income and resources, but have also lost their documentation.
MEMBER QUESTION:
Why is there so large a variation in each private company's formulary and was there an effort to uniformly regulate the costs of plans and their offerings?
MCCLELLAN:
We are overseeing the drug formularies for every prescription drug plan. So in many important areas, there is no variation in formularies at all. This includes drugs for mental illness, HIV/AIDS, cancer, and immune conditions, where every drug plan has essentially every drug on their formulary.
The areas where the formulary may vary include such medications as statins for lowering cholesterol and the so-called nonsedating antihistamine drugs for hay fever. That's because many drugs in these classes generally provide the benefits that patients need.
Again, all of the drug plans must provide access to all medically necessary treatment. In designing our formulary oversight, we looked at the best practices of existing drug plans for seniors and people with a disability, including high-quality Medicaid drug plans, as well as high-quality retiree plans. The same kinds of formularies will be present in the Medicare drug benefit as have already been working to provide effective access to medicines.
MODERATOR:
Is there an appeal process if your doctor feels a particular drug not on the formulary is necessary to treat you?
MCCLELLAN:
All plans are required to meet Medicare standards for independent review and appeals. For urgent medical conditions, the appeals must be handled very quickly.
"We're using information technology to help people find the lowest cost plan."
MEMBER QUESTION:
I read that there will be a 10% increase per 12-month period if I do not sign up in my time period. Is this true?
MCCLELLAN:
People can sign up for the new drug benefit anytime between Nov.15 and May 15, 2006 without paying more. But the Medicare drug coverage is insurance and just like all other kinds of insurance, if you wait longer to sign up, you will probably pay more.
For example, Medicare provides insurance for physicians and outpatient hospital care under Medicare Part B. People who do not sign up for this voluntary insurance pay more if they enroll later.
The same thing is true for home insurance. If you wait until after your house is on fire, it will cost more. But I want to be clear that people have a significant amount of time to make a decision. There are no penalties if you enroll any time before May 15, 2006.
MEMBER QUESTION:
I understand there will be a deduction from my social security check of approximately $32 per month for the prescription service that allows me to choose from card providers. Is there also a charge from the provider?
MCCLELLAN:
The drug plans will have a monthly premium but many plan options will be available for premiums of much less than $32 a month. Many plans will have premiums under $20 or even less, and that's why it's important to shop for a plan that provides the coverage you need at the lowest cost.
As I said before, we're using modern information technology to help people find the lowest cost plan for their needs and preferences. Once you choose a plan, you can choose how to pay the premium, as well. If you prefer, the premium can be deducted from your monthly Social Security check or you can have the premium billed automatically to an account or credit card or you can send in a monthly check.
Besides the monthly premium, the drug plans will usually have co-pays for the drugs you use. Again, we will have tools to help you find the drug plan that gets you the greatest overall savings.
MEMBER QUESTION:
Can I change plans once I select one?
MCCLELLAN:
After you enroll in a plan you'll have a limited time to choose a different plan. In addition, every year there will be what's called an open-enrollment period when you can switch to any Medicare drug plan.
Because the drug plans know that our beneficiaries will have other options and this coverage is voluntary, they are working hard to negotiate low prices and provide good service. That's why the actual cost of this drug benefit is turning out to be much lower than people had expected.
MEMBER QUESTION:
In the aftermath of Hurricane Katrina, I've become increasingly concerned about the security of my family's health records. What can we do to ensure that this information is secure?
MCCLELLAN:
Among the many aspects of devastation caused by the hurricane, the impact on the availability of medical records has clearly been important. It emphasizes why it is critical for us to move as quickly as possible to an effective electronic health care system that preserves patient confidentiality and control.
There are a growing number of tools available to help people store their medical information electronically. In fact, WebMD is involved in many of these efforts.
Right now Medicare is launching an electronic data program called our Medicare Beneficiary Portal. This allows our beneficiaries to get access to any and all Medicare information about them. We are working to use this program with the new drug benefit so that, for example, people would be able to get electronic access to all their prescriptions.
"We are working with many partners like WebMD to help Medicare beneficiaries get the support they need."
We are also working to link this information, with a beneficiary's control, to a beneficiary's health record. Many people in this country are setting up their own electronic health records with help from their doctors and from WebMD. Medicare will increasingly be helping support those efforts to help us get to an electronic health care system. When there is a natural disaster, there will be disruptions in health care, but disruptions and access to medical records shouldn't be one of them.
MODERATOR:
Dr. McClellan, do you have any final comments for us?
MCCLELLAN:
I'd like to thank WebMD and all of your participants for this very interesting web discussion today.
WebMD is a trusted source for health information and clearly is a location visited by many knowledgeable and interested Americans, when it comes to important health care issues like Medicare coverage.
We are working with many partners like WebMD to help Medicare beneficiaries -- and all Americans who care about someone with Medicare -- to get the information and support they need to take advantage of Medicare's new drug coverage.
Along with our new preventive benefits, these are the most important new benefits in Medicare in the program's 40-year history. They mark a turning point where Medicare is moving from simply paying the bills when people get sick to helping them get coverage that helps them stay well.
The best way to do this is through a partnership with our beneficiaries, where they are empowered to get the coverage that's best for them, not a one-size-fits-all program that in too many ways has fallen behind the potential of modern medicine.
Partners like WebMD, as well as state health insurance assistance programs, and many advocacy groups for seniors, are helping us make this transformation in how Medicare works.
To get help with taking advantage of the new Medicare benefits visit us at medicare.gov or call us at 1-800-MEDICARE at any time or keep checking with our key partners, like WebMD, right here online. Thank you for your time.
Source: Mark McClellan, my.webmd.com/content/chat_transcripts/2/110398.htm?pageNumber=1
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