TOM MERTON/GETTY IMAGES When first implemented in 2006, Medicare Part D plans had a built-in gap in coverage. During this coverage gap (aka, "Donut Hole") drug plans paid nothing toward the cost of your medications. But that's no longer the case. In 2012, the Affordable Care Act (ACA) implemented a phase-in of discounts for beneficiaries in the Coverage Gap phase of their plan. To demonstrate the rapid change, in 2018, those in the Donut Hole paid 35% of the cost of brand-name drugs and 44% for generics. In 2020, the final year of the phase-in, beneficiaries pay 25% of the cost for any brand-name or generic medication. If you thought that the Coverage Gap was going to be totally eliminated from 2020 Medicare Part D plans, you're not alone. The Coverage Gap phase, which acts as a second deductible, is a design characteristic of the Part D program. MedicareWire found that the key to understanding the Part D Donut Hole going forward is to look at the four phases of Medicare … [Read more...]
Medicare Open Enrollment 2013… It’s Here!
Medicare 2013 open enrollment is here and the number of Medicare Advantage plans with four- and five-star ratings is up from 106 in 2012 to 127 in 2013 (CMS, Modern Healthcare's "Window to Washington" reports, Zigmond, 10/12). The CMS plan ratings rank plans on a one- to five-star scale. The quality information is collected from the insurance carriers, Medicare records, and an annual survey of beneficiaries. Overall, the number of MA plan choices grew by 7%. For 2013 there are 11 five-star plans and 116 plans with four or four-and-a-half stars (Jaffe, "Capsules" Kaiser Health News, 10/15). That's great news for beneficiaries. In 2012, only 51% of beneficiaries had access to four- or five-star rated plans. That figure could reach 68% in 2013 (Norman, CQ HealthBeat, 10/12). According to the Columbus Dispatch, CMS officials reported that the department is being aggressive about moving seniors out of lower-rated MA plans and into higher-scoring ones. Specifically, CMS will mail … [Read more...]
Obama Crows About Private Medicare Provider Success while Bashing GOP Plans
While the President sharply criticizes Mitt Romney over plans to further privatize Medicare, he crows about the success of private health plans in delivering prescription drug benefits and health care services to Medicare beneficiaries. The Obama administration reports that it's satisfied with the private plans. “Medicare Advantage premiums down 7 percent on average, enrollment up 10 percent,” the administration announced in February. It also claimed that the quality of health care provided by Medicare Advantage plans is steadily improving. Earlier this month the Obama administration released the results of competitive health care bidding for 2013: “Medicare prescription drug premiums to remain steady for third straight year.” According to the Medicare Payment Advisory Commission report released in June, Federal spending on Medicare drug benefits is 30 percent lower than the Congressional Budget Office predicted when the prescription drug legislation was passed in 2003. That’s great … [Read more...]