Wednesday, October 31, 2007
There IS help out there!
The booklet, Choosing a Medicare Health Plan (see link at left), is one of a series of booklets for people with Medicare. It was developed jointly by the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality. It is a clear and comprehensive review for people who want to learn more about Medicare and how to select an appropriate plan.
Tuesday, October 30, 2007
Are you ready? It is time to choose your Medicare plan for 2008.
The enrollment period for making changes to your 2008 Medicare plan is November 15 to December 31. Failing to make changes during this time period, could cause you to be locked into your current plan until March 31, 2009. During the enrollment period, you will have the opportunity to choose between the Original Medicare—the traditional fee-for-service program run by the federal government—and several Medicare private health plans that have low premiums or offer special benefits. According to an announcement made by Health and Human Services Secretary Mike Leavitt, beneficiaries in every state will have access to at least one prescription drug plan with premiums of less than $20 a month, and a choice of at least five plans with premiums of less than $25 a month.
Many of the private health plans offered under the Medicare Advantage Program have low premiums or offer special benefits. These plans are required to cover at least the same inpatient (Part A) and outpatient (Part B) services covered by Original Medicare. Some private health plans also offer additional benefits, like dental or vision care, that Original Medicare does not cover. Moreover, Medicare prescription drug coverage (Part D) is included in most of these benefits packages. So many decisions, so little time! There is so much to consider when choosing how to get your Medicare health coverage.
The Medicare Rights Center offers the following guidelines for people planning to join private health plans.
Make sure you can use the doctors, specialists and hospitals that you prefer.
Make sure you can afford a plan before you join it. Prices and options vary widely.
Understand the private provider’s rules in advance. You will be required to follow them
To read more about how to choose a Medicare health plan, Medicare prescription drug coverage, and supplemental coverage, including Medigap plans and Medicare Savings Programs, log on to the Medicare Rights Center website at http://www.medicarerights.org/help. html.
Before you begin your trek through the Medicare jungle you should understand the following basic Medicare related terms.
Formulary
o A list of drugs that a company or plan decides it will carry. If a drug is “off-formulary,” generally your doctor has to make a special plea to use it and has to have a good reason. You also might have to pay more for it.
Premium
o A monthly payment for insurance.
Medicare Advantage
o Managed-care plans, such as an HMO. Medicare Part C. The plans may provide more services than traditional Medicare, but may limit members to certain doctors and hospitals.
Deductible
o What a Medicare member pays before drug coverage kicks in. Can be zero to $250 a year.
Step therapy
o Step therapy means a patient must try a lower-cost, often generic, product first. If it isn’t effective, the patient then “steps” to a different, often more expensive, drug.
Quantity limits
o Limits on the quantity of a drug a pharmacist can dispense each month.
Co-Payment (Co-Pay, Co-Insurance)
o Amount you pay to get a drug after you’ve paid your deductible. Some plans have one flat rate; others have different rates based on the type of drug.
Happy Hunting!
Many of the private health plans offered under the Medicare Advantage Program have low premiums or offer special benefits. These plans are required to cover at least the same inpatient (Part A) and outpatient (Part B) services covered by Original Medicare. Some private health plans also offer additional benefits, like dental or vision care, that Original Medicare does not cover. Moreover, Medicare prescription drug coverage (Part D) is included in most of these benefits packages. So many decisions, so little time! There is so much to consider when choosing how to get your Medicare health coverage.
The Medicare Rights Center offers the following guidelines for people planning to join private health plans.
Make sure you can use the doctors, specialists and hospitals that you prefer.
Make sure you can afford a plan before you join it. Prices and options vary widely.
Understand the private provider’s rules in advance. You will be required to follow them
To read more about how to choose a Medicare health plan, Medicare prescription drug coverage, and supplemental coverage, including Medigap plans and Medicare Savings Programs, log on to the Medicare Rights Center website at http://www.medicarerights.org/help. html.
Before you begin your trek through the Medicare jungle you should understand the following basic Medicare related terms.
Formulary
o A list of drugs that a company or plan decides it will carry. If a drug is “off-formulary,” generally your doctor has to make a special plea to use it and has to have a good reason. You also might have to pay more for it.
Premium
o A monthly payment for insurance.
Medicare Advantage
o Managed-care plans, such as an HMO. Medicare Part C. The plans may provide more services than traditional Medicare, but may limit members to certain doctors and hospitals.
Deductible
o What a Medicare member pays before drug coverage kicks in. Can be zero to $250 a year.
Step therapy
o Step therapy means a patient must try a lower-cost, often generic, product first. If it isn’t effective, the patient then “steps” to a different, often more expensive, drug.
Quantity limits
o Limits on the quantity of a drug a pharmacist can dispense each month.
Co-Payment (Co-Pay, Co-Insurance)
o Amount you pay to get a drug after you’ve paid your deductible. Some plans have one flat rate; others have different rates based on the type of drug.
Happy Hunting!
Monday, October 29, 2007
Another Change to Medicare Prescription Drug Plan? Will it Help?
A recent report by Consumer’s Union and Medical Rights Center concluded that private insurance companies were not getting the best deals on prescription drugs for Medicare recipients. The report quoted Robert Hayes, President of the Medical Rights Center as saying, “Day after day we see men and women with Medicare unable to get the medicine they need because of the confusing and exploitative marketplace that dominates the for-profit drug offerings from private insurance companies”. As a result of their findings, the two organizations recommended that older adults and persons with disabilities be given the option of choosing a prescription plan through the original Medicare program in addition to the Part D plans currently run by private insurance companies. In view of the many problems Medicare Part D participants have encountered, a revamping of the program seems reasonable. Some members of Congress agree with this recommendation and consequently introduced the Medicare Prescription Drug Savings and Choice Act on October 24, 2007.
This Act (HR 3932) is meant to deliver a meaningful benefit and lower prescription drug prices under the Medicare Program. It says in part, “…the Secretary shall offer one or more Medicare operated prescription drug plans (as defined in subsection (c)) with a service area that consists of the entire United States and shall enter into negotiations in accordance with … pharmaceutical manufacturers to reduce the purchase cost of covered part D drugs for eligible part D individuals who enroll in such a plan.” It further states, “…the Secretary shall negotiate with pharmaceutical manufacturers with respect to the purchase price of covered part D drugs in a Medicare operated prescription drug plan and shall encourage the use of more affordable therapeutic equivalents to the extent such practices do not override medical necessity as determined by the prescribing physician.”
Under current law the government is expressly forbidden from negotiating the price of prescription drugs on behalf of Medicare beneficiaries. The main argument advanced by proponents of HR3932 and other advocates for granting the federal government the power to negotiate is that lower prices for prescription drugs could be obtained and passed on to Medicare beneficiaries. By using the market power of several million Medicare beneficiaries they argue that the pharmaceutical companies would provide deep discounts to the federal government in order to prevent the loss of a significant portion of their market.
On the other hand, those who oppose allowing the federal government to negotiate drug prices claim that the resulting discounts would not be significant and that the governments efforts, if effective, might drive prices down to the extent that research and development would be discouraged and fewer products would be introduced.
I honestly don’t know who is right on this issue. I do know that a significant increase in Medicare premiums is slated for 2008. The Medical Rights Center predicts that this increase will result 1.6 million people being reassigned to a different drug plan. I have already started searching for a replacement plan and I can only tell you that the confusion grows.
This Act (HR 3932) is meant to deliver a meaningful benefit and lower prescription drug prices under the Medicare Program. It says in part, “…the Secretary shall offer one or more Medicare operated prescription drug plans (as defined in subsection (c)) with a service area that consists of the entire United States and shall enter into negotiations in accordance with … pharmaceutical manufacturers to reduce the purchase cost of covered part D drugs for eligible part D individuals who enroll in such a plan.” It further states, “…the Secretary shall negotiate with pharmaceutical manufacturers with respect to the purchase price of covered part D drugs in a Medicare operated prescription drug plan and shall encourage the use of more affordable therapeutic equivalents to the extent such practices do not override medical necessity as determined by the prescribing physician.”
Under current law the government is expressly forbidden from negotiating the price of prescription drugs on behalf of Medicare beneficiaries. The main argument advanced by proponents of HR3932 and other advocates for granting the federal government the power to negotiate is that lower prices for prescription drugs could be obtained and passed on to Medicare beneficiaries. By using the market power of several million Medicare beneficiaries they argue that the pharmaceutical companies would provide deep discounts to the federal government in order to prevent the loss of a significant portion of their market.
On the other hand, those who oppose allowing the federal government to negotiate drug prices claim that the resulting discounts would not be significant and that the governments efforts, if effective, might drive prices down to the extent that research and development would be discouraged and fewer products would be introduced.
I honestly don’t know who is right on this issue. I do know that a significant increase in Medicare premiums is slated for 2008. The Medical Rights Center predicts that this increase will result 1.6 million people being reassigned to a different drug plan. I have already started searching for a replacement plan and I can only tell you that the confusion grows.
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