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Keeping Part D Strong: The Value of Choice

Consumer choice is one of the most powerful tools in any marketplace. Don’t like the service at Restaurant A? No problem, there are many others waiting to serve you. Department Store X is having a great sale and Store Y isn’t…I know where I’m going to shop.

As consumers and smart shoppers, we vote with our pocketbook every time we make a purchase, and by doing so, we affect the market that wants our business. While we embrace the importance of competition in many other types of commerce, we often overlook its importance in health care.

For Medicare Part D, choice is a critical part of the program design. In fact, there was initial concern there would not be enough plans offered. However, as you know, the opposite happened. Many companies entered the Medicare Part D marketplace and continue to provide seniors like you with a wide variety of plan options so you can find one that best meets your individual needs.

Choice — and the resulting competition among plans — has made you the real winners by keeping premiums steady, program satisfaction high and making Medicare Part D a successful public-private initiative.

Some want to change this successful program – to limit choices or undermine the elements of consumer empowerment that have made it so successful. Attempts to weaken and disrupt Part D’s competitive structure do not serve the best interests of the seniors like you who benefit from the program. As Part D beneficiaries, we need to stand firm to protect this program which is fundamental to our health and well-being.



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Seniors Spoke Out…And Were Heard! 

THANK YOU to every senior and supporter who spoke out during the recent budget debate.  While a senator proposed making harmful changes to the Medicare Part D program, the Senate did not vote on the proposal, choosing to keep Part D in its current form. No doubt, this was due to all of your hard work to protect this vital program. Because of advocates like you, Part D remains intact and will continue to provide seniors access to affordable medications. 


Stay tuned to Seniors Speak Out and share your stories and photos with us about how Medicare helps you live life to the fullest. You never know when we may need to speak out again!



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Keeping Part D Strong: Don’t “Fix” a Successful Program

In George Washington’s time, doctors frequently treated patients by bleeding them with leeches. Just as this procedure didn’t produce successful outcomes, “bleeding” Medicare Part D is a misguided attempt that would be equally unsuccessful. 

 

Medicare Part D is a rare commodity, a government program that is healthy and works well! Here are some reasons why:

 

1)     Seniors like the program, consistently giving it a near 90% satisfaction rate;

2)     Research demonstrates Part D contributes to reductions in hospitalizations; 

3)     Consumers are empowered by many optionsamong coverage plans;

4)     Premium costs have been relatively stableover the past five years.

5)     The net federal spending for the program was nearly 50 percent less than anticipated by CBO projections.

 

If you rely on the Medicare prescription drug program, now is the time to keep up with policy threats to the program and get involved to ensure your access to prescription drugs is not threatened. We can’t let this vital program, which protects the health of tens of millions of seniors and people with disabilities, be endangered by misguided changes. As the old adage goes, if it ain’t broke…



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With Final Rule, Seniors Are Protected, But Threats to Part D Remain

In early February, the Centers for Medicare & Medicaid Services (CMS) released a final rule to make changes to Medicare Advantage and Part D. Among other things, the rule aimed to finalize remaining changes included in a proposed rule from January 2014 but that were not finalized last summer. Importantly, this final rule not only leaves out the harmful proposed changes that Medicare Today and hundreds of other organizations spoke out against last year, the rule actually listed some of the most controversial provisions that were purposefully left out.

As noted in CMS’ final rule summary:

“The rule does not finalize any of the following provisions: 

  • Lifting the protected class designation on three drug classes – antidepressants, antipsychotics and immunosuppressants for transplant rejection;
  • Requiring Medicare Part D sponsors to include any pharmacy willing to accept the terms and conditions to participate in narrower pharmacy networks that offer preferred cost sharing to beneficiaries;
  • Reducing the number of Part D plans a sponsor may offer; and
  • Codifying CMS interpretation of the Part D non-interference provision.”

This is a critical victory for seniors and would not have been possible without the collaboration and hard work of hundreds of organizations and individuals like you that opposed these changes, which would have undermined the Part D program and jeopardized seniors’ access to critical medications. We applaud the effort advocates have made since the very beginning of this debate to ensure seniors are heard and protected.

It is critical for seniors and advocates alike to remain vigilant against new, potentially harmful policy changes to Part D. As legislators and regulators continue to assess the program, we urge them to reach out to patient and health advocates to discuss any proposed changes, to ensure their efforts do not endanger a successful program that helps keep seniors healthy.

We are pleased that CMS has heeded the concerns of advocates, and we look forward to working together to continue to safeguard Part D against changes that would negatively impact access to affordable prescription drug coverage for seniors and disabled beneficiaries.



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Exploring Your Part D Coverage

During open enrollment, you may have signed up for a new Part D plan, or maybe you stuck with the same drug coverage you’ve had for years. Either way, making sure you know some basic information about your plan will help guarantee that you are getting your medications at the lowest possible cost. So at the beginning of this year, take some time to sit down and review the elements of your Part D coverage.

The first thing you want to look at when reviewing your Medicare Part D plan is its formulary, or the list of medications it covers. You can look up your plans formulary by going to your insurance provider’s website or search plans in your area through Medicare’s website at http://www.medicare.gov/.

The next thing you’ll want to think about is how much you will be paying for your medications. There are a number of different factors that can influence the total amount you will need to pay out of pocket for your prescriptions. Below is a list of some of the basic elements that can impact your costs and what each term means:

Premium– This is the amount you pay for your insurance coverage plan. You usually pay this amount on a monthly basis, but can sometimes pay quarterly or annually.

Deductible- The deductible is the amount you are required to pay annually before your plan will begin to cover your expenses. The deductible you have to meet does not include the payments you made towards your premium. Once you meet your deductible, your plan will begin to cover your expenses but you may still need to pay cost-sharing in the form of a copay or coinsurance (more on that below). A high deductible can make your out of pocket costs each year much more significant, so make sure you factor that into your cost calculations.

Copay– A copay is the fixed amount you’ll have to pay towards your medications each time you get them filled.

Coinsurance– Coinsurance means that rather than play a flat rate for your medications, you will pay a percentage of the medication costs. If one or more of your medications requires coinsurance that could significantly impact your costs.

After you have figured out what drugs your Medicare Part D plan covers and what costs you will be expected to pay, the next thing you want to look at is what pharmacies are covered under your plan. Some plans have a preferred relationship with certain pharmacies, which may make obtaining your medications less expensive.

Take some time this month to look over your coverage and explore the additional resources on this site to further understand your Part D plan. If you are not on a 5 star rated plan and find for any reason your plan is not working for you, you can change to a 5 star plan at any time and not have to wait until the next open enrollment season.

If you have any questions contact your Medicare SHIIP Counselor at your local Area Agency on Aging. You can also call Medicare all day, any day except Federal holidays at 1-800-633-4227.



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Keeping Part D Strong: Standing Against Harmful Changes

If you’re like me, your Part D coverage is a critically important part of your health plan and allows you to access the medications you need every month. It’s not something I take for granted, and I know you don’t either. Every time I go to the pharmacy, I’m thankful that I have coverage I can rely on and that helps me afford my medications.

For years, I have been advocating for policies that protect Part D and safeguard it against changes that might negatively impact the affordability of the prescription drug coverage that helps to keep them healthy.

Luckily, I’m not alone. In fact, recently almost 400 advocacy organizations wrote to Congress asking them to oppose changes to Medicare Part D that could cause an increase in premiums and cost-sharing for many seniors.

As comforting as it is to know so many dedicated lawmakers are fighting to protect our Part D coverage, we know that seniors and individuals with disabilities also have a powerful voice, and it’s critical that you use it. Get involved in the fight and make sure you are heard. The easiest way to stay updated is to join our Facebook page to keep up to date on breaking news and developments. And be sure to let us know what’s on your mind in the comments!!



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Seniors Sound Off: Learn About Part D and Get Involved

In the last 3 weeks, two of my friends have been diagnosed with very serious illnesses. One is enrolled in Medicare and has Part D coverage and one is not yet old enough to be eligible. Their experiences in accessing the medicines they need have been quite different and have led me to once again appreciate the security and strength that Medicare Part D coverage provides.

Of course the examples of two people cannot tell a whole story but I believe their situations do illustrate two points that all Medicare beneficiaries need to consider:

  1. How do we best learn about and utilize all of the benefits Medicare Part D provides?
  2. How do we support efforts to protect the Medicare coverage we have?

Over the next few weeks I have invited several people with great expertise in Medicare to help answer these questions. I also hope you will send in your questions, ideas, and concerns. I promise we will respond!!

Together we can work to protect against any threats to our Medicare Part D coverage.

Remember — your voice makes all the difference!!!



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Keeping Part D Strong: Protect a Program that Works

Have you used your Medicare Part D plan this year? I have, I changed pharmacies and refilled two prescriptions that I take regularly.  It took only a minute or two and I was on my way–just another errand in the course of a busy day.

But as one who worked for many, many years to advocate for prescription drug coverage in Medicare, I cannot help but reflect on how much Part D has changed the lives of older Americans and individuals with disabilities–providing peace of mind, enabling them to remain active, and, most importantly, restoring and maintaining their health! It’s almost inconceivable to think that just a decade ago, Medicare did not provide beneficiaries with coverage for prescription drugs. What a different world that was!

We have made much progress, but we also must safeguard it. This year is going to be a difficult one for Congress and, indeed, the entire government. There are lots of issues, lots of pressure to act, and enormous demands on our national budget, and, of course, lots of politics. As we have seen over the years, this kind of situation can lead to misguided actions that negatively impact Medicare.

From beneficiary satisfaction ratings nearly 90% or higher, to the steady premium costs, to the broad choice among plan options, Medicare Part D has been and remains a program that works — truly works– for almost 40 million seniors and disabled individuals who depend upon it.  Let’s be on guard and be ready to defend our benefit and redirect lawmakers and regulators to the many programs that don’t work and desperately need their attention. Part D should be off the table!



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Protect and Preserve the Medicare Part D LIS Program

Sometimes there is a double meaning to the term “Medicare reform.” “Reform” can mean improve and strengthen or it can mean change and weaken.  One example is a proposed reform of the Medicare Part D Low-Income Subsidy (LIS) Program, also known as Extra Help. This program saves low-income beneficiaries close to $4000 per year in prescription drug costs according to the Centers for Medicare and Medicaid Services (CMS).

The proposed reform would change and weaken the program by requiring low-income Medicare beneficiaries to pay higher copays for brand name drugs while lowering copays for generic drugs. The reform, first proposed by the Medicare Payment Advisory Commission (MedPAC), aims to drive more seniors and individuals with disabilities to use generic drugs, which in theory could lower costs to Medicare.

However, this proposed reform is flawed for a number of reasons. It fails to take into account that many patients, including those at or below the poverty level, require access to brand name drugs because their doctor has determined these medications will produce more positive health outcomes than generic medications would provide. In these instances, patients must have affordable access to brand name drugs or their health and well-being could suffer as a result.

Unfortunately, the proposal would increase cost sharing for these patients.  According to analysis by the Leadership Council on Aging Organizations (LCAO), this would deter access to needed medicines which could in turn lead to much higher Medicare costs on other types of health care services.

Further, even if this change provided some exclusion for certain therapeutic classes of drugs, the exclusion may not be broad enough to address the treatment of chronic diseases for which there are often no generic substitutes.

The LIS program must be protected and preserved. This program works to keep cost sharing low for the most vulnerable beneficiaries to ensure patients can access the treatments they need. Adding to those costs could make health care unaffordable for them. The most inappropriate way to celebrate Medicare’s 50th anniversary in 2015 would be to adopt an LIS reform proposal that increases costs for low-income people instead of maintaining its commitment to improve their quality of life.



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Stand Alone or Take Advantage?

A very important question you should ask regarding Medicare prescription drug coverage is what type of plan you want.  There are two very different choices.

The first is to enroll in Medicare Part D. This is a stand-alone plan that covers just your medications. You use this coverage in conjunction with the medical coverage you receive with Medicare Parts A and B (hospitalization, provider visits, testing, etc.).

The other option is to opt for a Medicare Advantage Plan that provides all of the health care services under Part A and B as well as coverage for your medicines in one plan. Examples of Medicare Advantage Plans include Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Medicare Medical Savings Account Plans, and Special Needs Plans.

Both types of plans have advantages, the right choice for you depends on many factors including where you live and your preferences regarding provider choice. Also, be sure to examine more than just the bottom line on premium costs when evaluating any program.

Some beneficiaries choose to enroll in traditional Medicare health coverage as wells as a stand-alone drug plan (Part D) because it gives them freedom to choose providers without having to coordinate within a network or get referrals. The Part D plans cover your medicines but do not include extra services or provide care. (Note: Some beneficiaries who have regular Medicare and Part D plans also purchase Medicare Supplemental Insurance to assist in copayments and deductibles for medical services.) Part D plans are available throughout the United States, so you have this option no matter where you live.

On the other hand, Medicare Advantage Plans provide health coverage through specific provider networks and facilities. Once you enroll, you are required to seek care within your network. In some cases, these plans also offer additional services not available to beneficiaries who aren’t in their program. Medicare Advantage Plans contract with Medicare to provide Medicare Parts A and B services as well as coverage for your medicines. If you choose to enroll in a Medicare Advantage Plan you do not need to purchase Medicare Supplemental Insurance. These plans are not available everywhere, so it’s important to check what is available in the region or area in which you live. You can check online using the plan finder at www.medicare.gov or use our tools to find a local office to assist you in your search.

Here are a few questions to consider when determining what is right for you:

  • Does my current doctor or other care provider participate in the Medicare Advantage Plan?
  • If not, am I willing to change doctors/providers?
  • Are the care providers and other facilities in Medicare Advantage Plans convenient to me?
  • Are my medicines covered?

One last thing: Medicare provides a rating of 1 to 5 stars for Medicare prescription stand-alone plans and Medicare Advantage Plans. These ratings are based on both Medicare quality standards and beneficiary experience. For a full explanation of the star rating system, go to www.medicare.gov and don’t forget to look for and consider the rating as you select a plan.

Remember that a Medicare is open 24/7 at 1-800-633-4227.