The Coverage Gap Can be a Thing of the Past
WASHINGTON, DC,
October 3, 2006
Tags:
Health Care
With Medicare Part D, Congress delivered on a promise to the American people and passed a comprehensive Medicare prescription drug benefit for America’s seniors. It is the most significant improvement to Medicare coverage in 40 years – since Medicare was established in 1965. Enrollment began in January of this year, and I believe the program is proving itself to be a huge success. Approximately 38 million people, 90% of all Medicare beneficiaries, are receiving comprehensive prescription drug coverage through Medicare Part D, employer-sponsored retiree health plans or other creditable coverage. More than 2 million Part D prescriptions are being filled every day. And most notably, the program cost for 2006 was lower than expected, and looks to continue this trend in the future. CMS anticipates the cost of the average monthly plan premiums for 2007 to be nearly 40% lower than originally estimated. Regarding the “donut hole” in some Medicare plans - I am very concerned about anyone who has experienced problems in obtaining their medicines. However, I do not believe that this is the crisis situation that some make it out to be.Research done by PriceWaterhouseCoopers shows that 92% of Medicare beneficiaries will not enter the Medicare drug benefit’s coverage gap because they will not be exposed to the coverage gap, or they have prescription drug coverage from plans outside of Medicare Part D, or have not yet enrolled. The majority of Medicare beneficiaries who do enter the coverage gap - which, remember, is only 8% of all Medicare Part D beneficiaries - will spend $1750 or less in the gap. If you are one of the 8% of Medicare beneficiaries who will enter the gap, there are options for covering it. Beneficiaries do have access to plans that reduce or eliminate the coverage gap. According to Centers for Medicare and Medicaid Services (CMS) data, 4 of the 10 sponsors of national stand-alone prescription drug plans offered coverage in the gap, and Medicare will help you find these plans. You can find them on the Medicare website, www.medicare.gov. If you look on the website at plans in your area, you will find that there are plans that provide coverage in the gap. There are plans specifically for generic drugs and those for both generic and brand names. You can find programs that cover 100% of formulary drugs without raising the monthly premium significantly and without an annual deductible. In addition, if a beneficiary finds themselves exposed the gap they will have a chance during the next annual enrollment period to select a plan that best meets their needs. Customer service is a priority, and Congress and CMS are working to eliminate any delays or other difficulties for those needing assistance. While considerable progress has been made, change of this magnitude in such a short time span is bound to encounter some difficulties – but I think one of the strengths of the program is that they are constantly reevaluating and improving. Enhancements to the Medicare Prescription Drug Plan Finder are planned to make it more user-friendly. Specifically, the Medicare Personal Plan Finder (MPPF), which assists beneficiaries in selecting a Medicare Advantage plan, will be redesigned with the ability to better personalize searches. Also, the Total Monthly Cost Estimator function will provide a graph of the month-by-month cost share for a selected plan so that users can view how their cost share may change on a monthly basis as reflected by the coverage levels of the drug benefit. Recent news from CMS states that seniors will have more and cheaper drug plan options next year. In 2007, Medicare Part D will offer 2,844 stand alone plans, nearly double the number of plans available to seniors in 2006. And with that growth in the market, more plans will offer larger formulas and coverage in the gap. Approximately 83% of seniors will have access to plans with premiums lower than what they are paying this year and, on average, formularies will be 13% larger offering seniors a wider range of medications. In short, it appears that most seniors are pleased with Medicare Part D. A Kaiser Family Foundation tracking survey indicated that more than 80% of Medicare drug plan enrollees are satisfied. Health Affairs said that nearly 60% called the program a “major benefit” to seniors. Similarly, the Medicare Rx Network found that 87% of beneficiaries said they were satisfied with Medicare Part D and 59% said they were saving money. To those who keep calling for changes, I will say that I think we have already started down the right path. Let’s give the current program a chance to prove itself. I hope we can manage not to trip ourselves up in the process. |
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