Medicare Watch

CMS Outlines Doughnut Hole Discount Program

People with Medicare who hit the coverage gap or “doughnut hole” in the Medicare drug benefit next year will receive a 50 percent discount on brand-name drugs at the pharmacy—without having to send in receipts or request a refund—according to draft guidance implementing the recently passed health reform law.

The guidelines from the Centers for Medicare and Medicaid Services (CMS) also state that the insurance companies offering Part D plans will inform pharmacies through their electronic claims systems when consumers are eligible for the discount, although the discounts will come from drug manufacturers.

State pharmaceutical assistance programs (SPAP) that provide coverage through the doughnut hole will also benefit from the discounts, while consumers enrolled in these programs will continue to pay the copays charged by their SPAP. Consumers enrolled in Part D plans offered by their employers, which often provide coverage through the doughnut hole, will not be eligible for the discount, according to CMS’s proposed guidance. The guidance is open for public comment until May 14, 2010.

Read the CMS draft guidance.

Program to Mesh Food Stamp, MSP Outreach

The United States Department of Agriculture (USDA) is asking state agencies for proposals to help increase enrollment in the Supplemental Nutrition Assistance Program (SNAP; formerly Food Stamp Program) among people with Medicare in low-income assistance programs. The USDA project will specifically target people with Medicare Savings Programs (MSPs) and Extra Help, which help Medicare consumers with limited incomes pay their medical and prescription drug costs. States selected by the USDA will complete pilot projects by 2013, and the outreach and enrollment methods deemed most effective will inform future enrollment efforts.

Read the USDA’s request for applications.

The Medicare Rights Center is already working to coordinate enrollment in SNAP, MSP and Extra Help. In 2009, Medicare Rights and the Food Bank for New York City joined forces to coordinate outreach and improve access to the affordable health care and food that older New York City residents need.

Read a press release about the partnership.

Medicare Reminder

If your monthly income is below certain levels ($1,354 for individuals and $1,822 for couples) and your assets are below specified limits (click here to see a detailed chart), you may be eligible for Extra Help, a federal program that helps you pay for some or most of the costs of Medicare prescription drug coverage.

Learn more about Extra Help and how to apply on Medicare Interactive, the Medicare Rights Center’s free online counseling tool.

 

Spotlight

Earlier this week, the U.S. Department of Health and Human Services released regulations that establish the Early Retiree Reinsurance Program included in health reform. The program will help employers provide health coverage for early retirees who are not yet eligible for Medicare.

Read Medicare Rights Center President Joe Baker’s statement on the program.