New Rules Released for Part C and Part D
This week, the Centers for Medicare & Medicaid Services (CMS) released proposed rules for the 2013 plan year governing Medicare Part C, which covers Medicare private insurance plans known as Medicare Advantage plans, and Part D, the Medicare prescription drug benefit. The rules cover a variety of issues within Part C and Part D, including plan quality, increased transparency, and further elimination of fraud, waste, and abuse.
For example, the proposed rules grant CMS regulatory authority to terminate Medicare contracts with plans that consistently perform poorly—in other words, plans that fail to receive at least three stars (on a quality scale of one to five) in three consecutive years. In addition, the rules also address conflicts of interest that create incentives for the inappropriate use of prescription drugs, such as anti-psychotics in long-term care facilities. Such improper prescribing practices may not only result in waste in the Medicare program, but also potentially put patients’ safety at risk, according to a recent report by the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG). In an effort to further eliminate waste in the program and save money for beneficiaries, the rules allow providers and patients in certain situations the option of requesting and paying cost-sharing for a short-term supply (less than 30 days) of a drug—for example, when a doctor prescribes a trial fill of a treatment.
In addition, the proposed rules codify parts of the Medicare Improvements for Patients and Providers Act (MIPPA) that expand access to benzodiazepines and, for certain health conditions, barbiturates, and important improvements to Medicare included in the Affordable Care Act (ACA), such as the closure of the Medicare prescription drug coverage gap. As a result of the ACA, from January to August of this year nearly 1.8 million people with Medicare received discounts on brand-name drugs during the coverage gap, with total savings over that period reaching almost $1 billion.
Read the proposed rule.
Read Medicare Rights Center President Joe Baker’s statement on the rule.
Read CMS’s release on the closure of the Medicare prescription drug coverage gap and the increasing popularity of new preventive benefits.
New Reports Offer Insight on Deficit-Reduction Proposals
A new report released by the Center on Budget and Policy Priorities, titled “Converting Medicare to Premium Support Would Likely Lead to Two Tier Health Care System,” explores the problems inherent in premium support proposals, in which the government provides a capped amount to an individual to purchase health coverage—in most cases through private plans. Though premium support is not a new concept, such proposals have gained popularity among certain policymakers—including House Budget Committee Chairman Paul Ryan, who authored the premium support proposal passed in the House budget—as a way to save the government money. However, according to the report, premium support would have adverse affects on beneficiaries, who would be required to pay significantly more out of pocket and would potentially face cherry-picking by insurers who would favor attracting healthier enrollees. Some beneficiaries, specifically those with low and moderate incomes, would also find the most up-to-date medical care out of reach.
A second report released by CBPP discusses the need for a balanced approach to deficit reduction, which many believe would help to prevent a dangerous and massive restructuring of Medicare. The report, “‘Supercommittee’ Should Develop Balanced Package of Tax Increases and Spending Cuts,” finds that tax cuts authorized from 2001 to 2003, which include tax breaks for the wealthiest Americans, and the wars in Iraq and Afghanistan are major contributors to the growing deficit and by 2019 will account for nearly half of the $20 trillion in debt that will be owed. In addition, while income has drastically increased for many in top income brackets, the proportional amount they pay in taxes has significantly decreased over the same period. As a result, restructuring tax policies to ensure that higher income individuals share in the sacrifice is necessary. This would help prevent low- and middle-income individuals from bearing a disproportionate share of the burden of deficit reduction, which would result from spending cuts affecting programs like Medicare, Medicaid and Social Security.
Read the CBPP report “Converting Medicare to Premium Support Would Likely Lead to a Two-Tier Health Care System.”
Read the CBPP report, “‘Supercommitee’ Should Develop Balance Package of Tax Increases and Spending Cuts.”
It is very important that you review your drug plan every year. Medicare private drug plans can change their costs and the list of drugs that they cover every year.
Most people can change Medicare drug plans only during Fall Open Enrollment, which runs from October 15 to December 7 each year.
Even if you are satisfied with your current plan, you should check if there is another plan in your area that offers better coverage at a lower price.
When choosing a Medicare private drug plan, make sure to look at all the costs, not just the premium. Your costs throughout the year will depend on what drugs you take, whether your plan covers them, and whether there are any coverage restrictions. Another plan may have lower copays, cover more of your drugs, have fewer restrictions or offer some coverage during the coverage gap.
The Medicare Plan Finder tool now has information on plans available in 2012. Visit Medicare Plan Finder.
Learn more about reviewing your Medicare prescription drug coverage at www.medicareinteractive.org.
Medicare Rights Center released a report this week on the value of coalitions for individuals and organizations engaged in Medicare advocacy. The report,Strength in Numbers: A Guide to Building Effective Medicare Advocacy Coalitions, examines reasons and best practices for forming a coalition, and provides case studies that illustrate the experience of coalition-building in regions throughout the country.
Read the report.