Medicare Watch

Medicare Rights Center Outlines Improvements to Part D

Each year, the Medicare Rights Center answers 15,000 Medicare questions through its national helpline—one quarter of those calls pertain to the prescription drug benefit, Medicare Part D. Drawing from our experience counseling and educating people with Part D, Medicare Rights submitted a written statement to the Senate Special Committee on Aging reflecting on 10 years of Medicare prescription drug coverage. The statement suggested improvements to the prescription drug benefit in the following categories:

• Ensuring drug affordability
• Diminishing plan complexity
• Making Plan Finder a robust tool
• Improving the Medicare Part D appeals process
• Navigating complex coverage rules
• Securing more reasonable drug prices

Many calls to the Medicare Rights helpline come from beneficiaries who are having difficulty affording their prescription medications. While the Affordable Care Act (ACA) closes the prescription drug coverage gap (also known as the doughnut hole) and provides some beneficiaries with better access to medications, high copayments during the initial coverage period place a strain on low- and middle-income Medicare beneficiaries. In its statement, Medicare Rights encourages policymakers to ensure drug affordability, such as by removing the asset test for the Extra Help benefit.

Medicare Rights also urges members of Congress to pursue policy options that allow the federal government to secure more reasonable prices for Part D medications, particularly by supporting the restoration of drug rebates for low-income Medicare beneficiaries. According to the Congressional Budget Office (CBO), restoring these rebates would save $133.7 to $141.2 billion to the Medicare program over 10 years without shifting added costs to beneficiaries.

While Part D is a success in providing drug coverage to millions of older adults and people with disabilities, the program is not without its flaws. As outlined in the statement, policymakers should address these challenges in order to ensure that Medicare beneficiaries have affordable access to prescription drugs.

Read Medicare Rights’ statement.

CBO Report Details High Health Care Costs for Duals

Last week, the Congressional Budget Office (CBO) released a report on the characteristics and health care spending trends of dual eligible beneficiaries (people enrolled in both Medicare and Medicaid), and emerging policies related to improving health care and reducing spending for this population. CBO found that federal and state governments spent more than $250 billion on health care for dually eligible beneficiaries in 2009, due to the extensive health care needs of the population. According to the CBO report, one-fifth of people receiving Medicare and full Medicaid benefits have three or more chronic conditions, and more than 40 percent need high-cost long-term services and supports.

According to the CBO, policymakers should be concerned about the high cost of health care for dually eligible beneficiaries. Further, the different payment and approval procedures associated with the two programs increases the risk that dually eligible beneficiaries receive care that is not coordinated, potentially increasing costs and worsening outcomes.

The Affordable Care Act created a three-year demonstration project to integrate Medicare and Medicaid financing for services provided to dually eligible beneficiaries. New York’s demonstration program is expected to roll out in eight counties early next year. Working in coalition with key partners nationally and in the state, Medicare Rights is working to ensure that the demonstration improves access to coordinated care.

Read the CBO report.

Medicare Reminder

If you have Extra Help, the federal assistance program that helps people with limited incomes pay for their Medicare drug costs, you will pay lower copays at the pharmacy for your medications. Your Extra Help status should be documented in the pharmacy’s system.

However, in some instances, your Extra Help status may be incorrectly documented in the pharmacy’s system, and your pharmacist may not know that you have Extra Help. If you do have Extra Help, you can use what’s called “Best Available Evidence” to show your pharmacist that you have Extra Help. Examples of Best Available Evidence may include:

• Your Medicaid card
• Your Medicare Savings Program award letter
• Your Extra Help award letter

If you present this information to your pharmacist, he/she should update the system to reflect that you have Extra Help. You should also be able to pick up your medications and pay Extra Help copays at the pharmacy.

Learn more about Extra Help at www.medicareinteractive.org

Spotlight

This week, Services and Advocacy for GLBT Elders (SAGE) and Freedom to Marry sponsored a panel at the National Press Club to discuss how the Defense of Marriage Act (DOMA) negatively impacts older same-sex couples. Moderated by political strategist and CNN commentator Hilary Rosen, the panel featured Dr. Yanira Cruz, president and CEO of the National Hispanic Council on Aging; Paul Nathanson, executive director of the National Senior Citizens Law Center; Stacy Sanders, federal policy director at the Medicare Rights Center; Thomas Sciacca, a New York City attorney with expertise in estate and disability planning; and Imani Woody, an LGBT senior, as well as director and founder of Mary’s House for Older Adults.

DOMA places financial hardships on same-sex couples that married heterosexual couples do not face. In addition, DOMA creates the very real risk of increased costs or gaps in health coverage for LGBT elders newly eligible to Medicare. LGBT elders transitioning to Medicare from a same-sex partners’ employer plan who inadvertently delay Medicare enrollment or those who are unable to rely on a partners’ work history because their marriage goes unrecognized are most at risk. Stacy Sanders, federal policy director at Medicare Rights, said, “Family ties and Medicare build the foundation of health security for our nation's seniors. DOMA undermines that security on both counts by treating married same-sex couples differently. With some of our most vulnerable citizens depending on Medicare after a lifetime of hard work and taxes paid, our government owes them better.”

Read more about the panel discussion.