Your Weekly Medicare Consumer Advocacy Update
The Affordable Care Act Celebrates Its Fourth Anniversary
CMS Announces Further Medicare Improvements Thanks to Health Reform
Four years ago this week, the Affordable Care Act (ACA) was passed into law, bringing real benefits to the tens of millions of Americans who have Medicare. The Center for Medicare and Medicaid Services (CMS) announced that as a result of the ACA:
- About 7.9 million Medicare beneficiaries have saved $9.9 billion on prescription drugs in the coverage gap thanks to discounts on brand name and generic medications;
- In 2013 alone, 37.2 million beneficiaries accessed at least one preventive service, including mammograms, prostate cancer screenings, and the annual wellness visit, at no out-of-pocket cost; and
- The Medicare program is on stronger financial footing, resulting in stable Medicare Part B premiums in 2014 and an improved outlook for future beneficiaries.
In a recent statement, Medicare Rights Center’s president Joe Baker said, “On many counts, the Medicare program is stronger than ever, due in large part to the ACA. Medicare beneficiaries are receiving preventive services at no cost as well as more affordable prescription drugs in the coverage gap, and while the immediate benefits of health reform are encouraging, there is still a lot to look forward to as the law is being implemented.”
Future improvements that will occur as ACA implementation continues include:
- Closure of the Part D coverage gap by 2020;
- More responsible spending by Medicare Advantage (MA) plans through the requirement that 85% of plan revenues are spent on health care, which started this year; and
- Gradual reductions in overpayments to MA plans to bring them more in line with costs under Original Medicare.
Mr. Baker concluded by saying, “The ACA tackles the systemic causes of rising costs in the Medicare program, and so far the results are promising. Most importantly, the ACA demonstrates that the federal government can contain costs without shifting even higher health care costs to beneficiaries, all while improving Medicare benefits. Continued implementation of the Affordable Care Act is essential to preserving and strengthening Medicare for today’s and future beneficiaries.”
New Brief Stresses Importance of Quality Measures for Demonstrations on Care for the Dually Eligible
The Commonwealth Foundation recently published an issue brief about quality measures for care coordination demonstrations designed to serve those dually eligible for both Medicare and Medicaid. According to the Kaiser Family Foundation, there are approximately 9 million dually eligible beneficiaries in the US. Dually eligible beneficiaries must navigate a complicated health system with two forms of insurance (Medicare and Medicaid) that have different costs and coverage rules. Many of these beneficiaries have multiple chronic conditions and other complicated medical needs. Therefore, those dually eligible often receive care across multiple settings, resulting in more expensive care.
The Affordable Care Act (ACA) authorized states to establish demonstration programs to increase quality and access to care while decreasing costs. The states who chose to establish a demonstration will give their dually eligible residents the option to receive both Medicare and Medicaid benefits through a single insurance plan.
Determining the proper quality measures will help policy makers and analysts assess the success of the demonstration programs. The demonstrations are creating innovative ways to provide health insurance coverage; however, there is a lack of standardized measurement standards that track the entire range of demonstration benefits. Based on an analysis of eight states that are establishing demonstrations, the Commonwealth Fund brief made three key observations:
- There are uneven and inadequate quality measures. Quality measures vary greatly by state. Furthermore, some categories are better measured through existing measures than others. This makes it difficult to measure the success of some components of duals demonstrations, such as nursing home and long-term care quality.
- Proposed and existing quality measures do not adequately consider quality of life issues. Many existing quality metrics measure medical issues, not quality of life issues. Time and money will have to be spent to determine how to measure this important quality metric.
- Long term supports and services (LTSS) also lack consistent quality measures. Many LTSS quality measures revolve around care that would be provided in the nursing home, not in the community. New measures have to be developed to make sure demonstration beneficiaries are receiving the quality care they deserve.
It is important for these three points to be addressed before the demonstrations are implemented. If they are not, it will be difficult to determine what areas may need improvement during the demonstration periods and whether the demonstrations are successful.
Volume 5, Issue 11
The coverage gap, also known as the doughnut hole, is a period of time during your Part D prescription drug coverage when the amount you pay for your drugs suddenly increases. The coverage gap starts when your total drug costs—including what you and your plan have paid for drugs—reaches $2,850 in 2014.
As a result of the Affordable Care Act, you get discounts to help you pay for your drugs during the coverage gap. In 2014, there is a 52.5 percent discount on brand-name drugs and a 28 percent discount on generic drugs while you are in the coverage gap. These discounts will gradually increase each year until 2020, when you will typically pay no more than 25 percent of the cost of your drug.
In 2014, once you have paid $4,550 out-of-pocket, you reach catastrophic coverage. During catastrophic coverage, your costs will be significantly less.
A recent study by The American Journal of Medicine studies the link between access to food and the underuse of medication among chronically ill adults with limited incomes. The study suggests that due to financial constraints people with limited incomes will take less medication than they are prescribed or go without their medication all together, especially if they also have trouble affording food.
The study also shows that the respondents with incomes just above the Federal Poverty Level—an annual income amounting to just $11,700 for an individual—can also have trouble accessing food and underuse their medication. Often times these individuals are not eligible for assistance from the government. Those who are eligible for government assistance, like Medicaid, are less likely to report food access problems and medication underuse due to an inability to afford the medicine.