The AGS Foundation for Health in Aging is committed to helping you understand Medicare with a particular focus on Medicare Part D. We aim to provide you with the information you need to make informed decisions.
Open Enrollment for 2007 Medicare Prescription Drug Coverage Starts November 15, 2006
For Medicare beneficiaries interested in signing up for a Medicare prescription drug plan for the first time, and those interested in changing plans, open enrollment starts November 15 and runs through December 31. Beneficiaries who are satisfied with their current plans need not do anything during the enrollment period. Those looking for a first, or new, plan can make use of several online Centers for Medicare and Medicaid Services (CMS) tools. CMS'
2007 Drug Plan Finder can help beneficiaries compare plans.
Rx Enrollment Check-up can help current enrollees determine whether they should switch to a new plan or stick with the one they have.
Beneficiaries Can Now Apply for “Extra Help” With Medicare Prescription Drug Coverage Costs Electronically, Via NCOA Web Site
Medicare beneficiaries can now apply to the Social Security Administration for “Extra Help” with Medicare prescription drug plan costs by logging onto the National Council on Aging’s
BenefitsCheckUp Web site. The site, recently updated to allow beneficiaries to apply for Extra Help electronically, streamlines the application process.
Beneficiaries can also use the Web site to find out if they qualify for other federal or state benefit programs such as the Medicare Savings Program, Medicaid, Supplemental Security Income, State Pharmacy Assistance Programs, or Food Stamps.
Extra Help covers co-pays and other Medicare prescription drug coverage costs. In addition, those who qualify for Extra Help don’t encounter the gap in coverage known as the “donut hole.” On average, Extra Help saves eligible beneficiaries $3,700 a year in Medicare drug plan costs, the NCOA estimates. According to the organization, more than 630,000 beneficiaries who qualified for Extra Help in 2006 will need to reapply for this assistance for 2007.
CMS Proposal Would Allow Researchers and Other Agencies Access to Medicare Prescription Drug Benefit Claims Data for Studies
The Centers for Medicare and Medicaid Services (CMS) has proposed a new regulation that would allow researchers and federal agencies such as the FDA and NIH to use Medicare prescription drug benefit claims data for research and quality studies aimed at improving the health of seniors and people with disabilities.
CMS will accept comments on the proposed rule – which was published in the
Federal Register this week – through December 18.
Under the proposed rule, Medicare prescription drug claims data would be linked to other Medicare information – on hospitalizations and physician visits-- that is already available to researchers and other federal agencies.
Among other things, CMS notes, the drug benefit data could help researchers: compile more comprehensive information on drug side effects; identify more effective and more cost-effective drug therapies for chronic diseases; reduce health disparities by identifying beneficiaries who are not receiving recommended drug therapies; and implement strategies to ensure that beneficiaries follow recommended treatment regimens. The data could also help investigators determine whether certain drug treatments increase or decrease the utilization of various health care services.
“Through the appropriate use of the new prescription drugs claims data, we have an unprecedented resource to help us learn more about prescription drugs usage by seniors and how we can help get the most benefit from prescription drugs,” said former CMS Administrator Mark McClellan, MD.
Researchers using available Medicare hospitalization and physician visit data must adhere to a list of safeguards, and the same safeguards would apply to researchers using the drugs claims data, according to CMS. These include requirements that researchers obtain the minimum data necessary to complete their work and keep beneficiary and provider personal information confidential unless absolutely necessary.
CMS spokesman Peter Ashkenaz said the agency is open to suggestions concerning the most effective use of the data, including whether CMS should impose additional regulations to external researchers to protect against the misuse of data for non-research, commercial purposes.
Medicare Prescription Drug Plan Finder Now Available
With the 2007 Prescription Drug Open Enrollment starting November 15, 2006, the Centers for Medicare and Medicaid Services have launched the
2007 Drug Plan Finder tool to help people with Medicare and their families and friends compare plans now and prepare for the start of open enrollment.
CMS has enhanced the 2007 Medicare Drug Finder by making navigation more user friendly and streamlining the look of the site. Other enhancements include:
- Locate plans by state
- Compare plans based on price and benefit structure
- Search for plans that fit your needs, for example low deductibles and no coverage gap
- The Formulary Finder will assist in finding drug plans that best match the beneficiaries list of prescription drugs
- The Monthly Cost Estimator will help beneficiaries plan for their monthly costs and include information on how to save money
CMS is also launching
Medicare Options Compare, an updated version of what was formerly known as the “Medicare Personal Plan Finder,” which will allow beneficiaries to:
- Get information about the original Medicare Plan and Medicare Health Plans like HMOs and PPOs
- Get information about Medigap Policies
- Compare plans’ out-of-pocket costs
Medicare Beneficiaries Should Carefully Consider Their Choices Among Prescription Drug Plans in 2007, Say Experts Who Cite Both Changes in Plans and an Increase in Plans Offered
Both older adults who are already enrolled in Medicare prescription drug plans, and those enrolling in a plan for the first time, should take a “careful look” at their choices in plans, experts advise as the drug benefit’s “open enrollment” period nears. During open enrollment – which begins November 15 and ends December 31 -- beneficiaries can select or change plans.
Even enrollees who are satisfied with their plans this year should check to see whether and how their coverage might change next year, to determine whether they could do better with a different plan, America’s Health Insurance Plans president and CEO Karen Ignagni told USA Today.
There will be plenty of new choices among plans, according to the Centers for Medicare and Medicaid Services (CMS), which reported last week that the number of companies offering plans nationwide will jump from 9 this year to 17 in 2007.
Many new plans will offer what older adults have been requesting -- such as lower deductibles and at least some degree of coverage during the benefit’s “donut hole” or coverage gap, CMS Administrator Mark McClellan told USA Today last week.
Nearly 83% of beneficiaries will have access to plans with premiums lower than those they are paying this year, the Department of Health and Human Services estimates. Nonetheless, CMS estimates that the average premium will be roughly $24 next year, about what it is this year. While some plans are lowering their premiums, others are raising them. Plans are also changing their “formularies” – the lists of drugs they cover – and other policies.
CMS has published a guide,
Rx Enrollment Check-Up, that, among other things, can help beneficiaries determine whether they should enroll in a new plan or stick with their 2006 plan.
CMS Releases Tip Sheets Explaining the "Donut Hole" Coverage Gap, and Offering Advice on Bridging It
CMS has prepared two tip sheets related to the "donut hole," or coverage gap in most Medicare prescription drug benefit plans.
CMS Launches "My Health. My Medicare" Campaign
The Centers for Medicare and Medicaid Services (CMS) has launched a new promotional campaign -- the "
My Health. My Medicare" campaign- to help beneficiaries better understand, evaluate and make the most of available Medicare health and prescription drug benefit options. Among other things, the campaign encourages healthcare providers to help beneficiaries take advantage of available coverage. The campaign will include media outreach, regional and national events to promote Medicare benefits, and the distribution of information and promotional materials such as flyers and posters.
CMS & SSA Post Schedule of Medicare Prescription Drug Benefit Deadlines and Mailings for Beneficiaries
The Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration (SSA) in late August released a comprehensive schedule of both these
deadlines and planned mailings to beneficiaries
Cost of Premiums for Medicare Prescription Drug Coverage Less Than Expected
In an interim
final rule published in the August 26 Federal Register, the Centers for Medicare and Medicaid Services announced that it is redistributing state allocations used to pay for Medicare Part B premiums for low-income beneficiaries.
Medicare+Choice Local Plan Information
The
Medicare & You 2006 Handbook contains local and area-specific Medicare health plan information. The handbook also provides information about Medicare benefits, rights and protections, and answers to most frequently asked questions about Medicare.
Medicare Physical Now Available
If your Medicare Part B coverage began on or after January 1, 2005, Medicare will cover a
one-time preventive physical exam within the first six months that you have Part B. The exam, mandated by the Medicare Modernization Act (MMA), will include a thorough review of your health, education, and counseling about the preventive services you need, like certain screenings and shots, and referrals for other care.
