Protect yourself and those you love—get your free flu shot

It’s that time of year again.  With the beginning of fall comes the beginning of flu season. 

Get your flu shot early and stay healthy!  It’s free for people with Medicare, once per flu season in the fall or winter, when given by doctors or other health care providers (such as senior centers and pharmacies) that take Medicare.

Schedule your flu shot today!

More Americans Accessing Improved Medicare Coverage

By Don Berwick, Administrator, Centers for Medicare & Medicaid Services

Millions of Americans are enjoying improved Medicare coverage thanks to the Affordable Care Act. More people are getting preventive services to keep them healthy, and people with high prescription drug costs are seeing the coverage gap “donut hole” starting to close. Here are the latest numbers from the past few months:

  • July:
    • Through the end of July, 1.28 million Americans with Medicare have received discounts on brand name drugs in the Medicare Part D coverage gap — up from 899,000 through the end of June and 478,000 through the end of May.
    • These discounts have saved seniors and people with disabilities a total of$660 million, including $199 million in July alone!

For state-by-state information on the number of people who are benefiting from this discount in 2011, visit this page.

  • August:
    • Through the end of August, over 18.9 million people with Original Medicare, or 55.6 percent, have received one or more free preventive services.
    • During the same time period, over 1.2 million Americans with Original Medicare have taken advantage of Medicare’s new free Annual Wellness Visit, up from 1.06 million in July.

For state-by-state information on the numbers of people who are utilizing preventive services in 2011, visit this page.

Over the coming years, provisions of the Affordable Care Act will help close the coverage gap completely. Here is a sense of what people with Medicare can look forward to:

  • 2013: Paying less and less for your brand-name Part D prescription drugs in the coverage gap.
  • 2020: The coverage gap will be closed, meaning there will be no more “donut hole,” and people with Medicare will pay only 25% of the costs of their drugs until they reach the yearly out-of-pocket spending limit.

The chart below shows what people with Medicare prescription coverage will pay over time:

Medicare Prescription Drug Coverage Over Time

chart showing Medicare Prescription Drug Coverage Over Time

Improving Care for People with Medicare

By Don Berwick, M.D., Administrator of the Centers for Medicare & Medicaid Services. Crossposted from HealthCare.gov

If you or a loved one has ever had the unfortunate experience of having a chronic or serious illness, you’ve experienced the frustration of our fragmented health care system. Just when you are feeling your worst, there you are in the doctor’s office or hospital room, repeating the same information time and time again, sitting through the same medical test more than once, and trying to track down lost or unavailable medical charts. These are all aspects of our current health care system we could each do without.

This can be a particular problem for the more than half of Medicare beneficiaries with five or more chronic conditions such as diabetes, arthritis, and kidney disease. These patients often receive care from multiple physicians and in multiple sites. A failure to coordinate care can lead to patients not getting the care they need or receiving duplicative care. This lack of coordination also increases their risk of suffering medical errors, such as receiving prescriptions for medications that ought not to be taken together. It can also cause complications that lead to needless hospital stays. Nearly one in five Medicare patients discharged from the hospital is readmitted within 30 days – a readmission many patients could have avoided if their care outside of the hospital had been better coordinated.

Improving coordination and communication among physicians and other providers and suppliers will help improve the care Medicare beneficiaries receive, while also helping lower costs. Numerous studies have shown that better care often costs less, because coordinated care helps to ensure that the patient receives the right care at the right time.

Thanks to the Affordable Care Act, the Department of Health and Human Services (HHS) today released proposed new rules to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs are designed to create and support a team of health care providers who treat individual patients by working together across care settings.

Over the last months, CMS has conducted extensive outreach to patient advocates, doctors, nurses, hospitals, health plans, employers, and other interested stakeholders to hear their thinking about the best way to shape this effort. We will continue to seek feedback on the proposed rules released today so that the final rules reflect the broadest consensus on how to improve care for people with Medicare and to provide a model for private payers to draw upon. We look forward to working with patients and care providers to build the most patient friendly and cost-effective health care system achievable

Under the proposal, ACO teams of doctors, hospitals and other health care providers and suppliers working together would coordinate and improve care for patients with Original Medicare. ACOs would have to meet high quality standards in five key areas:

•Patient/Caregiver Experience of Care
•Care Coordination
•Patient Safety
•Preventive Health
•At Risk Population/Frail Elderly Health

An ACO will be rewarded for providing better care and investing in bettering the health and lives of patients. ACOs are not just a new way to pay for care. They are a new model for the organization and delivery of care. Accountable Care Organizations are designed to lift the burden of fragmented and disconnected care from patients, while improving the partnership among patients, doctors, hospitals and other providers of care in making health care decisions.

To read more on this, check out the fact sheet. You can also read my blog at the New England Journal of Medicine.

Your Start to a Healthy Future Begins with a Physical Exam

By Donald Berwick, M.D., Administrator, Centers for Medicare & Medicaid Services

If you’re new to Medicare, take charge of your health and wellness with a thorough physical exam.

Getting an in-depth physical exam is a smart and easy way for you and your doctor to set a starting point for your personalized health care. It’s your roadmap for effective, efficient and timely health care, and it will help lower our healthcare system’s per-person costs.

Medicare covers two types of physical exams—one when you’re new to Medicare and one each year after that.

“Welcome to Medicare” physical exam

Medicare covers a one-time “Welcome to Medicare” physical exam if  you get it within the first 12 months you have Part B.  Beginning in 2011, you can get this exam for free if your doctor accepts assignment.

Your comprehensive “Welcome to Medicare” physical exam includes:

  • A review of your medical and social history including risk factors you can change
  • A physical exam that includes measuring your height, weight, blood pressure, visual acuity screen, and body mass index
  • Education, counseling, and referrals based on the results of your physical exam
  • A brief written plan, such as a checklist, for getting appropriate screening and/or other Medicare Part B preventive services
  • A review of your potential risk factors for depression

Yearly “wellness” exam

Thanks to the new healthcare law, Medicare also covers a  yearly “wellness” exam (once you’ve had Part B for longer than 12 months and if it has been at least 12 months from your “Welcome to Medicare” physical examination) which will help you develop or update a prevention plan, based on your current health and risk factors. You’ll pay nothing for the exam as long as your doctor accepts assignment (agrees to be paid directly by Medicare and accepts the amount Medicare approves for the service).

So get the most from your new Medicare benefits and stay in control of your health: Don’t delay.  Schedule your physical exam today!

NOTE: This blog was updated on January 5, 2011.

What is the Donut Hole?

By Jonathan Blum, Deputy Administrator and Director for the Center of Medicare at the Centers for Medicare and Medicaid Services

 

A number of visitors to www.HealthCare.gov have told us they’d like to know more about the Medicare “donut hole” in the Part D program.

If you aren’t familiar with Medicare, it is a health insurance program for people 65 or older, people under 65 with certain disabilities, and people with End-Stage Renal Disease (permanent kidney failure). People with Medicare have the option of paying a monthly premium for outpatient prescription drug coverage. This prescription drug coverage is called Medicare Part D.

In 2010, basic Medicare Part D coverage works like this:

  • You pay out-of-pocket for monthly Part D premiums all year.
  • You pay 100% of your drug costs until you reach the $310 deductible amount.
  • After reaching the deductible, you pay 25% of the cost of your drugs, while the Part D plan pays the rest, until the total you and your plan spend on your drugs reaches $2,800.
  • Once you reach this limit, you have hit the coverage gap referred to as the “donut hole,” and you are now responsible for the full cost of your drugs until the total you have spent for your drugs reaches the yearly out-of-pocket spending limit of $4,550.
  • After this yearly spending limit, you are only responsible for a small amount of the cost, usually 5% of the cost of your drugs.

You may have read in the 2010 Medicare & You Handbook that there are some Medicare Part D plans that offer coverage in the donut hole—but these plans may charge a higher monthly premium. (There are also some Part D plans that are “enhanced” and offer fixed co-pays (for example $5, $10, and $20) for prescription drugs instead of the deductible and 25% cost-sharing that was described above. These plans also may charge a higher monthly premium.)

For those that qualify, there is also a program called Medicare Extra Help that helps you pay your premiums and have reduced or no out-of-pocket costs for your drugs.

Needless to say, for most people with Medicare Part D, the donut hole presents serious financial challenges. Some people have had to choose between their rent or groceries and their prescription drugs.

But, the recent health reform law – the Affordable Care Act – has some important changes that will help to relieve this burden for the people with Medicare that hit the donut hole each year (and are not already on a program called Medicare Extra Help,):

  • This year, if you enter the Part D donut hole, you will receive a one-time, $250 rebate check. The mailing of these checks began in June. If you are eligible and do not receive your check, call your Part D plan first and then 1-800-Medicare.
  • Starting in 2011, you will receive a 50% discount on brand-name drugs in the donut hole, and you will start to pay less and less for your generic Part D drugs in the donut hole.
  • Starting in 2013, you will pay less and less for your brand-name Part D prescription drugs in the donut hole.
  • By 2020, the coverage gap will be closed, meaning there will be no more “donut hole,” and you will only pay 25% of the costs of your drugs until you reach the yearly out-of-pocket spending limit.

Throughout this time, you will get continuous Medicare Part D coverage for your prescription drugs as long as you are on a prescription drug plan.

If you would like more information on the one-time rebate check, feel free to check out this brochure or call 1-800-MEDICARE. (Please note that you do not need to do anything to receive this rebate check and should not provide any personal information such as Medicare, Social Security or bank account numbers to anyone calling about the rebate.)

 

Securing Medicare

Don Berwick, M.D., Administrator of the centers for Medicare and Medicaid Services

I am pleased today to bring good news to you about the health and future of Medicare.  As a result of the Patient Protection and Affordable Care Act, as amended, the financial outlook for Medicare is substantially improved compared to prior evaluations.  This improvement is not without some important qualifications, but it nonetheless represents a very positive change in the expected operations of the Medicare trust funds.

In 2009, Medicare provided health insurance coverage to 46.3 million people.  Total Medicare expenditures were $509 billion and income was $508 billion.  The average Medicare benefit per enrollee was $11,743.  These Medicare expenditures were slightly lower than estimated in last year’s Trustees Report.  Within the total, Part A and Part D spending were each slightly lower than estimated, while Part B outlays were slightly higher. Medicare expenditures in 2009 represented 3.5 percent of Gross Domestic Product.  Last year, these costs were projected to increase steadily (and rapidly) to over 11 percent of GDP by the end of the long-range, 75-year projection period.  In the new report, based on the cost-containment efforts of the Affordable Care Act, Medicare is projected to represent 6.4 percent of GDP in 2084.

Other good news?  The Hospital Insurance (Part A) trust fund is projected to be able to pay all benefits on time until 2029—12 years longer than last year’s estimate of 2017.  And the long-range actuarial deficit for HI is only one-sixth of its prior level—specifically, 0.66 percent of taxable payroll versus 3.88 percent.

These favorable changes depend critically on a specific ACA provision, which will slow the rate of growth in Medicare payments to most categories of providers by about 1.1 percent annually in anticipation of improvement in productivity.  It is important to note that the effect of these adjustments will reduce payment rates over time, and it is possible that providers would not be able to slow their cost growth correspondingly.

However, as someone who has spent my career improving care for patients, I have seen firsthand the substantial improvements in quality and cost-effectiveness that can be achieved by health care providers.  As a result of this provision, providers will have strong financial incentives and many other supports to find more efficient ways to care for patients that not only reduce costs but more importantly improve quality.

Our agency intends to work with providers to support these improvements and carefully monitor the impact of this provision on access to high quality care for all beneficiaries. Despite the uncertanties, the picture is far more positive than last year – with the Affordable Care Act, we can make the future of Medicare secure.

Strengthening Medicare

Cross-posed from healthcare.gov:

Don Berwick, M.D., Administrator of the Centers for Medicare and Medicaid Services

Millions of Americans rely on Medicare for their health care security. But for years, skyrocketing health care costs have threatened the long-term financial health of the program. Many people with Medicare have worried about the long-term solvency of Medicare and whether or not there would be enough funds in the program in the future to pay for care for them and their children.

Thanks to some important new features of the Affordable Care Act, Americans can rest assured that Medicare will continue to be there – better than ever – for our seniors and individuals with disabilities.

Today, my agency, the Centers for Medicare & Medicaid Services, released a new report, Affordable Care Act Update: Implementing Medicare Costs Savings, demonstrating just how much – and how fast – important provisions of the Affordable Care Act will improve the financial health of Medicare. In 2010 and 2011 alone, these provisions will save Medicare an estimated $8 billion and almost $418 billion by 2019. These savings will protect the solvency of the Medicare Trust Fund through 2027, extending its life by 12 years.

These new savings will come largely as a result of reducing excessive payments to private health insurance companies, promoting better quality of care, and cutting Medicare waste and fraud through powerful new tools. These tools keep bad actors out of the Medicare program in order to prevent fraud in the first place and enhanced technologies to help law enforcement stop fraud quickly when it does occur.

And there are many important investments in support of innovation for clinicians and health care organizations who are trying every day, as the Centers for Medicare & Medicaid Services is, to make health care better for patients and more affordable at the same time.

There are other actions in the new law that strengthen Medicare by improving the health of those who receive benefits. These include improving outreach and coordination efforts after a patient is discharged from the hospital to prevent unnecessary hospital readmissions and reducing preventable surgical errors.

Many of the programs in the Affordable Care Act are designed to ensure that people with Medicare continue to have access to quality, affordable care. This year, many people with Medicare who have fallen into the Medicare donut hole are receiving a one-time $250 rebate check to help with their drug costs, making sure that financial concerns do not interrupt needed treatment agreed on by a patient and a doctor.

And next year, all people with Medicare will have access to annual wellness visits and other preventive services with no cost-sharing, giving millions of Americans an opportunity to get potentially life-saving screenings. Over time, new reforms will also encourage better coordinated care.

Together, this adds up to a good deal for people with Medicare and taxpayers. If you or someone you love is on Medicare, make sure to check out sections like here and here on www.healthcare.gov that talk more about how the Affordable Care Act affects you.

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