Medicare Prescription Drug Benefit: A Progress Report

Based on the news release “New Progress Report Shows Millions Of Beneficiaries Are Saving Money And Choosing Plans With Enhanced Coverage Options” at www.hhs.gov

Edited Article and Commentary by Dr. Don Rose

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On April 4, 2006, Secretary Leavitt of HHS (the U.S. Department of Health and Human Services) issued his Progress Report III (PDF) on the Medicare Prescription Drug Benefit. At the time of this report, the Medicare Part D Prescription Drug Plan was only three months old -- and yet, in that short time, more than 27 million Medicare beneficiaries signed up for prescription drug coverage, enjoying significant savings in their drug prescription costs. The White House website, whitehouse.gov, points out that, as of the end of April, more than 30 million people had signed up for the Medicare Drug Benefit, surpassing the administration's enrollment goal of 28 to 30 million beneficiaries. Even though the White House site does cite a USA Today story claiming many seniors are unaware of the Medicare program's May 15 enrollment deadline ("Many Seniors Unaware Of Deadline For Medicare Drug Plan," USA Today, 4/26/06), the site also says that the government may ultimately enroll 90 percent of the estimated 43 million eligible seniors by May 15, assuming enrollment rates continue at the January-through-April pace.

In short, the administration seems pleased with the rate of enrollment in the new Medicare Drug Plan. According to Whitehouse.gov, 30 million seniors enrolled means over 65 percent of eligible beneficiaries are receiving coverage, a figure sure to grow as May 15 draws near. Plus, millions are being automatically enrolled or do not need to take action. As of March 23, there were 11 million seniors with retiree coverage partially subsidized by the government and 5.8 million seniors were auto-enrolled. In April, about 1 million low income seniors who had not picked a plan (yet qualify for extra help) were being auto enrolled. About 6 million people didn't need to sign up because they have other coverage.

Still, the May 15 deadline does apply to a large number of seniors. In an effort to increase plan awareness, the President has been making speeches about the new Medicare benefit as the deadline looms. Whitehouse.gov admits that many people may be assisted by the Medicare Drug Benefit yet do not realize it. If you are one of them, talk to your pharmacist or health care professional, search the Web, gather information using government resources, and take action. Seniors who wish to take maximum advantage of the new benefit should take action before the mid-May deadline. To help raise awareness, we offer the article below, based on a news release from the HHS website. In it, we share some HHS information related to the new drug benefit. All seniors are urged to sign-up before May 15, so they don’t pass up an average savings of $1,100 per person. --D.R.

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Introduction

In April 2006, HHS Secretary Mike Leavitt released the third in a series of progress updates on the new Medicare Prescription Drug Benefit. The report detailed substantial increases in enrollment in the previous month, as well as data showing that the vast majority of seniors are choosing alternatives to the standard government-designed plan.

Millions Are Saving Money, Choosing Plans With Better Coverage Options

"Enrollment has been accelerating because beneficiaries know that the savings are real and so are the benefits," Secretary Leavitt said. "We expect to see a substantial surge before May 15 - that's why we're encouraging seniors to sign up now so they do not pass up an average savings of $1,100 per person."

After the first three months of the Medicare Part D Prescription Drug plan, over 27 million beneficiaries were receiving prescription drug coverage. Around 90 percent of Medicare beneficiaries enrolled in a plan different than the standard plan designed by the government. Many chose plans that offer lower deductibles or no deductibles, fixed co-payments for most drugs, and extra coverage in the coverage gap. (All plans offer coverage until you hit a limit of $2,250 in total drug costs, and offer coverage when your out-of-pocket costs exceed $3,600, but only some plans offer coverage in the gap between $2,250 and $3,600. The Generics Only Plan covers generic drugs in the gap, whereas the Generics and Brands Plan covers both generic and brand drugs in the gap.)

Program Itself Sees Savings -- and Improvements

Beneficiaries are not the only ones seeing savings. The overall cost of the program to taxpayers for 2006 has dropped 20 percent since last July's estimate. States will save $700 million in 2006 compared to what they thought they would spend.

In addition, the report addressed efforts being made by the Centers for Medicare & Medicaid Services (CMS) to improve and strengthen the program including:

· Enrollment reconciliation -- A relatively small number of beneficiaries were carried on the books of more than one Medicare plan. CMS is working with plans to ensure each beneficiary is enrolled in the plan of their choice.
· Customer service -- CMS has increased its monitoring of plan call centers to ensure beneficiaries are receiving timely and accurate information.
· Transition -- Working with plans, pharmacists and physicians, CMS has provided guidance to ensure smooth transitions to drugs that are covered and, when necessary, to provide timely exceptions.

Conclusion

The report concludes with action steps for the weeks leading up to the May 15 enrollment deadline, including frequent data exchanges and accuracy checks with drug plans to assure beneficiary information is as up-to-date as possible; monitoring of plan care center wait times; and continued aggressive outreach and education to plans, providers and pharmacists so that beneficiaries have appropriate medications during any transition period.

Resources

The “Secretary’s Progress Report III on the Medicare Prescription Drug Benefit” is available at http://www.hhs.gov/secretaryspage.html.

http://www.hhs.gov/ -- The official website for HHS (the U.S. Department of Health and Human Services).

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HHS.gov content is, to the best of our knowledge, reliable and accurate.

Dr. Don Rose writes books, papers and articles about computers, the Internet, AI, science and technology, and issues related to seniors.

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