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April 14, 2006
Good afternoon, this is Leslie Norwalk, the Deputy Administrator of the Center for Medicare & Medicaid Services (CMS), the agency that oversees the Medicare program. I am pleased to be answering your questions today about the new Medicare prescription drug coverage.
Over forty years ago, Medicare was created to guarantee health care for seniors and people with disabilities. Since then, millions of Americans have appreciated the dependable health care coverage that Medicare has provided for treatment from doctors and hospitals when they get sick.
Since January 1, Medicare has offered voluntary prescription drug coverage to ALL Medicare beneficiaries (even those who have won the lottery!). Finally, seniors and people with disabilities are going to get help with up-to-date, life-enhancing prescription medicines. So far, 29.6 million people are benefiting from this coverage. While were happy so many have signed up, we realize there is more work to be done between now and May 15th.
Its very straightforward to sign up for the new benefit, all you need to do is call 1-800 MEDICARE, and have a list of your prescriptions and your Medicare card on hand.
People with Medicare are selecting plans that best meet their needs. According to a recent Washington Post-ABC News poll, 75 percent of people with Medicare found it was to sign up and nearly two-thirds said the new program saved them money.
Joe, from Missoula writes:
Medicare prescription drug coverage is insurance that covers brand-name and generic drugs at participating pharmacies in your areas. Under the program, private companies offer drug plans that you have the option of joining. Its a voluntary program that can help you save money on the prescriptions you need.
When you get Medicare prescription drug coverage, you pay part of the costs, and Medicare pays part of the costs. People with limited income and resources may qualify for extra help that can lower or even eliminate out-of-pocket costs for this coverage.
Each plan must meet a standard of coverage set by Medicare. However, plans can vary on which pharmacies they use, which drugs they cover and how much they charge. But all plans are required to cover all medically necessary treatments. Additionally, all plans cover nearly all of the drugs that are used to treat cancer, seizure disorders, HIV/AIDs, as well drugs taken after a transplant, anti-psychotics and anti-depressants. This is true regardless of the monthly premium.
If you call 1-800-MEDICARE with a list of your prescriptions and your Medicare card number in hard, our customer service representatives will help you find the plan thats best for you. Its that simple. Customer service representatives are available 24 hours a day, 7 days a week. If you sign up in April, your coverage will begin on May 1st.
Denise, from Baltimore County
CMS has also established more than 200 grassroots networks nationwide to encourage outreach collaboration between various stakeholders, including: the Social Security Administration (SSA), State Health Insurance Assistance Programs (SHIPs); Area Agencies on Aging (AAA), AARP, Medicare Today, local and state level health officials, and local non-profit groups. CMS conducted nearly 900 in-person training sessions, trained over 4,000 partners and participated in thousands and thousands of partner events since January 1, 2006. In addition:
Beneficiaries can get the help they need by calling 1-800-MEDICARE with a list of their prescriptions and their Medicare card number in hand. Medicares customer service representatives will help them find the plan thats best for them based on their current drug needs and pharmacy preferences. Its that simple. Customer service representatives are available 24 hours a day, 7 days a week. If they sign up in April, your coverage will begin on May 1st.
Finally, through 1-800-MEDICARE seniors in rural areas all across the country are able to get the latest information on the drug benefit and learn about what resources are available and closest to them. Beneficiaries who want face-to-face help even when they live in rural areas can call 1-800-MEDICARE and ask for information for the local SHIP (state health insurance assistance program). The SHIP can arrange for help in person, for beneficiaries who need it.
Wayne, from St. Helena, CA
Sheila Hill: "So I calculated that for a three-month supply of two brand-name drugs, I only pay $88 plus premiums totaling $57.06. My three-month supply now costs me $145.06 instead of $492.27 from Canada. Annually, that comes to $580.24, saving me $1,388.84 per year, or $115.74 per month. What a deal! So, I signed up. The entire process from inquiry to sign-up took less than 20 minutes total. Medicare was knowledgeable, asked me specific questions, and then came up with the best choice." (Sheila Hill, Op-Ed, "Medicare Part D Sign-Up Was Simple," [Fort Lauderdale, FL] Sun-Sentinel, 3/19/06)
Jim Nelson, 79: "I'm really happy with it, and I don't know why people are not signing up already." (Melanie Markley, "Some Warm To Drug Program," The Houston Chronicle, 3/30/06)
People are reviewing their choices and selecting plans with different features. A vast majority of beneficiaries, nearly 85 percent, have selected a plan different than the one standard plan that Congress designed. About 80 percent of beneficiaries selected a plan with NO deductible. I know a number of you are concerned about the so-called coverage gap or donut hole. There are a number of plans available that have no gap in coverage. About 25 percent of enrollees chose such a plan, and many beneficiaries picked a plan with premiums under $20 a month.
The important thing is that beneficiaries weighed their options and selected a plan. I know that the process can seem overwhelming, but there is help available. Our customer service representatives are available around the clock to help you sort through your choices and enroll you in a plan. Theyll walk you through the process. There are some things to keep in mind when thinking about the plan thats best for you: cost, coverage, convenience, and peace of mind. Some of these factors might be more significant to you than others depending on your situation and drug needs.
We have worked diligently to ensure the new Medicare prescription drug program enrollment process is as seamless as possible for people with Medicare. That is why we have 6,000 customer service representatives at 1-800-Medicare available 24 hours a day, 7 days a week to answer questions about what plan is right for them, based on the drugs they take, and the pharmacy they use.
Moreover, we've worked closely with the states and 14,000 partners to provide face-to-face help for people who want to narrow down the options to choose an insurance plan that makes the most sense for them. We also have a website, www.medicare.gov, for people who are comfortable with surfing the web for additional information. Drug Plan Compare does the math and compares the plans in California, for example, on the basis of the drugs that a beneficiary takes and includes any premiums, co-payments or deductibles that a beneficiary would be asked to pay. These are all important tools to help beneficiaries in whatever way they find most comfortable, over the phone, in person or on the web.
Kim, from Kentucky writes:
People with Medicare are reviewing their choices and selecting plans with different features. Our customer service representatives are available around the clock to help you and your mom sort through her choices and enroll in a plan. Theyll walk you through the process. There are some things to keep in mind when thinking about the plan thats best for her: cost, coverage, convenience, and peace of mind.
Cost: Plans may have a monthly premium, deductible or copayments, and may set a limit on what they will pay. So compare monthly premiums and determine copayments and yearly deductible. Plans will also discount the price of the drugs they cover. With Medicares new drug coverage, a typical person with Medicare, who has no prescription drug coverage today, will save about 50% on prescription drug costs.
Coverage: Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Each plan has to provide access to medically necessary prescription drugs. Compare plans on how they meet your moms needs.
Convenience: Prescription drug plans contract with local pharmacies. Look for conveniently located pharmacies that participate in the Medicare prescription drug program. Also note that some plans offer prescriptions through the mail.
Peace of mind: Even if your mother does not take a lot of prescription drugs now, its still good to consider joining. As we age, most people need prescription drugs to stay healthy. Signing up for Medicare prescription drug coverage today can help protect her savings from high prescription drug costs often associated with major health problems such as heart disease and cancer. Should yearly out-of-pocket drug costs exceed $3,600, Medicare will pay up to 95% of the bill.
Some of these factors might be more significant to you than others depending on your situation and drug needs. But the most important thing to remember when you and your mom start looking for a plan is how easy it is. As I stated previously, its easy, all you need to do is call 1-800 MEDICARE, have a list of your moms prescriptions and her Medicare card on hand. Medicare does the math, and can tell you what plans are the least expensive for your mom. We can also tell you specific information about AARP and Aetna, and other companies that offer the drug benefit in Kentucky. Well help you find the right plan for your mom.
Cliff, from Brimfield, Ohio
About 7.7 million people have enrolled in a stand-alone Medicare prescription drug plan. That means they opted to keep their Medicare A and B coverage they way it has always been while adding the new drug coverage or Part D to their benefit package.
An additional 5.7 million people are enrolled in a Medicare Advantage plan. These are health plans that cover doctor and hospital care as well as prescriptions. These plans usually provide lower costs if you use the doctors and hospitals that participate in the plans network. Many also provide extra benefits, like dental coverage or reduced premiums for their enrollees.
Medicare now provides drug coverage to people who used to get their drugs from Medicaid. Medicare has worked with the States to switch more than 5.7 million people from Medicaid to the new Medicare program where they will have no premiums, no deductibles, and no gap in coverage and pay very little or nothing for almost all their prescriptions.
Medicare also is helping employers or unions that offer retiree drug coverage. Provided the coverage offered meets Medicares standard, employers and unions can receive a subsidy from the government for continuing to provide coverage. About 6.8 million people are benefiting from this subsidy.
An additional 3.5 million people get their drug coverage through the militarys TriCare program or the Federal Employees Health Benefit Plan.
Finally, many other beneficiaries (not counted in the 29.6 million) have what we call Creditable Coverage. That means that they have drug coverage that is as good as, or better, than Medicare coverage. There are 3.2 million beneficiaries that receive prescriptions through the Veterans Administration. If they are happy with this coverage, they dont need to make a change. In addition, 2 million beneficiaries are working and receive drug coverage through their current employers. They may sign up for the drug benefit when they retire, but dont need to do anything now. A half a million other beneficiaries have retiree drug coverage through their former employer or union, but their employer or union has not applied for a Medicare retiree drug subsidy.
Thus, of the 42 million beneficiaries, over 35 million have Medicare drug coverage, or drug coverage that is as good as or better than Medicares. That means that we are spending the next month reaching out to the remaining 7 million beneficiaries, so they can decide what works for them before May 15th.
Remember, if you call 1-800-MEDICARE with a list of your prescriptions and your Medicare card number in hard, our customer service representatives will help you find the plan thats best for you. Its that simple. Customer service representatives are available 24 hours a day, 7 days a week.
Tony, from Phoenix, AZ
Carter, from Chattanooga, TN
I know that a number of websites tout the savings available from Canadian pharmacies. But some of these websites are based on the basic Medicare drug benefit that Congress designed in 2003. They do not consider the much better deals that many Medicare drug plans are actually offering this year.
I did some shopping myself to compare prices between those available at www.canadadrugs.com and the cheapest prescription drug plan available in zip code 45419, which is in the Dayton Ohio area. Theres quite a difference. I compared prices for Lipitor, Actonel, Advair, Celebrex, Diovan, Evista, Flomax, Fosamax, Glyburide/Metformin, Nexium, Norvasc, Plavix, Premarin, Prevacid, Singulair, Synthroid, and Zocor.
For Lipitor, I found a price of $164.15 for a ninety 10mg tablets on a popular Canadian pharmacy website. I could get the same drugs for $48.43 from the Medicare prescription drug plan.
I compared the annual price for all of these drugs on the Canadian website ($19,229) with the annual price for all of these drugs in the least expensive plan in Ohio ($4401.69) saving nearly $15,000 using the Medicare Prescription Drug plan. Of course, no beneficiary will take all of these drugs, but the Medicare Prescription Drug program is likely to save you money, no matter where you live or what drugs you take.
And the Medicare Prescription Drug program will provide something that the Canadian pharmacies cannot: catastrophic coverage. If you need help with very high drug costs, only the Medicare Prescription Drug program will cover 95% of your costs after you spend $3600. You also should know that spending on drugs from Canada does not count toward the $3,600 out-of-pocket spending limit that triggers the very low-cost catastrophic coverage offered by the Medicare drug plans.
There are other drawbacks to relying on Canada pharmacies, even ones that are safe and reputable. It's still illegal under American law. Sometimes, deliveries are intercepted by U.S. authorities. By enrolling in a Medicare plan, you will have the peace of mind that you can get your medicines from your local pharmacies when you need them.
By calling 1-800-MEDICARE with a list of your prescriptions and your Medicare number, our customer service representatives will help you find and enroll in a drug plan that best meets your needs. Its that simple and you are likely to find considerable savings like many others have.
tyler, from maine writes:
Medicare has Part A (Hospital Insurance), Part B (Medical Insurance), and Part D (Prescription Drug Coverage).
Starting January 1, 2006, Medicare provides dependable prescription drug coverage that will make it easier for everyone with Medicare to pay for the drugs they need to stay healthy.
Medicare Part A (Hospital Insurance) helps cover your inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. You must meet certain conditions to get these benefits. Medicare Part B (Medical Insurance) helps cover your doctors services and outpatient care. It also covers some other medical services that Part A doesnt cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. Medicare Part C is known as the Medicare Advantage Program. And Medicare Part D is the prescription drug coverage that has been the main topic of todays discussion.
The Medicare and You Handbook describes each of these in greater detail. If you do not have this handbook, call 1-800-MEDICARE and ask that one be sent to you.