August 29, 2005
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 that will be available to all
people with Medicare in January 2006.
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. In the years
following Medicare's creation, though, medicine has changed. Modern medicine is increasingly about prevention, early diagnosis, and patient
involvement, and prescription medication.
If prescription drugs can prevent the surgery and limb amputations that used to be standard diabetes treatment, then it makes no sense not to use
The same goes for heart disease, or arthritis, or any chronic disease that today can be managed with medication. Medicare, unfortunately, hasn't kept
up with modern, prevention-oriented care. But that's changing. Medicare is becoming more focused on prevention. Instead of just paying for costly
complications when you get sick, Medicare is going to pay for preventive care and drugs to help beneficiaries stay well.
Starting January 1, Medicare will provide voluntary prescription drug coverage to ALL Medicare beneficiaries. Finally, seniors and people with
disabilities are going to get help with up-to-date, life-enhancing prescription medicines.
While the drug benefit is for all Medicare beneficiaries, regardless of income, Medicare will provide extra help to people with limited means. With
this extra assistance, Medicare will cover approximately 95% of their prescription drug costs. For most people with limited means, the extra help
means no premiums, no deductibles, no gap in coverage, and co-pays of only a few dollars for all prescriptions.
No one with Medicare will ever again have to face the terrible choice between medicine and life's other basic necessities, like rent or food.
To learn about the Medicare prescription drug benefit, call 1-800-MEDICARE or visit www.medicare.gov.
Eunice, from Far Rockaway
Could Medicare and Medicaid help disable people
Yes. Medicare and Medicaid are both designed to help people with disabilities manage their health care. Once you are found to be disabled and eligible for Social Security, you will begin to receive your Medicare coverage 24 months later. This coverage will help you with your health care needs, preventive services and beginning next year, prescription drugs. If you are under 65 you may be eligible for Medicare if: 1) you are disabled and have been receiving Social Security Disability Insurance for more than 24 months; OR 2) you get continuing dialysis for permanent kidney failure, or you have had a kidney transplant (End-Stage Renal DiseaseESRD); OR 3) you have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), commonly known as Lou Gehrigs Disease. Contact the Social Security Administration (1-800-772-1213) for further information.
If you have limited resources, you may find that Medicaid, which is run by your state, will provide you with even more health care coverage. In New York, you can contact the New York State Dept of Health at 800-541-2831 to learn more about Medicaid and how it can help you.
William, from Brevard, NC
I need information on the new medicare card. How do the changes affect
the average American? Thank You
Here are the basics about Medicares new prescription drug coverage, available beginning January 1, 2006:
1. The Medicare drug benefit will offer help for everyone on Medicare, whether they are age 65 or over, or on Medicare because of a disability. It will provide help to beneficiaries even if they have a pre-existing condition. This is real help: On average, it will provide over $1100 in financial support. For a typical senior, it will cut the bills in half. ALL Medicare beneficiaries are eligible, regardless of their income.
2. The Medicare drug benefit offers comprehensive protection against very high drug costs. After a person spends $3600 it will pay for 95% of medications peace of mind that people with Medicare will not use all of their savings if medication bills are high.
3. The Medicare drug benefit will pay for brand-name and generic drugs. Drugs can be obtained through a local retail pharmacy or through mail-order.
And, it will workno matter how someone gets Medicare today.
Participants can add drug coverage to Medicare benefits and keep them.
If Medicare participants have coverage from a retiree health plan, Medicare offers new support for their former employer to make that health plan more secure.
If they are members of a Medicare health plan, theyre probably already getting some drug coverage. And that coverage is going to get better.
Vern, from Grand Marsh, WI
It is my understanding that about 20 of the total cost of the "Medicare
Modernization Act of 2003" will be paid to various pharmacuetical
companies and health care Insurance providers, so they can sell some
type of insurance coverage to subscribers. If this is true, why was it
necessary to do it that way???
The Medicare prescription drug coverage is relying on the expertise and experience of the organizations that provide health coverage and that includes drug coverage to millions of American under 65. Through this expertise, people with Medicare will see their drug costs drop significantly.
The Medicare prescription drug benefit is being provided through private insurance companies that are approved by the Medicare program. These companies are negotiating on behalf beneficiaries for lower drug prices. They will be offering Medicare prescription drug coverage in January to all Medicare beneficiaries for a monthly premium. While the average premium is $32 a month, beneficiaries will have access to at least one plan with premiums under $20, and in some states that premium will be much lower than $20. More information will be contained in the 2006 Medicare & You Handbook, which Medicare beneficiaries will receive in the mail in mid-October. To learn more about the Medicare prescription drug benefit choices, call 1-800-MEDICARE or visit www.medicare.gov.
Sara, from Minnesota writes:
Why does the President feel that it's acceptable that a lot of people
around the country can't afford medicare? And if he doesn't feel it's
acceptable, what is he doing to make medicare more affordable?
President Bush does not feel its acceptable that any one cannot afford their Medicare or any health care services. Thanks to the new Medicare law, which he signed in 2003, people with Medicare no matter where they live will find it easier to get comprehensive health care services through what are called Medicare Advantage plans. Many of the Medicare Advantage prescription drug plans will have additional benefits beyond the standard Medicare coverage and have monthly premiums that are significantly less than $20. People enrolled in these plans are already saving about $100 a month on average in out-of-pocket health care costs, compared to traditional Medicare alone or with an individual Medigap plan.
More information about these plans will be available beginning in October.
Gary, from Baton Rouge, La.
How does this new Medicare plan change from the exisiting one? When does
it take effect?
There have been a number of improvements that the new law made to Medicare. Beginning this past January, Medicare expanded the number of preventive services it would cover and, for the first time, began to offer a Welcome to Medicare physical for people who are just signing up for Medicare. And last year, people with Medicare could sign up for a prescription drug discount card. Nearly 7 million Medicare beneficiaries did just that and saw savings averaging about 20 percent below what they had been paying for their prescription drugs. But the discount cards were an interim step until the new prescription drug coverage that begins in January.
If you are interested in receiving prescription drug coverage under the Medicare program, you will have to sign up for the benefit between November 15, 2005 and May 15, 2006, and by December 31, 2005 for benefits to begin in January 2006.
If you already have prescription drug coverage through a previous employer or through TriCare for Life, you may want to keep this existing coverage rather than sign up for the new Medicare drug benefit. You should ask your employer if the coverage you have is as good as the Medicare program. This is sometimes referred to as Creditable Coverage.
People who currently have Medicaid and are over the age of 65 will be automatically enrolled in this new benefit.
Sara, from Michigan writes:
I am 24 years old. My grandparents are in their late-80s and they have
never once mentioned Medicare - only my grandfather's military
healthcare benefits. How can I fully ensure that they are taking
advantage of the benefits that the government offers?
Thank you for helping your grandparents. You set a great example for your peers. The Medicare program coordinates with military healthcare benefits, including VA benefits and TriCare for Life program. You can find out more information about TriCare for Life and how it interacts with Medicare by accessing their website at www.tricare.osd.mil/tfl/default.cfm. Contact 1-800-MEDICARE (1-800-633-4227) for more information about this or any other Medicare questions you or your grandparents may have.
Rosemarie, from Florida writes:
I have been trying to understand the new Medicare D insurance but have a
few questions.I have prescription benefits with my AARP supplemental
insurance and am fortunate that I still do not need to have any
prescription drugs, which at my age 68 can change overnight. I do not
fall into the low income catagory, but I am not well to do either. Now
if I elect not to take part D at this time, when I do need part D will
the monthly premiums be higher and will there be a late enrollment
penalty at all times after May 15 or will there be open enrollment
periods yearly. In other words, right now the premium is approx. 34.00
per month, if I elect to wait 2 years will there be additional charges,
added to the 34.00. I believe I read somewhere it would be an additional
2.00 per month per year premium if I don't enroll now. This is not
including the late enrollment fee if there is one. I am sorry if my
question is as confusing as the rules.
Its good that you understand the importance of having prescription drug coverage, so you understand the importance of protecting yourself for the future. Thats also the goal of the new prescription drug coverage, to make sure you have protection from the high cost of drugs when you need it.
If you do not have drug coverage under your AARP policy, you should continue that coverage as it is. If you do have drug coverage under your AARP policy, the coverage is not as good as the coverage that will be available through the prescription drug plan. So that means if you decide to stay in your current policy for now and decide to enroll in a prescription later, you will have to pay your monthly premium and 12 percent more for each year that you chose not to enroll. So if you decide to enroll in 2008, you will have to pay your monthly premium and an additional 24 percent on top of that premium each month.
Thus, it makes sense to consider what prescription drug plan options in Florida have inexpensive premiums. These options may replace the drug coverage portion of your AARP policy, or provide coverage in addition to your current AARP policy that does not cover drugs. You may find that the new coverage will provide you with greater value than your current coverage, especially since it includes coverage for catastrophic costs. You will be able to choose prescription drug coverage from plans with premiums of $20 per month or less. Options will also include plans offering zero deductibles or deductibles lower than $250 annually, and plans that provide some coverage in addition to the standard Medicare drug benefit.
Contact the AARP to make sure that you may continue your supplemental coverage (for items and services other than prescription drugs). You may also contact 1-800-MEDICARE (1-800-633-4227) for more information about this or any other Medicare questions you have.
Janice, from Mt. Shasta, Calif.
Are all Medicare participants eligible for the new prescription
benefits? Does it cost anything extra?
Yes. All Medicare beneficiaries are eligible for the new prescription drug benefit. The Medicare drug benefit will offer help for everyone on Medicare, whether they are age 65 or over, or on Medicare because of a disability. It will provide help to beneficiaries even if they have a pre-existing condition. ALL Medicare beneficiaries are eligible, regardless of their income. While the average premium is $32 a month, beneficiaries will have access to at least one plan with premiums under $20, and in some states that premium will be much lower than $20. If you have limited income and resources, you will not pay any premium, but will only have to pay a small copayment for the cost of your drugs.
Sandy, from New Jersey
Just wanted to say my husband just used the Medicare Discount Drug Card
for first time and found it wonderful. Can this be used for donut period
when full plan goes into effect.
Thanks for the nice words about the discount card. In fact, the card program, which was created as an interim measure until the new drug coverage became available, will end on May 31, 2006 and you will no longer be able to use the card after you enroll in a prescription drug plan. So no, you wont be able to use it to fill the coverage gap. But you will be able to find a prescription drug plan that may have some additional coverage that will do that for you. The prescription drug benefit that goes into effect on January 1st should provide your husband with even greater savings than the Medicare Discount Drug Card. Look in your mailbox this October for the 2006 Medicare & You Handbook which will provide information about prescription drug plans available in your state.
Joe, from Detroit, MI
Hello, What is the difference between Medicare and Medicaid?
Medicare is the health care program for people over 65 and those younger people with a disability and is administered by the Federal government. Medicaid is a joint Federal-state program for low-income families and seniors.
ghl, from texas writes:
can I join some activity to promote the medicaid services??
You can contact your local Department of Human Services offices in Texas to find ways to participate. You may also contact local social work organizations in the state to find other volunteer activities that are being conducted in your community.
Julia, from West Virginia
Dear Leslie Norwalk,
Why cant they cover dental issues? If not why dont they have very many
dentist who base the dental profession on your income?
Thank You. Sincerely, Julia
Adding a new treatment like dental services will require a change in the law by Congress, although there are some special medical situations where Medicare might pay for dental care. Medicaid does cover some dental services, so if you believe you qualify for Medicaid, you should contact a local health and human services office in West Virginia for more information. You may also find some additional assistance from dentists in your community.
azalea, from new orleans, Louisiana
Ms. Norwalk - I am in the Humana HMO and I was told they will take care
of everything concerning Medicare. Not to worry. But I do, because of
the Prescription plan going in effect in January 2006. Should I be
worried about this as a part of the Humana Health system? Azalea
I hope that you and your loved ones are safely away from the hurricane.
No, I wouldnt be worried. All Medicare Advantage organizations, like Humana HMO, will be offering plans that incorporate the new prescription drug benefit beginning in January. You should receive specific information from Humana in October. Look in your mailbox this October for the 2006 Medicare & You Handbook, which will provide more general information about the Medicare Advantage program and the prescription drug benefit.
President Bush today announced that Medicare beneficiaries -- no matter where they live in the U.S. -- will be able to choose prescription drug
coverage that will cost less than we originally expected, including plans with premiums of $20 per month or less. There will also be plans offering zero
deductibles or deductibles lower than $250 annually, and plans that provide some coverage in addition to the "standard" Medicare drug benefit. For
just $20 or $30 per month, seniors and people with a disability will be able to get a Medicare prescription drug plan that will provide real help and
protect their life savings from ever being eroded by high prescription drug costs.
This should be good news as Medicare beneficiaries begin to look into all the options they will have available to choose their drug coverage for next
year. More information will be coming in October and enrollment begins on November 15.
This year, people with Medicare must make a decision about prescription drug coverage. That's because coverage is voluntary. They can choose to
enroll or not. But they are going to need to decide about signing up for prescription drug coverage. More specific information is on its way. CMS will
mail the Medicare & You handbook to more than 41 million households by mid-October. Around that time, beneficiaries will be able to get personalized
information on plans that reflect their own needs and preferences.
Thank you for your questions, and remember, you can always call 1-800-MEDICARE to get the information you need about the new Medicare prescription drug
benefit, twenty-four hours a day, 7 days a week. Customer service representatives can answer your questions as well as give you the locations of
counselors in your areas that can help you in-person on a one to one basis. We also have lots of information available on our website: