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Welcome to "Ask the White House" -- an online interactive forum where you can submit questions to Administration officials and friends of the White House. Visit the "Ask the White House" archives to read other discussions with White House officials.

November 17, 2005

joe, from u.s writes:
are you scott's brother? that guy who gives briefings and gaggles all the time? hey scott's brother, how many people are healthy in the us

joe's brother

Dr. Mark McClellan
Hi Joe’s brother. Yes, that guy who gives briefings and gaggles all the time is my younger brother, Scott. He has a tough job during the day, but when we talk in the evenings and on the weekends, I can tell you he’s a great brother and a wonderful uncle to my daughters.

On your other question, most people in the U.S. are healthy, but many of us could use more exercise and many of us haven’t taken full advantage of preventive medicine. It’s also good that Medicare is now covering preventive care, and starting next year, prescription drugs, so people in Medicare can have access to the benefits of modern medicine so they can prevent the complications of diseases.

Daniel, from Lakeville, CT writes:
Can you talk about the donut hole in drug coverage for Medicare? Supposedly if your cumulative drug expenses reach $2,250, the Medicare benefit won't kick in again unless your costs reach $5,100. Is this true? Thanks.

Dr. Mark McClellan
Thanks for asking that question, Daniel. Medicare’s standard benefit does cover 75 percent of drug costs up to $2,250. So for a premium that starts at under $20 a month or just a few hundred dollars a year, you get $1500 worth of help. If you reach the coverage gap that starts at $2,250 in the basic benefit, and then you would pay for the drugs (with a discount that your plan gives you) until your out-of-pocket expenses reach $3,600. After that, Medicare picks up 95 percent of the costs, so you are protected against very high expenses. But you don’t have to get just the basic coverage. Because of competition, you can choose a drug plan that has no deductible if that’s what you want. And you can choose a plan that provides coverage in this gap. So if you don’t want a donut hole, you don’t have to have one.

SHARON, from ANDERSON SC writes:
DEAR SIR: WHAT ALL WILL THIS COVERAGE COVERS AND THE BENEFITS? MY PARENTS ARE RETIRED AND WOULD LIKE TO KNOW.

Dr. Mark McClellan
Hi Sharon. That’s a great question. The prescription drug plans will cover brand name and generic drugs, and they must cover all medically necessary treatments. Premiums are lower than $20 in most parts of the country. If your parents have coverage from a former employer or union, and it’s good coverage, then Medicare can provide a direct subsidy to that employer or union to help pay for the coverage. If your parents have retiree coverage already, they should look for information from their benefits administrator or human resources administrator about how it will work with Medicare. Most people with retiree coverage are going to take advantage of the Medicare drug benefit by staying right in the coverage that they already have.

Uri, from Beverly Hills, CA writes:
Dr. McClellan, With an MD and a PhD, you would seem to be a pretty smart guy. I imagine at some point you were practicing medicine andor doing research in the medical field. What made you give up directly helping people to administrate for our government? What advice would you give to others based on your choice?

Dr. Mark McClellan
I appreciate that question, Uri. I was sort of the “black sheep” in the family, going to medical school and getting involved in medical research, and I didn’t really plan on going into work in government. But it’s funny how things work out. The fact is, it’s a very important time for health professionals to be involved in health care policy, since there are so many important issues at stake. I try to live by the advice my grandfather gave me: It’s not the dollars you make, it’s the difference you make. It is a very exciting time to be at the Centers for Medicare & Medicaid Services, where we have some of the best opportunities ever to bring the high quality and the best of modern medicine to the millions of Americans who depend on our programs. There are more opportunities than ever for health professionals to get involved in government policy, and I’d encourage you to look into those opportunities if you are interested.

mike, from arlington ma writes:
is there an easy way to check the coverage for certain drugs under the new Medicare D? i find it confusing and am trying to research various plans in Massachusetts and i wonder if you could publish a list of coverge for various common drugs as a national guideline?

Dr. Mark McClellan
Thanks for that question, Mike. All of the Medicare prescription drug plans are required to cover all medically necessary drugs, and all of the plans have very broad formularies (the covered drug lists). If you have some specific plans in mind, you can go to Medicare’s Formulary Finder on www.medicare.gov, or call us at 1-800-MEDICARE, and we can tell you whether your specific drugs are covered by a particular plan. You can also use Medicare’s Prescription Drug Plan Finder at www.medicare.gov, which can narrow down your choices based on the drugs you take. The website and our customer service representatives can also tell you whether there are ways to lower your out-of-pocket costs, such as by taking generic drugs. As you may know, generic drugs are approved by the FDA and act in exactly the same way as a brand-name drug. Beyond these broad coverage requirements, if there is nonetheless a problem about coverage for a drug that your doctor thinks you need, plans are required to have expedited processes for you or your doctor to be able to get coverage for the drug, as well as appeals for coverage that are reviewed independently by Medicare, not by the drug plan.

ray, from 52625 writes:
explain the income guide lines

Dr. Mark McClellan
Thanks, Ray, for that question. It’s important to remember that the new Medicare drug coverage is available to everyone, regardless of income. In addition, Medicare is providing extra help to people with limited means. About 1 out of 3 people with Medicare are eligible for this extra help – it’s not just available to a few, and it can help most people who are living month to month on a fixed income only. If your income is below $14,355 a year ($19,245 if you are married and living with your spouse), you may qualify for the extra help that on average will pay for 95 percent of drug costs. Also, your financial assets like retirement accounts and any real estate other than your home cannot be worth more than $11,500 if you are single, or $23,000 if you are married and living with your spouse. On average, for people with extra help, Medicare will pay for about 95 percent of your prescriptions for no premium, no gap in coverage and only small co-payments. If you still have questions about your coverage, we'd welcome your call at 1-800-MEDICARE.

Joe, from Tennessee writes:
I can't seem to find anyone that can explain the Medicare D prescription drug coverage where a layman can understand it. It is very confusing to everyone I talk to.Thank You

Dr. Mark McClellan
Joe, thank you for your question. What surveys of seniors show is that as people find out about the coverage – and there are lots of places to go to do that – they are much more likely to want to enroll, especially if they don’t have coverage. That’s what I’ve seen too, as I’ve had the chance to travel around the country and talk to seniors and the volunteers in the many organizations that are working with seniors. It is an important new program and that means there are new things to learn about it, but it’s really worth it. Medicare’s new prescription drug coverage is a big new addition to Medicare, finally bringing a key part of modern medicine to seniors and people with a disability. It’s worth taking a look because if you don’t have coverage now, you could save 50 percent or more on your current drug costs, as well as get peace of mind from protection against high drug costs in the future. And we have many ways for you to get help to find a plan that fits your needs. For example, if you call us at 1-800-MEDICARE, we can tell you where to go in your area for face-to-face-counseling. You can also get personalized assistance at www.medicare.gov or by calling 1-800-MEDICARE. At our website or our 24/7 toll-free number, we can tell you what it means for you personally. It's worth finding out about - coverage options start for a lot less than people expected, under $20 a month almost everywhere in the country, and Medicare will typically cover more than half the costs of drugs compared to not having coverage. In addition, if you call us at 1-800-MEDICARE, we can tell you where to go in your area for face-to-face-counseling.

Sanjuana, from Kansas writes:
If a person became US Resident 5 years ago she is now 69 years old, widow, and does not have any income, can she apply for madicare?

Dr. Mark McClellan
The Social Security Administration handles Medicare eligibility and enrollment. You can contact the Social Security Administration at 1-800-772-1213 to enroll in Medicare or to ask questions about whether she is eligible. You can also visit their web site at www.socialsecurity.gov. Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance), and starting next year, Part D (Prescription Drug Coverage). You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. If she or her husband did not pay Medicare taxes while they worked, and she is age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A by paying a premium.

Marcia, from Buffalo, NY writes:
Wouldn't the program have been more efficient if seniors' prescription bills were submitted and paid directly by the government? These insurance companies are diverting huge amts. of money to advertising their options - money that could be better spent directly paying for medicine. All the overhead (advertising, enrollment sales people, screening and approving of medicines, etc.) is wasting huge amounts of $ that could better be spent directly on seniors' medical needs. This current system is so confusing, so bloated with overhead - it's a travesty...

Dr. Mark McClellan
Thanks for your question, Marcia. With the new Medicare coverage, the government is not trying to force you into a "one size fits all" plan that may not be what you want. In fact, until now people haven’t had a choice about their coverage, and that’s how Medicare’s benefits got so far behind. Instead, you have a choice about your coverage, and we can help you get the information you need to choose a plan that is a good fit for you. Also, because you can choose, we are seeing lower costs and better benefits than many independent experts predicted. There are plans available for under $20 a month that will cover about half of drug costs for a typical senior, and there are plans that offer very comprehensive coverage with no gap for only around $60 a month. And people with limited means can get very comprehensive coverage for a zero premium. So it's worth taking a look - and you can get personalized information about what the coverage means for you by going to medicare.gov or calling 1-800-MEDICARE.