|
Illustration Explains the Doughnut Hole
Families USA recently updated its pictorial description of the Medicare Part D doughnut hole to reflect 2009 numbers. Counselors can now use this visual tool to help walk beneficiaries through the cost-sharing amounts they are responsible for if enrolled in a Medicare Part D plan.
For this and other helpful tools, please do not forget HAP's 2009 Annual Enrollment Period Toolkit. Although the AEP is over, the toolkit contains useful information such as a fact sheet on the new MIPPA marketing rules for plans and a list of drugs that are not covered under Part D.
States Struggle with Budget Cuts to Senior Programs
The current economic crisis is significantly affecting programs for older Americans at the state level, leaving many state aging directors to make difficult choices about necessary budget-related reductions in their programs while also grappling with the sharply increased need for those same services.
A report recently released by the National Association of State Units on Aging (NASUA), The Economic Crisis and its Impact on State Aging Programs, found that the economic downturn resulted in 40 percent of surveyed states reporting an increase in the need for services provided by SHIPs. On a related note, the National Governors Association (NGA) recently predicted that based on current indicators, budget shortfalls for states will continue well into fiscal year 2010.
Beginning in February, HAP will be working with its partners in the Medicare program and policy community to bring greater attention to the need for increased federal funding in 2010 for the entire SHIP network. If you would like more information about HAP's efforts in support of increasing federal funding for SHIPs, please contact us at SHIPhelp@hapnetwork.org.
CBO Estimates Cost of Changes to Medicare
In a recent report entitled, Budget Options, Volume 1: Health Care, the Congressional Budget Office (CBO) analyzes the fiscal and policy implications of a variety of proposed changes to the American health care system. In particular, Chapter 4 (beginning on page 35) examines the options for changing several federal health insurance systems, including Medicare. Three proposed changes to Medicare that are closely examined include:
- Increasing the age of Medicare eligibility from 65 to 67;
- Creating a Medicare buy-in program for individuals aged 62 to 64; and
- Eliminating or reducing the 24-month Medicare waiting period for Social Security Disability recipients
As with all changes to the health care system, these potential changes to Medicare have political as well as economic consequences.
- As proposed, increasing the age of Medicare eligibility would save the Medicare program $85.6 billion over ten years.
- According to CBO's calculations, creating a buy-in program for Medicare would cost $1.6 billion over ten years.
- Eliminating the 24-month waiting period would cost Medicare $113 billion over ten years, while reducing the wait to 12 months would cost $65 billion in the same time frame.
Since enacting each of these changes would affect more than just the Medicare budget, the CBO report goes on to examine the political and social effects as well.
Report Finds Increasing Costs in Cancer Drugs
In December, Avalere Health and the American Cancer Society Cancer Action Network (ACS CAN) released a report, Cost Sharing for Patients in Medicare, that looks at the costs and coverage of oral cancer drugs in Medicare drug plans. Costs and restrictions on these critical drugs are rising under Medicare, which raises serious implications for Medicare beneficiaries with cancer. The report findings include:
- In 2009, the majority of plans now place brand-name oral anti-cancer drugs on Tier 4. Plans charge as much as a 33 percent co-insurance amount for drugs on Tier 4 — meaning these oral anti-cancer drugs can cost thousands of dollars per month. Since Tier 4 is often considered a "specialty tier," enrollees in such plans may not request an exception to the cost-sharing assigned to these drugs.
- Since 2006, many plans have begun shifting these expensive drugs to higher and higher tiers.
- In 2009, plans have more prior authorization requirements for these drugs than in any other prior year of Medicare Part D.
More information about this report is available at the Avalere News Room.
|
|
|
Get Involved: January Is National Mentoring Month!
National Mentoring Month (NMM) is a time to spotlight the importance of mentors in our communities. This January, we encourage SHIPs to celebrate the mentoring program that exists within your SHIP team.
The Merriam-Webster Dictionary describes a mentor as "a trusted counselor or guide." According to this definition, all SHIP counselors are mentors as they help guide beneficiaries through the Medicare maze. Take some time this January to recognize your mentors for their contributions, particularly for their help with the recent Annual Enrollment Period. Check out a list of simple and low-cost ways to recognize mentors in your program.
Mentoring can also be a great way to support and encourage new volunteers, while still recognizing existing volunteers for their knowledge and experience. If you don't already, consider pairing new volunteers with existing volunteers to help them learn and grow as the New Year rolls on. These same principles can also apply to mentoring paid staff members, such as local SHIP coordinators. A little recognition can go a long way for your mentors during the 2009 Open Enrollment Period.
What’s your SHIP already doing?
Let us know more about your mentoring program at SHIPhelp@netowrk.org.
We’d love to share your work with the rest of the SHIP community!
|
|
New GAO Report Assesses PFFS plans
A recent report released by the Government Accountability Office (GAO) found that enrollment in Medicare private fee-for-service (PFFS) plans can often result in significantly higher costs for beneficiaries than other Medicare Advantage (MA) plans or traditional fee-for-service Medicare. Some key findings in the report include:
- Beneficiaries enrolled in PFFS plans tended to be younger and healthier than their MA plan counterparts, but they faced greater financial risk because of the limited protections from unexpected costs and the hidden requirements around pre-notification.
- Enrollees in other MA plans and traditional Medicare did not typically bear the same cost burden for their care.
- Despite the recent growth in PFFS plan enrollment, beneficiaries tended to leave PFFS plans at a much higher rate, with disenrollment numbers at 21 percent compared to only 9 percent for other MA plans.
CMS is currently investigating the administrative practices of PFFS plans to ensure that beneficiaries are not incurring unexpected and disproportionate financial risk, and that plans are fully complying with what is required of them under the law.
For more information on PFFS plans and what to consider when joining an MA plan, see HAP's Making Informed Decisions booklet.
CMS Supports GAO Recommendations to Amend the AEP Schedule
In a recent report by the Government Accountability Office (GAO), Medicare Part D: Opportunities Exist for Improving Information Sent to Enrollees and Scheduling the Annual Election Period, GAO recommends amending the current AEP schedule (November 15 - December 31) "to include a sufficient processing interval to fully enroll beneficiaries prior to the effective date of their new coverage" which is January 1. This recommendation is based on findings that about "1 million beneficiaries who chose to switch prescription drug plans (PDPs) during the 2008 AEP were not fully enrolled in their new plan by January 1, 2008."
Both CMS and plan sponsors agree that an interval period would provide more time to process enrollments, and would in turn reduce any burden placed on beneficiaries, pharmacies, and plans. CMS also supports GAO's recommendations to strengthen its process to evaluate Annual Notices of Coverage (ANOCs) so that they are more user-friendly to beneficiaries. The GAO's recommendations in this report are largely based on interviews with advocates, including SHIP counselors from California, Texas, Florida, and New York, and providers.
|
