In today’s economy with tight budgets and limited resources it is vitally important to take advantage of any government assistance available. And with the cost of prescription drugs going higher and higher there is a relief found for those who qualify for the Medicare Prescription Drug Plan.
If you have limited income and resources Social Security and the Center for Medicare and Medicaid Services (CMS) can offer extra help with prescription drug costs. To be eligible for this help it is important to know what does (and does not) represent an income or a resource and what are the limits.
Income
To qualify for additional assistance with Medicare prescription drug plan costs, your annual income must be limited to $16,245 for an individual or $21,855 for a married couple. Luckily the following does not count as income:
- Victim’s compensation; or
- Scholarships or education grants.
Resources
Resources are valuable things that you own. Additional help with Medicare prescription drug plan costs, your resources must be limited to $12,510 for an individual or $25,010 for a married couple. The following does not count as Resources:
- Your personal possessions;
- Resources you could not easily convert to cash, such as jewelry or home furnishings;
- Property you need for self-support, such as rental property or land you use to grow produce for home consumption;
- Non-business property essential to your self-support;
Up to $1,500 (or $3,000 if you are married and living with your spouse) of the cash value of life insurance policies you hold;
Burial spaces; or
Interest earned on money you plan to use for burial expenses.
For additional information on exclusions or what constitutes resources you can visit www.socialsecurity.gov or call Social Security. In order to determine if you are eligible you can fill out form SSA-1020 also called the “Application for Help with Medicare Prescription Drug Plan Costs .”
Medicare Part D Explained
Anyone that currently has Medicare Part A or B is eligible for prescription drug coverage under Medicare Part D. Medicare Part D is the prescription drug benefit plan enacted in 2006 as part of the Medicare Prescription Drug, Improvement, and Modernization Act.
In order to qualify for Medicare Part D, a person with medicare must be enrolled in a stand-alone Prescription Drug Plan or a Medicare Advantage Plan. These plans are designed and executed by private insurance companies but are overseen by the Medicare program. Unlike Medicare Part A and B, Part D is not standardized. This means that the drugs covered can vary widely between providers and drugs covered by one provider may not be covered by another. Critics of the plan say that this leads to unnecessary confusion and may actually prevent many from obtaining prescription drug coverage that they need.
To enroll in Medicare Part D, you must select a plan during the annual election period which is November 15th through December 31st. This is also the only time that Medicare recipients can change from one plan to another. If medicare D participants are already enrolled in a plan and wish to remain in the same plan it is not necessary to enroll again. They will simply remain in the same plan the following year.
Medicare Part D Standard Benefit
Although the type of drugs covered by Part D plans is not standardized, the actual medicare drug benefit structure is the same no matter which plan provider is chosen.
As of 2009, the standard Medicare Part D benefit has an initial $295 deductible. Once the deductible is met, the participant must pay for 25% of the cost covered by their Part D plan. After the total prescription drug cost paid by both beneficiary and plan provider reaches $2700 ($295 deductible+ $2405 in drug cost) the beneficiary is then subject to an additional deductible or a “coverage gap” until the total drug cost reach $4350. This basically means that the beneficiary is responsible for 100% or $3454 of the cost of their prescription drugs until they are eligible for additional coverage under the next tier of Part D, the Catastrophic Coverage Benefit. At this point plan members pay $2.40 for generic drugs and $6 for others or a flat 5% of coinsurance, whichever is greater.
I will be posting an easy to follow chart of the standard benefit soon.
Three years ago, Medicare Part D was started in an effort to allow seniors to obtain cheaper drugs by stimulating competition among insurers. In some ways, the program has been success, but the cost to taxpayers to run the program is 3.5 times the cost of the prescription drugs provided.
The initial idea was the the government would use the collective buying power of 40 million medicare patients as a bargaining tool to force phamraceutical companies to lower prices. The plan did not account for the powerful pharma lobby which quickly secured direct government subsidies insuring that they would be reimbursed no matter what they charged for the drugs.
Soon, there will be even more money poured into the bloated program as part of the economic stimulus plan. What can be done to reduce the waste and bring costs back in line?
First, require private insurers accepting public money to offer a plan option equivalent to what the Department of Veterans Affairs offers, at the same price.
Another step would be to mandate that the Department of Health and Human Services negotiate drug prices on behalf of Part D plans. Instead of reimbursing private insurers for pharmaceuticals through unlimited direct subsidy, Washington should compare prices paid by Part D plans to Medicaid’s best prices (currently both price lists are confidential), and pay at either market or Medicaid rates, whichever is cheaper.
Allow individual states to monitor and manage Medicare regulations.
Medicare should clearly outline plans with simple side-by-side comparisons of costs and benefits.
Download a copy here . Excerpts from the Executive Summary:
Effective Interventions
Three types of interventions have been demonstrated to be effective in reducing hospitalizations for Medicare beneficiaries with multiple chronic conditions who in general are not cognitively impaired:
Transitional care interventions in which patients are first engaged while in the hospital and then followed intensively over the 4 - 6 weeks after discharge
Self-management education interventions that engage patients for 4 -7 weeks in community-based programs designed to “activate” them in the management of their chronic conditions
Coordinated care interventions that identify patients with chronic conditions at high risk of hospitalization in the coming year, conduct initial assessments and care plann...
In yet another example of sensationalism posing as legitimate journalism, the Associated Press’s Carla K. Johnson penned an article over the weekend calling people with mental illness who live in nursing homes a “threat.” What kind of threat? Well, according to the article, it appears to be the usual one, drawing an unscientific and unsupported link between mental illness and violence:
Over the past several years, nursing homes have become dumping grounds for young and middle-age people with mental illness, according to Associated Press interviews and an analysis of data from all 50 states. And that has proved a prescription for violence, as Jackson’s case and others across the country illustrate.
Younger, stronger residents with schizophrenia, depression or bipola...
With the release of the Medicare Trustees’ report for 2009, the worsening economy, and the continued high and rising cost of health care, many are anxiously awaiting a credible plan to reform the Medicare program and the health system as a whole. As Peter Orszag and others have argued persuasively, the ever-growing cost of health care is the largest threat to our nation’s long-term fiscal future. One smart way to address this problem is by using Medicare—the nation’s largest purchaser of health care—as a catalyst for improving quality, value, and efficiency throughout our heterogeneous delivery system.
What is really wrong with Medicare?
Until we have thoroughly used current and expanded tools to reduce waste and inefficiency in the delivery system, it is not necessary to increas...
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Another powerful Senate Democrat has issues with the Obama administration’s plans for funding health reform.
“Some of us have real pause about putting substantially more money into the health-care system when we have already got a bloated system,” Senate Budget Committee Chairman Kent Conrad said today, Dow Jones Newswires reports.
The comment came at a committee hearing where Tim Geithner was testifying on the merits of the budget blueprint, which includes a long-term health fund drawn from projected savings in Medicare and Medicaid as well as cut in tax deductions for the wealthiest Americans.
Geithner called health reform a “moral imperative, an economic imperative and a fiscal imperative for our nation,” DJ Newswires said.
Geithner heard rese...
If you want to have any insight into how complex and horrible the medical system is, then you need to set aside 24 hours and read this.If you pay someone to create these sorts of manuals, you should be paying someone to read them.....otherwise, who will follow the rules?The short answer. No One.That is why President Obama is auditing doctors at an alarmingly higher rate than has occurred in the past. No one is following the rules......even the insurers that make the rules.How in the world do we expect to fix a system mired in this much red tape?Oh.....don't worry. The INTERNET will fix it........yeah right......The Sherpa says: How can the government focus on effectiveness without focusing on the effectiveness of its policies and procedures? They can't. Which is why audits are up this mont...
THE PRESIDENT: To Sir Edward Kennedy. (Applause.) That’s the kind of greeting a knight deserves. (Laughter.) It is thrilling to see you here, Teddy. We are so grateful for you taking the time to be here and the extraordinary work that your committee has already started to do, along with Mike Enzi; I know Max Baucus and Chuck Grassley on the Senate side; Henry, I know that you guys are gearing to go on the House side.
So I just want to, first of all, thank all of you for participating. Today was the first discussion in this effort, but it was not the last. In the coming days and weeks we’ll be convening a series of meetings with senior administration officials here at the White House to further explore some of the key issues that were raised today and to bring more voices into ...
This week’s Diabetes Forum 2009 conference was two full days of presentations on policy and reform — a dizzying array of statistics and political jargon and acronyms like “four-tier formularies,” “SNPs” and “VBID” and “double-digit Medicare margin.” Surely all very important stuff in the netherworlds of managed care and reimbursement administration. But what the heck?! [...] (Source: Diabetes Mine)
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