Medicare Part D in 2011
How Does Health Care Reform impact Medicare Part D in 2011?
One of the goals of the Patient Protection and Affordable Act and the Health Care and Education Reconciliation Act of 2010 is to make health benefits more accessible, especially for low-income individuals. The new laws produced some positive changes in Medicare prescription drug benefits. Those changes include shrinking the coverage gap and making the Extra Help prescription drug program more accessible.
The Donut Hole in 2011
The "donut hole" (or "coverage gap") continues to shrink as a result of changes in Medicare Part D. In 2010, the government had issued $250 checks to beneficiaries who were in the coverage gap. Added to that benefit, the new laws now provide ways for beneficiaries to pay less out of their own pocket for certain medications while in the coverage gap. Prescription drug manufacturers now offer a fifty percent discount on brand-name drugs to beneficiaries within the gap. The government will also provide a seven percent discount on generic medications during that period.
Keep in mind that you can always save money by using generic medications over brand-name drugs. If you're prescribed a brand-name medication, you can ask your doctor if a generic alternative is suitable and available for your condition. While they may look different, generic medications are FDA approved and are equally as effective as their brand-name counterparts.
Low Income Subsidy for 2011
Extra Help is the low-income subsidy for Medicare Part D prescription drug plans. To qualify, beneficiaries must meet a specific low-income threshold. Changes in Medicare Part D improve the low-income benchmark premiums by excluding Medicare Part C rebates and quality bonus payments from the calculations that determine the benchmark. This allows for stability among the number of benchmark plans for the low-income subsidy. The laws also provide a means to absorb the cost differential for low-income subsidy plans that bid slightly more than the benchmark. This helps more plans remain at a $0 premium low-income subsidy.
In addition, widows and widowers can keep their low-income subsidy plan - without having to re-apply for eligibility - for up to one year after the death of a spouse.
Other changes in Medicare Part D in 2011
For Medicare beneficiaries who receive additional support through the AIDS Drug Assistance Program or the Indian Health Service, changes in Medicare Part D in 2011 allow the out-of-pocket expenses that result from these programs to count toward the Medicare out-of-pocket maximum.
The new laws also give authority to create drug classes and exceptions to classes to the Secretary of Health and Human Services in the hope of helping more medications make it onto private health insurance companies' formulary drug lists. A formulary lists medications that are covered under the particular prescription drug plan.
Another important change in Medicare Part D in 2011 is that the Annual enrollment period has been moved up an entire month. For plans effective January 1, 2012, the annual enrollment period runs from October 15 through December 7. This increase the enrollment window to 53 days - one week longer than the previous enrollment period of 46 days. It also provides several weeks for Medicare to issue ID cards so more members have them in hand before benefits begin.
