As GOP Readies Attack on Healthcare Reforms, HHS Touts Benefits

John Commins, January 25, 2011

As Republicans in Congress prepare to dissect the Affordable Care Act, the Obama administration is stepping up its public relations campaign to point out the program's benefits for Medicare beneficiaries.
Health and Human Services Secretary Kathleen Sebelius said three million Medicare beneficiaries who fell into the "donut hole" prescription drug coverage gap in 2010 have been mailed a one-time, tax-free $250 rebate check.

"For too long, many seniors and people with disabilities have been forced to make impossible choices between paying for needed prescription medication and necessities like food and rent," Sebelius said in an HHS announcement. "The Affordable Care Act offers long overdue relief by lowering prescription drug costs each year until the donut hole is closed."

Eligible beneficiaries who fell into the donut hole in 2010 are continuing to receive rebate checks and HHS said ACA will reduce prescription drug costs for beneficiaries in the donut hole each year until it is closed in 2020. Starting in 2011, HHS said beneficiaries in the donut hole will receive a 50% discount on covered brand name medications while in the donut hole. Medicare will also begin paying 7% of the price for generic drugs during the coverage gap.

HHS is also promoting the ACA's financial provisions that it says will extend the life of the Medicare trust by another 12 years. Under the ACA, HHS said the average savings for traditional Medicare enrollees will amount to more than $3,500 over the next 10 years. Savings will be even higher – as much as $12,300 over the next 10 years – for seniors and people with disabilities who have high prescription drug costs. Total savings per beneficiary enrolled in traditional Medicare are estimated to be $86 in 2011, rising to $649 in 2020.  For a beneficiary in the donut hole, estimated total savings increase from $553 in 2011 to $2,217 in 2020.

HHS said ACA also provides new Medicare benefits, safeguards, and incentives in 2011:

  • Original Medicare no longer charges out-of-pocket costs for the "Welcome to Medicare" physical exam and, for the first time since the Medicare program was created in 1965, Original Medicare now covers an annual physician wellness visit, also at no cost.
  • Most Medicare beneficiaries can now receive critical preventive services, including certain cancer screenings such as mammograms and colonoscopies, for free.
  • Qualifying doctors and other healthcare professionals providing primary care to people on Medicare a 10% bonus for primary care services.
  • An innovation center that will research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patient with Medicare, Medicaid or Children's Health Insurance Program coverage.
  • To prevent fraud, there will be more strenuous screenings for healthcare providers who want to participate in Medicare, Medicaid, or CHIP. In addition, enforcement officials will be able to see healthcare claims data from around the country in a searchable database, and criminal penalties for fraud will be strengthened.
John Commins

John Commins is a senior editor at HealthLeaders Media.

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