Asclepios
An Ounce of Prevention
August 20, 2009 • Volume 9, Issue 33
For people with Medicare, the America’s Affordable Health Choices Act of 2009 (HR 3200), the health reform bill passed by three House committees, provides better access to affordable prescriptions and health benefits. The bill includes provisions that would remove obstacles, such as out-of-pocket payments, that prevent people from accessing wellness and prevention services covered by Medicare. Some of these changes include:
- The consolidation of all Medicare-covered immunization benefits under Part B to ensure all people with Medicare have affordable access to preventive vaccines. Currently, the influenza, pneumococcal and hepatitis B vaccines are covered under Part B, while other immunizations, such as the shingles vaccine, are covered by Part D. Many people with Medicare—especially people with low incomes—run into trouble when they try to get vaccines that are covered under Part D, which is a pharmacy-based delivery system. Vaccines are administered at doctor’s offices, but since doctors do not participate as providers in the Part D program, many people with Medicare end up having to purchase the vaccine themselves; they pay the full cost of the vaccine out of pocket and then file a claim for reimbursement with their Part D plan. In many cases, people with Medicare cannot afford these high up-front expenses, and decide to forgo the vaccine. Section 1310 in HR 3200 will reduce this obstacle by consolidating coverage for all preventive vaccines under one payment system in Part B.
- The bill also waives the deductible and cost-sharing for preventive benefits. For example, Medicare currently covers 80 percent of the cost of a hepatitis B vaccine after the deductible is met, and the patient is responsible for the remaining 20 percent; HR 3200 would have Medicare cover the full cost, with no deductible. With an emphasis on prevention and wellness, this bill ensures that people with Medicare are able to get all necessary federally recommended vaccines by having Medicare pay for them in full. Other preventive care, such as glaucoma screening and diabetes self-management training, would also be covered in full.
- Section 1232 of HR 3200 requires that Medicare pay indefinitely for immunosuppressive drugs for kidney transplant recipients. Currently, these drugs are covered for only 36 months, while patients need the drugs much longer to avoid infection.
Health care reform is designed to ensure that all Americans can receive the care they need. HR 3200 includes a number of provisions that, while rarely discussed in news stories and media reports, include improvements to the Medicare program that will help people gain access to effective and routine preventive services.
Medical Record
“MedPAC, an independent federal body that advises Congress on Medicare issues, has suggested that Congress should permit coverage for appropriate preventive vaccines under Medicare Part B instead of Part D. ‘If beneficiaries have to pay the full payment rate for vaccines and then seek reimbursement from their plans, physicians are concerned that the out-of-pocket cost will discourage beneficiaries from seeking preventive care,’ MedPAC told Congress in 2007.” (CDC Seeks to Protect Older Adults with Shingles Vaccine, Centers for Disease Control and Prevention, 2008)
“We want to strengthen preventive care under Medicare—no co-payments for checkups and wellness visits. Much of the money we spend on health care goes to treat chronic diseases which could be prevented from becoming more serious if patients received more preventive care. Preventive care is especially important for seniors, because it will increase the chance that your doctor can catch an illness in its early stages.” (Frequently Asked Questions about Health Insurance Reform, White House, 2009)
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Medicare Part D Monitoring Project
The Medicare Rights Center would like to hear about your experience, or that of someone you know, enrolled in a private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed.
Submit your story at http://www.medicarerights.org/issues-actions/tell-your-story.php.
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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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