Medicare Watch

Medicare Preserved in President’s Budget, but Congress May Target the Program

This week, President Obama’s administration released its proposed federal budget for 2012. Funding for Medicare programs remains mostly stable, and includes a few improvements. The budget increases funding for fighting Medicare fraud, which has been shown to eliminate waste and improve the financial outlook of the program. Also, the budget proposes reducing the time before generic versions of certain medications are allowed into the market, from 12 to 7 years. Generic drugs are more affordable than their brand-name counterparts.

In addition, the budget proposes freezing Medicare physician payments for two years and using this time to produce a long-term solution to reforming Medicare physician payment rates.  Without such reform, physician rates would be cut under the Sustainable Growth Rate (SGR) formula, which was put in place by the Balanced Budget Act of 1997. The temporary month-to-month patches to Medicare payment rates that have been put in place over the past year have led some providers to question their participation in the Medicare program. Although the president’s proposed two-year freeze would create greater stability in the program, a permanent solution is necessary. 

Congress is the final arbiter of the budget. The chairman of the House Budget Committee, Representative Paul Ryan, has said that he will specifically target Medicare in budget proposals. While not offering specific proposals for the 2012 budget, a bipartisan group of senators, including Senator Richard Durbin and Senator Tom Coburn, have also indicated that they may include Medicare in upcoming deficit-reduction legislation. 

Read the president’s budget and accompanying fact sheets.

Health Reform Q&A

It’s time for another installment of our newest feature. Today we answer a question about the Medicare prescription drug benefit’s coverage gap. The gap, commonly known as the “doughnut hole,” will be phased out as a result of the Affordable Care Act. People who reached the doughnut hole in 2010 received a $250 rebate check. As the 2010 rebate winds down and the 2011 discounts begin, consumers who believe they were eligible for a rebate but did not receive one should understand how to navigate the process.

Q: Both my husband and I hit the doughnut hole in 2010, but we have not received a check. Where do we go to find out what happened to our checks?

A: If you and your husband reached the doughnut hole at the very end of 2010, your checks may still be in the mail. If you did not receive the rebate within 45 days of entering the doughnut hole, you should first contact your drug plan directly. If your drug plan disputes your eligibility for a $250 rebate, you have the right to appeal the plan’s decision. If the plan correctly forwarded the proper information to Medicare to trigger the rebate check, you should check with Social Security to ensure that the address on file is correct. As always, you can call 800-MEDICARE for assistance. However, you cannot file an official complaint about not receiving a rebate until four months after the date you entered the doughnut hole.

Read more about the $250 doughnut hole rebate.

Please keep sending us your questions about health reform and Medicare, and look for more answers in upcoming issues of Medicare Watch.

Click here to send us your questions.

If you have received a discount on drugs in the doughnut hole in 2011, or have already visited your doctor for free preventive services or the new annual wellness visit, we want to hear your story!

Click here to share your story.

 

Medicare Reminder

As consumers settle into new prescription drug plans, they should be aware that their plans may not cover all of the medications they need. Plans may choose not to cover certain drugs, or to place restrictions on them. Common restrictions include:

• Prior Authorization, which requires you to get permission from the plan before a drug will be covered;
• Step Therapy, which requires you to try a cheaper drug before a more expensive one will be covered; or;  
• Quantity Limits, which limit how much of a drug will be covered. 

 

Learn how to get your drug plan to cover the medications you need at www.MedicareInteractive.org.

 

Spotlight

The Kaiser Family Foundation has released a primer on Medicare spending and financing, just in time for the budget debate in Washington. The primer outlines Medicare spending trends and provides an outlook for the program’s future.

Read the primer.