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Health Reform and Prescription Drugs
The Affordable Care Act provides many changes to health care for seniors over the next several years, and the most immediate impact may be already over and done with for many seniors. Under Medicare Part D's Prescription Drug coverage, many senior citizens were shocked to find a major gap in coverage benefits. Health Care Reform aims to close that gap.
Source: Uwe E. Reinhardt, data from Centers of Medicare and Medicaid Services, Data & Statistics.
Eliminating the Donut Hole
The gap, known as the 'Donut Hole' of Medicare Part D, provides prescription drug benefits for costs up to $2,830 in total prescription-drug spending. After the $2,830 level is reached, coverage inexplicably stops until total drug costs reach $6,440. In the gap between $2,830 and $6,440, Medicare beneficiaries have been forced to pay the full costs of prescriptions out of pocket.
Fortunately for you, as a senior, Health Care Reform immediately provides a $250 rebate check in 2010 if you fell within the coverage gap. In the coming years, Health Care Reform should close the 'hole,' and the gap should be completely closed by 2020.
High-income Surcharges for Medicare Part B and D
Starting in 2011, Medicare Part D enrollees who earn more than $85,000 ($170,000 for married couples filing jointly) will be forced to pay a 'high-income surcharge' for Part D premiums. This high income surcharge is currently in place for Medicare Part B, and for Part B premiums the average cost could be raised from $96 monthly to $155 monthly, or possibly more.
Health Care Reform freezes the high-income surcharge limit on Part B coverage at the current level from 2011 to 2019, rather than allowing increases with inflation. It also imposes this same high-income surcharge on Medicare Part D premiums. The details of the cost of this surcharge have not yet been revealed.
Medicare beneficiaries are permitted to contest a high-income surcharge due to certain life changes, such as marriage, divorce, job loss or reduced work hours – anything that affects your income level.
For most seniors, the Affordable Care Act will impact many aspects of both Medicaid and Medicare coverage, as well as prescription drug coverage, so it's important to keep on top of these changes as details become revealed over the next year.
* You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:
1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week;
The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call, 1-800-325-0778; or Your State Medicaid Office
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