Pete Hoekstra

Medicare

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MEDICARE HIGHLIGHTS


The Medicare Prescription Drug Improvement and Modernization Act (MMA) offers significant support to seniors who depend upon Medicare for their health care. It will provide more than 40 million seniors with a prescription drug benefit that they do not currently receive.

The new Medicare program provides consumers with more control over their medical expenses and eases the burden of the high cost of prescription drugs. The voluntary prescription drug program, which is the main focus of the new law, will be administered primarily by private insurers and require a monthly premium from participants.

For the first time Medicare offers a comprehensive physical for new beneficiaries, cholesterol screenings and other preventive care initiatives and chronic care management. It also addresses adequate reimbursement for physicians, hospitals and other health care providers to ensure that all seniors maintain access to high-quality health care in their communities.

I joined my colleagues in extending this much-needed coverage to our nation’s seniors, but Congress must continue to monitor the progress of the new entitlement to ensure that the long-term solvency of the Medicare program.

Below are a few of the reforms and programs that the Medicare bill addresses:


CHANGES BEGINNING IN 2006


Prescription drug benefit


For the first time, individuals will have access to a prescription drug benefit through Medicare. Most of the prescription drug plans (PDPs) will include a $250 annual deductible and an average monthly premium of about $25.

The government will pay 75 percent of annual coverage up to $2,250. Once the beneficiary has paid $3,600 out of pocket, the government will pick up 95 percent of the coverage.

Beneficiaries are guaranteed access to at least one PDP and one integrated plan in each region. Two PDPs would be required if no integrated plan is available.

If no private plans bid in a region, the government would offer a fall-back plan.

Individuals will be able to sign up for the plan that best meets their needs starting November 15, 2005, and will begin to receive benefits starting January 1, 2006. The initial enrollment period ends May 15, 2006, after which a permanent increase will be included in the beneficiary’s monthly premium. The next open enrollment period will take place November – December 2006.

You may review the plans available to Medicare beneficiaries in West Michigan by calling 1-800-MEDICARE or by visiting www.medicare.gov and clicking on the “Compare Medicare Prescription Drug Plans” link.


Low-income assistance


Under the MMA, seniors receiving benefits through both Medicare and Medicaid will automatically be enrolled in a Medicare PDP.

Beneficiaries with incomes of up to 150 percent of the poverty level (currently $27,600 for a family of four) will receive a benefit with no gaps in coverage but will be subject to premiums based on a sliding fee scale and modest co-payments for services.

Individuals eligible for additional assistance will receive information from the Social Security Administration or you may call 1-800-772-1213 for more information.


Retiree coverage


Companies will receive $70 billion in subsidies and tax breaks over 10 years to encourage them to continue offering health care for their retirees.

Qualified retiree plans will be able to have maximum flexibility on plan design, formularies and networks.

Employers will be able to provide premium subsidies, cost-sharing assistance for retirees who enroll in a Medicare drug plan and integrated plans.

Employers must notify their retirees by November 15, 2005 whether or not they will continue to offer a PDP that is either equivalent to or better than the Medicare PDP.


CHANGES BEGINNING IN 2007


Income relating