Medicare Roundup: Changes from health reform, payments for HIV patients

Mar 26 2010

USA Today: "Perhaps the biggest factor in whether your Medicare costs will rise or fall depends on your Medicare plan. There are two: a traditional Medicare plan run by the federal government and Medicare Advantage, which is run by private insurance companies. Medicare Advantage costs more than the traditional plan, but provides more generous benefits. There are 10.2 million seniors who have Medicare Advantage. The law attempts to slow the growth of Medicare, saving the federal government $455 billion over 10 years. About $135 billion of the savings will come from changes in how the federal government pays private insurers who administer Medicare Advantage plans. Costs could go up or benefits could be reduced, or both, for those covered by Medicare Advantage."

"Another major Medicare provision deals with prescription-drug costs. ... Under the new law, seniors who spend more than $2,830 per year on prescription drugs will receive a one-year, $250 rebate this spring to help with prescription costs. In 2011, the law would discount brand-name prescription drugs by 50% for those in the coverage gap. The discount would gradually increase until 2020, when the coverage gap would be closed" (Kiely, 3/25).

CBS News reports on the prescription drug coverage gap known as the doughnut hole: "Seniors fall into the doughnut hole once they hit their $2,830 limit. Then they have to pay $3,610 out of pocket for drugs before prescription coverage picks up again at $6,440. This year, seniors who fall into that doughnut hole will get a $250 rebate. In 2011, they will receive a 50 percent discount on brand-name drugs. Also, seniors will receive a 7 percent discount on generic drugs, which will increase 7 percent every year thereafter. ... In 2020, the doughnut hole will close, meaning seniors will receive no gap in coverage." 

CBS adds:  "Starting next year, the legislation also gives all seniors free annual wellness exams and preventive tests, like screenings for high blood pressure and certain cancers" (Cobiella, 3/24).

Meanwhile, CQ HealthBeat covers Medicare and HIV: "Some patients who use antiretroviral therapy to suppress HIV, the virus that causes AIDS, develop severely hollowed cheeks, a condition that makes them look gaunt and seriously ill. Effective immediately, Medicare will pay for 'filler treatments' to counter this localized loss of fat ... the Centers for Medicare and Medicaid Services (CMS) noted that 'patients have reported feeling stigmatized by these changes, particularly if their HIV status has not been disclosed previously, and believe their relationships with others are adversely affected.' In some cases, CMS said, patients stop taking their antiretroviral drugs as a result. Those medications are needed to stave off medical deterioration and death from AIDS. ... Most patients with HIV are younger than 65. But in many instances they qualify for Medicare on the basis of disability" (Reichard, 3/24).

On a separate note, Health News Florida reports that "Six Medicare Advantage plans that have been in trouble in the past are still breaking marketing rules in ways that place beneficiaries at risk, according to a report by the Inspector General of the U.S. Department of Health and Human Services. The companies found in violation have 12 percent of the enrollees in Medicare Advantage plans nationally, according to HHS. Those selected for the investigation were among those who had drawn the most complaints in the past for such matters as tricking beneficiaries into signing up for the wrong plan, and sometimes even enrolling them without their knowledge" (Gentry, 3/24).