[NYAPRS Enews] Medicare Update: 50% Savings on Some Drugs, $250 Check for Some

Tue May 25 09:26:44 EDT 2010

CMS SENDS MEDICARE MAILING TO BENEFICIARIES 

TO EDUCATE THEM ON THE NEW AFFORDABLE CARE ACT AND WHAT IT MEANS FOR
MEDICARE 

Medicare beneficiaries will soon receive important information in the
mail about the immediate benefits they may see from the enactment of the
Affordable Care Act. 

The mailing from the Centers for Medicare & Medicaid Services (CMS),
which will be available in both English and Spanish, outlines key
provisions of the Affordable Care Act that are important for people with
Medicare as well as members of their families. 

Medicare mails the Medicare & You handbook to all beneficiary households
every fall to provide people with Medicare the most up to date
information about changes in Medicare.  These annual mailings have from
time to time been supplemented with additional mailings that inform
beneficiaries about major changes in the law that significantly affect
Medicare.  

"It's important that our Medicare beneficiaries get facts about this
important new law timely so they can learn what stays the same and what
will change and improve in terms of their benefits," said Marilyn
Tavenner, acting CMS administrator.  "As a trusted resource for
beneficiaries and their families, we believe that this information will
help to inform them about the Affordable Care Act and remind them to be
on the alert for any scams asking for personal information.  CMS has
learned from implementing previous major pieces of health reform
legislation like Medicare Part D that unfortunately new opportunities
for Medicare beneficiaries also bring new opportunities for scam artists
to try and defraud seniors." 

"The new law not only strengthens Medicare, but also ensures the
guaranteed benefits that beneficiaries have come to rely upon don't
change," said Tavenner. "CMS is viewed by beneficiaries as the official
and trusted source of information, so it is critical that we reach out
quickly to ensure beneficiaries understand their Medicare coverage and
how it will improve." 

The first benefit that several million Medicare beneficiaries will
receive as a result of the passage of the new law is a one-time check
for $250, if they enter the Part D donut hole and are not eligible for
Medicare Extra Help.  The donut hole is the period in the prescription
drug benefit in which the beneficiary pays 100 percent of the cost of
their drugs until they hit the catastrophic coverage. 

"The $250 check that some beneficiaries will soon see in the mail
following the brochure for all Medicare beneficiaries is the first step
towards the closing of the coverage gap," said Tavenner. "Next year, all
beneficiaries who enter the gap will get a 50 percent discount for
covered brand name Part D drugs, and by 2020 will no longer have a gap
in coverage." 

In addition to the rebate check, the new mailing to beneficiaries
outlines other benefits available under the Affordable Care Act.
Beginning next year, the Affordable Care Act ensures that Medicare
beneficiaries will get preventive care services like colorectal cancer
screening and mammograms without cost-sharing, in addition to an annual
"wellness visit."   The law also includes new tools to help fight fraud
by helping Medicare crack down on criminals who are seeking to scam
seniors and steal taxpayer dollars.  

Because Medicare is a trusted resource for beneficiaries and their
family members, the mailing encourages them to log on to
www.medicare.gov
<http://links.govdelivery.com:80/track?type=click&enid=bWFpbGluZ2lkPTgzO
DY3NCZtZXNzYWdlaWQ9UFJELUJVTC04Mzg2NzQmZGF0YWJhc2VpZD0xMDAxJnNlcmlhbD0xM
jE1Nzg5NzIwJmVtYWlsaWQ9aGFydmV5ckBueWFwcnMub3JnJnVzZXJpZD1oYXJ2ZXlyQG55Y
XBycy5vcmcmZXh0cmE9JiYm&&&101&&&http://www.medicare.gov/>  or call
1-800-MEDICARE to get their questions about Medicare or the Affordable
Care Act answered. 

------------------

MEDICARE PART D BENEFICIARIES WILL SEE 50% SAVINGS ON APPLICABLE DRUGS
IN THE COVERAGE GAP IN 2011 

CMS Hosts June 1 Public Meeting To Discuss New Requirements,
Manufacturer Agreement 

The Centers for Medicare & Medicaid Services (CMS) today issued new
guidance to Part D plan sponsors to guarantee that Medicare
beneficiaries enrolled in Part D prescription drug plans will see 50
percent savings on their brand name and some authorized generic drugs
when they enter the coverage gap, or donut hole, during 2011. 

In a notice in the Federal Register, CMS also issued the draft model
agreement that drug manufacturers of applicable Part D drugs will sign
in order to participate in the discount program. These agreements with
manufacturers represent an unprecedented partnership to help millions of
Medicare beneficiaries. Discounts will apply when the beneficiary
reaches the coverage gap. Eligible beneficiaries will see the discount
when they buy their drugs at their local pharmacy counter. 

CMS will host a public meeting on June 1 to discuss and collect public
feedback about the draft manufacturer agreement, and to gather feedback
about the final Part D guidance released today. As part of the June 1
meeting, CMS is encouraging drug manufacturers, Part D plan sponsors,
and representatives from the beneficiary advocacy community to provide
input and comments. All stakeholders can register online at:
http://cmsconference.hcmsllc.com/Conf06012010/register.aspx
<http://links.govdelivery.com:80/track?type=click&enid=bWFpbGluZ2lkPTgzN
jMyNyZtZXNzYWdlaWQ9UFJELUJVTC04MzYzMjcmZGF0YWJhc2VpZD0xMDAxJnNlcmlhbD0xM
jE1Nzg3ODc4JmVtYWlsaWQ9aGFydmV5ckBueWFwcnMub3JnJnVzZXJpZD1oYXJ2ZXlyQG55Y
XBycy5vcmcmZXh0cmE9JiYm&&&101&&&http://cmsconference.hcmsllc.com/Conf060
12010/register.aspx>  

Closing the coverage gap is an important part of the Patient Protection
and Affordable Care Act of 2010, (the Affordable Care Act) signed by
President Obama earlier this year, beginning with a one-time check for
$250 in 2010 for those that reach the donut hole in 2010 and are not
eligible for low-income assistance, the 50 percent discount for
brand-name and some authorized generic drugs beginning in 2011 and
additional savings until drugs are covered throughout the coverage the
gap by 2020. 
"The documents we are releasing today facilitate the implementation of
the Affordable Care Act's provisions to help Medicare beneficiaries with
the high costs of their prescription medicines," said CMS Deputy
Administrator and Director of the Center for Medicare Jonathan Blum. 

The Part D plan guidance released today was finalized after receiving
comments on the draft guidance that was issued on April 30. This
guidance clarifies how the discount program will be implemented and that
CMS will coordinate the manufacturers' reimbursement for discount
payments that Part D sponsors provide on their behalf to applicable
beneficiaries under this program through a third-party administrative
contractor. The third-party administrator will also help to verify the
accuracy of the manufacturer discounts reported by Part D sponsors. 

For more information on this program, see the Federal Register notice
that will be displayed on May 21, 2010 at:
http://www.federalregister.gov/OFRUpload/OFRData/2010-12559_PI.pdf
<http://links.govdelivery.com:80/track?type=click&enid=bWFpbGluZ2lkPTgzN
jMyNyZtZXNzYWdlaWQ9UFJELUJVTC04MzYzMjcmZGF0YWJhc2VpZD0xMDAxJnNlcmlhbD0xM
jE1Nzg3ODc4JmVtYWlsaWQ9aGFydmV5ckBueWFwcnMub3JnJnVzZXJpZD1oYXJ2ZXlyQG55Y
XBycy5vcmcmZXh0cmE9JiYm&&&102&&&http://www.federalregister.gov/OFRUpload
/OFRData/2010-12559_PI.pdf>  
Or visit http://www.federalregister.gov/inspection.aspx
<http://links.govdelivery.com:80/track?type=click&enid=bWFpbGluZ2lkPTgzN
jMyNyZtZXNzYWdlaWQ9UFJELUJVTC04MzYzMjcmZGF0YWJhc2VpZD0xMDAxJnNlcmlhbD0xM
jE1Nzg3ODc4JmVtYWlsaWQ9aGFydmV5ckBueWFwcnMub3JnJnVzZXJpZD1oYXJ2ZXlyQG55Y
XBycy5vcmcmZXh0cmE9JiYm&&&103&&&http://www.federalregister.gov/inspectio
n.aspx>  

----------------

"Medicare and the New Health Law - What it Means for You"

Starting tomorrow and throughout this week, Medicare beneficiaries
across the country should begin receiving copies of a brochure "Medicare
and the New Health Law - What it Means for You" in their mailboxes.  The
mailing from CMS outlines key provisions of the Affordable Care Act for
people with Medicare as well as members of their families.  The mailing
is being sent in both English and Spanish.  

Because Medicare is a trusted resource for beneficiaries and their
family members, the mailing encourages them to log on to
www.medicare.gov or call 1-800-MEDICARE to get their questions about
Medicare or the Affordable Care Act answered and reminds them to be on
the alert for possible scams.

The first benefit that many people with Medicare will receive as a
result of the passage of the new law is a one-time check for $250, if
they enter the Part D donut hole and are not eligible for Medicare Extra
Help.  Beginning next year, the Affordable Care Act ensures that
Medicare beneficiaries will get free preventive care services like
colorectal cancer screening and mammograms, in addition to a free annual
wellness visit.   The law also includes new tools to help fight fraud by
helping Medicare crack down on criminals who are seeking to scam seniors
and steal taxpayer dollars.  

The brochures can also be found at:
http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf (English) and
http://www.medicare.gov/Publications/Pubs/pdf/11467_S.pdf (Spanish).  

Please share this information with your members, partners and
constituents.

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