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- Apr 4, 2009
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Dispelling the Lies: What Health Reform Actually Means for Seniors
A lot of seniors are worried about what will happen to their Medicare coverage now that health reform has passed. The rumors are abundant: "the government will tell you when to die." "The government will tell your doctor not to do surgery on you if you are old." "The cuts in Medicare will mean cuts in the services you receive." None of this is true.
Here's what health reform means for you if you are over 65 years of age.
1.) The Medicare program will be stronger not weaker.
* Health reform will put a lot more resources into making the Medicare program more efficient. The new head of Medicare (to be appointed shortly) is a physician who is a national leader in quality improvement. He is expected to help Medicare providers focus on doing better not just doing more.
2.) You can keep your same doctor and your same health plan.
* Health reform doesn't change the basic structure of Medicare. The same physicians and hospitals who treat Medicare patients now will likely treat them in the future. And if Medicare can pay doctors faster and better, it is more likely they will continue to treat Medicare patients.
3.) You will actually have improved benefits -- preventive services without a co-pay and help with the cost of your prescription drugs.
The Medicare prescription drug program (or Part D as it is called) will also be improved. If you take several prescription drugs, you probably already know about the "donut hole" -- that's the popular term for a gap in coverage between what Medicare pays for your drugs and what you have to pay yourself. This very complicated program often hits seniors unexpectedly when they go into the pharmacy to get a drug and find out they have to pay 100% of the cost themselves.
A third of all Medicare beneficiaries fall into the donut hole each year (where they have to pay 100% of their drug costs), and don't climb out gain until they have spent $3,610 of their own money.
Not only do seniors in the donut hole have to pay all the costs of their drugs themselves, but 15% stop taking their drugs because they can't afford them, and over half of those don't resume those drugs even when Medicare starts paying again. So, while the donut hole was designed to save Medicare money, it has had the unintended consequence of causing seniors a lot of anxiety, loss of substantial income, and potentially making their diseases worse by forcing them to choose among food, rent and the drugs they need to stay healthy.
But there is good news. Health reform will help seniors with these drug costs. This year, 2010, seniors falling into the donut hole will receive a $250 rebate from the government, and starting next year there will be a 50% discount on brand name drugs, which will ramp up to a 75% discount on brand and generic drugs by 2020, eventually closing the donut hole gap completely.
Whole Article...
Linda Bergthold is a health policy consultant and researcher. She has over twenty-five years of experience and was a working group leader in Hillary Clintons Health Care Reform Task Force in 1993. She has been an advocate of health care reform for two decades in California and nationally. She has a Masters and Doctorate from the University of California at Santa Cruz in Sociology and was a Pew Fellow at the University of California, San Francisco, institute for Health Care Policy. She and her husband have three children and four grandchildren.
A lot of seniors are worried about what will happen to their Medicare coverage now that health reform has passed. The rumors are abundant: "the government will tell you when to die." "The government will tell your doctor not to do surgery on you if you are old." "The cuts in Medicare will mean cuts in the services you receive." None of this is true.
Here's what health reform means for you if you are over 65 years of age.
1.) The Medicare program will be stronger not weaker.
* Health reform will put a lot more resources into making the Medicare program more efficient. The new head of Medicare (to be appointed shortly) is a physician who is a national leader in quality improvement. He is expected to help Medicare providers focus on doing better not just doing more.
2.) You can keep your same doctor and your same health plan.
* Health reform doesn't change the basic structure of Medicare. The same physicians and hospitals who treat Medicare patients now will likely treat them in the future. And if Medicare can pay doctors faster and better, it is more likely they will continue to treat Medicare patients.
3.) You will actually have improved benefits -- preventive services without a co-pay and help with the cost of your prescription drugs.
The Medicare prescription drug program (or Part D as it is called) will also be improved. If you take several prescription drugs, you probably already know about the "donut hole" -- that's the popular term for a gap in coverage between what Medicare pays for your drugs and what you have to pay yourself. This very complicated program often hits seniors unexpectedly when they go into the pharmacy to get a drug and find out they have to pay 100% of the cost themselves.
A third of all Medicare beneficiaries fall into the donut hole each year (where they have to pay 100% of their drug costs), and don't climb out gain until they have spent $3,610 of their own money.
Not only do seniors in the donut hole have to pay all the costs of their drugs themselves, but 15% stop taking their drugs because they can't afford them, and over half of those don't resume those drugs even when Medicare starts paying again. So, while the donut hole was designed to save Medicare money, it has had the unintended consequence of causing seniors a lot of anxiety, loss of substantial income, and potentially making their diseases worse by forcing them to choose among food, rent and the drugs they need to stay healthy.
But there is good news. Health reform will help seniors with these drug costs. This year, 2010, seniors falling into the donut hole will receive a $250 rebate from the government, and starting next year there will be a 50% discount on brand name drugs, which will ramp up to a 75% discount on brand and generic drugs by 2020, eventually closing the donut hole gap completely.
Whole Article...
Linda Bergthold is a health policy consultant and researcher. She has over twenty-five years of experience and was a working group leader in Hillary Clintons Health Care Reform Task Force in 1993. She has been an advocate of health care reform for two decades in California and nationally. She has a Masters and Doctorate from the University of California at Santa Cruz in Sociology and was a Pew Fellow at the University of California, San Francisco, institute for Health Care Policy. She and her husband have three children and four grandchildren.