January 23, 2005

Medicare Prescription Drug Rules Now Issued



Fifteen hundred pages of rules governing the Medicare Prescription Drug program have now been published in final form. Are you feeling a little overwhelmed at this point?

The Washington Post published a piece on this describing the changes made to the rules as proposed last summer:

The agency also outlined several changes made in the regulations since a preliminary version was announced in July. They now assure that beneficiaries have access to convenient pharmacies, and charity payments have been added that can count toward true out-of-pocket spending needed before catastrophic coverage kicks in.

Rules also are being put in place to ensure that beneficiaries will be able to get drugs that might not be on the plan's list and to ensure that decisions whether medications would be covered under the plan are made within 72 hours or faster for expedited requests, McClellan said.
The plan guarantees that beneficiaries living in nursing homes will be able to enroll in a drug plan and provides automatic enrollment for people eligible for both full Medicaid and Medicare benefits to avoid gaps in coverage.


The article gives an overview of the plan:

The rules create a new regional Medicare Advantage program for preferred provider organizations, with 26 regions. All regional PPO plans are required to offer benefits identical to those of traditional fee-for-service Medicare.

Under the new program, participants will pay $35 monthly premiums and the first $250 in drug costs. Medicare will pick up 75 percent of the next $2,000 in prescription expenses. After that, a gap is built into coverage during which participants are responsible for the entire drug bills until costs top $5,100, after which the government pays 95 percent.

In a separate article, the Washington Post writes that the Administration is going to automatically sign up millions of low-income seniors:

After a lackluster response to its Medicare drug discount card, the Bush administration announced yesterday that it will automatically enroll millions of low-income seniors in the full drug benefit program when registration begins next fall.

Yet another article in the same paper says that Medicare will extend coverage for surgically implanted heart- shocking devices for people with weakened hearts:

The government has decided to expand its coverage for surgically implanted heart-shocking devices for people with weakened hearts, in what could be the most expensive single decision in Medicare's history, federal officials said yesterday.

More than half a million Americans with the progressive heart-weakening condition known as congestive heart failure could be eligible for the battery-powered implants and accompanying surgery under the plan, which Medicare officials said they will roll out in the next week or so.