No additional insurance/drug coverage/Medicare/article added

Sorry, I just figured out why no one answered this question - I'll go cut and paste.

Here, then -


New Medicare Bill Bars Extra Insurance for Drugs
By ROBERT PEAR

Published: December 7, 2003

ASHINGTON, Dec. 6 ?- Medicare beneficiaries will not be allowed to buy insurance to cover their share of prescription drug costs under the new Medicare bill to be signed on Monday by President Bush, the legislation says.

Millions of Medicare beneficiaries have bought private insurance to fill gaps in Medicare. But a little-noticed provision of the legislation prohibits the sale of any Medigap policy that would help pay drug costs after Jan. 1, 2006, when the new Medicare drug benefit becomes available.
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This is one of many surprises awaiting beneficiaries, who will find big gaps in the drug benefit and might want private insurance to plug the holes ?- just as they buy insurance to supplement Medicare coverage of doctors' services and hospital care.

Congress cited two reasons for banning the sale of Medigap drug policies. Lawmakers wanted to prevent duplication of the new Medicare benefit. They also wanted to be sure that beneficiaries would bear some of the cost. Health economists have long asserted that when beneficiaries are insulated from the costs, they tend to overuse medical services.

Gail E. Shearer, a health policy analyst at Consumers Union, said she had mixed feelings about the prohibition.

"I don't want a return to abuses of 1970's and 80's, when lots of confusing Medigap policies were sold to vulnerable seniors," Ms. Shearer said. But she added: "Many seniors and disabled people will face a huge gap in drug coverage. In a bill that's marketed as providing choice to consumers, comprehensive drug coverage is not really an option. That's a disappointment."

The new drug benefit would be the biggest expansion of Medicare since creation of the program in 1965. But patients would still face substantial costs.

Under the standard Medicare drug benefit, the beneficiary would be responsible for a $250 deductible, 25 percent of drug costs from $251 to $2,250 and all of the next $2,850 in drug costs. Private Medigap policies could not cover any of those costs.

A Medicare drug plan could further limit coverage by establishing a list of preferred medicines known as a formulary. The list must include drugs in each "therapeutic category and class" ?- antihistamines, antidepressants and cholesterol-lowering agents, for example.

But Medicare would not have to pay anything for drugs left off the list. While patients could appeal a denial of coverage, they could not buy private insurance to cover the costs of such drugs.

Under the standard benefit, a Medicare recipient would pay $3,600 of the first $5,100 of drug costs. After that, Medicare would pay 95 percent of the cost of each prescription. In theory, the bill establishes a limit of $3,600 a year on out-of-pocket costs.

But if a beneficiary bought drugs not listed on the formulary, the bill says, those costs would not be counted toward the $3,600 limit.

Congress began regulating the Medigap market in 1990, as a way to protect consumers, many of whom had bought duplicative policies. The federal government and state insurance commissioners developed 10 standard policies, to replace thousands then on the market.

Three of the 10 Medigap policies cover drugs. Under the legislation, an old policy with drug benefits could be renewed ?- but only by a person who chose to forgo the new Medicare drug benefit. A person who enrolls in the new program could not buy or renew a Medigap policy to help defray drug costs.

Nearly 12 million retirees have drug coverage and other health benefits from former employers. If those retirees sign up for the Medicare benefit, the employers can help pay the beneficiaries' share of drug costs. But those payments would not count toward the $3,600 limit on out-of-pocket spending.

Under the bill, low-income elderly people eligible for both Medicare and Medicaid, the federal-state program for low-income people, would receive their drugs through Medicare. Medicare drug plans will almost certainly cover fewer drugs than Medicaid now covers, state officials say. But the bill generally prohibits Medicaid programs from supplementing the Medicare drug benefit.

If state officials wanted to supplement the new Medicare drug benefit, they would have to pick up the entire cost of the extra coverage. States would not get the discounts and rebates they now receive from manufacturers under Medicaid.

Dr. Lynn V. Mitchell, the Medicaid director in Oklahoma, said she expected Medicare formularies to be "more restrictive" than the drug coverage policies of state Medicaid programs.

"If patients do not get optimal drug therapy," Dr. Mitchell said, "costs will balloon in other areas. Patients may need more inpatient hospital care."

House and Senate negotiators who worked on the Medicare bill encouraged the National Association of Insurance Commissioners to study the Medigap market, with a view to making major changes.

In a report accompanying the bill, the conference committee said Medigap policies should be revised to provide less upfront coverage and to require beneficiaries to pay more of the initial costs of hospital and physician services.

"Numerous studies have demonstrated that covering deductibles and coinsurance has led to higher Medicare spending because beneficiaries become insensitive to costs," the report said. "Beneficiaries with Medigap consume $1,400 more in Medicare services than beneficiaries without supplemental coverage."

This, it said, "drives up costs for everyone ?- premiums of Medicare beneficiaries without Medigap coverage and costs to taxpayers."

It sounds like people who have had a Medigap program with a drug plan may renew it. What is a little fuzzy is whether people getting into Medicare after 2006, can take their choice.

No, it's NOT fuzzy. Looks like the younger people coming in later WON'T have a choice.




I really wonder what is going to happen to the Medigap policies when the older people, who still have the choice, die off!

That is just a first step. Traditional Medicare will also eventually fall victim to this legislation. People will have a choice between HMO and HMO. The sheep will have been shorn.

au1929 - Let's us assume for the moment, that your fears are correct, and insurance for older people is privatized. There is another option besides HMOs. I would assume that the insurance companies would be falling over their feet developing traditional fee-for-service, and PPO plans similar to that which younger people use.

The problem is, that in a few years, baby boomers will be reaching Medicare age. At that point, Medicare, as we know it know, may not be fiscally able to sustain itself.

ANYONE except Bush in 2004...this administration is criminal and raping us as citizens....start this week by having dog food one meal a day...not alpo, the cheap stuff...increase by a meal a day until you're used to it......this is about the only real way to prepare for what's to come compliments of the Bush Crime syndicate.....

Phoenix32890
The fee for service plans developed by the Insurance companies will run into the same problem as Medicare. In order to make them profitable they will require costly premiums. Premiums that most will be unable to sustain.
The present legislation is geared to give a windfall to the insurance and pharmaceutical industries. In addition the cost to the government will be far greater than $400 bln. The entire premise of the legislation is a lie.

au1929 you expected something else? A rhetorical question.....

Bush to Sign Sweeping Medicare Changes
WASHINGTON (AP) - President Bush is signing into law the most far-reaching changes in Medicare since the program's inception nearly 40 years ago, checking off another priority amid questions about its fiscal wisdom. The most significant part of the $400 billion overhaul adds prescription drug coverage to the federal health insurance program for the elderly, starting in 2006. Beginning next May, seniors can buy a Medicare-approved discount card for $30 or less to help offset the growing costs of prescriptions

Question: What is the discount %? Who gets the $30?

I wonder what branch of government represent the Drug and insurance industries? It must be the department of screw the people.

Phoenix32890

I would draw your attention to the dicussion on this subject in the link noted.




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