15 February 2012
Introduction: The legislation and policy been analyzed in this paper 1. Who this legislation and policy affects and who it covers 2. Problems and issues this Health Care Reform Legislation attempts to address regarding Medicare Part D. 3. History of the legislation
4. The effectiveness of the legislation addressing the problems or issue 5. Summary
Health Care Reform Legislation Closes the Medicare Part D Coverage Gap. Recent health care reform legislation will greatly increase the availability of health insurance and broadly impact the delivery of health care in America. The Medicare Modernization Act of 2003 (MMA) established a voluntary outpatient prescription drug benefit for people on Medicare, known as Part D, that went into effect in 2006. All 49 million elderly and disabled beneficiaries have access to the Medicare drug benefit through private plans approved by the federal government. Medicare replaced Medicaid as the source of drug coverage for beneficiaries with coverage under both programs (“dual eligibles”). Beneficiaries with low incomes and modest assets are eligible for assistance with Part D plan premiums and cost sharing. The Patient Protection and Affordable Care Act of 2010 made some important changes to Part D – in particular, phasing out the coverage gap by 2020. Medicare Part D helps pay for your prescription medications. If you have Medicare Parts A & B, or if you've enrolled in a Medicare Advantage plan that does not include Part D coverage, you can get Part D coverage as a stand-alone prescription drug plan through a private insurance company. However, if you are enrolled in a Medicare Advantage plan that includes Part D coverage, you cannot have a separate, stand-alone Part D plan in this circumstance. What's covered?
Brand-name and generic prescription drugs are covered. The federal government created guidelines for the types of drugs that must be covered, along with setting a minimum standard of benefits. When you enroll in a Part D plan, it does not change the coverage or associated rules Page 2
for prescription drugs covered under Part B. Part B covers drugs in a variety of situations, particularly when drugs are administered in your doctor's office. A drug is considered a Part D drug only when it is prescribed for a medical use that is accepted and approved by the Federal Food, Drug and Cosmetic Act. It is also considered a Part D drug if its use is listed or approved to be listed in one of three industry-supported drug reference books. Each Part D plan has a formulary, or list of drugs, that meets these guidelines, as required by law. http://www.aarphealthcare.com/understanding-health-products/ready-for-medicare/closer-look--part-d.html 1.
This policy provides drug coverage for many elderly and disabled people who did not previously have it. The stand-alone prescription drug plans that are the lynchpin of the program did not previously exist. The structure of the program is clearly intended to increase the role of private plans in Medicare; the degree that this objective conflicts with or enhances the effectiveness of the program will be an important determinant of its success. This legislation and policy affects mostly the elderly and disabled people today. 2.
Three major problem and issue that Medicare Part D faces now and in the future, which has been addressed and attempted to resolve by the Health Care Reform Legislation are as follows: 1.
Keeping drug cost down: Prescription drug costs are too high. Rising drug costs create a growing strain on America’s seniors. A drug benefit was added to Medicare in 2006, but it includes a coverage gap commonly called the “donut hole.” In 2007, over 8 million seniors hit Page 3
the “donut hole.” For those who are not low-income or have not purchased other coverage, average drug costs in this gap are $340 per month, or $4,080 per year. Evidence...
References: Page 7
C. By 2020, 75 percent of the cost of generic drugs in the gap will be subsidized by Medicare (phased in beginning in 2011), while beneficiaries will pay the remaining 25 percent out of pocket.
Medicare Part D, (15 Feb 2012) Retrieved February 15, 2012, from http://www.kff.org/medicare/h08_7821.cfm, this source is the Medicare website.
Medicare Part D, (15 Feb 2012) Retrieved Feb 15, 2012, from http://www.kaiseredu.org/Issue-Modules/Prescription-Drug-Benefit-Under- Medicare/Background-Brief.aspx, this is a Kaiser website.
Medicare Part D, (15 Feb 2012), Retrieved Feb 15, 2012, from http://www.cbo.gov/doc.cfm?index=5406&type=0, this is a government Medicare website.
Health Care Reform Updates (15 Feb 2012), Doughnut-hole-reform, Retrieved 15 Feb 20 12, from, http://insurance.ohio.gov/Consumer/Documents/doughnut-hole-reform.pdf, this is an
History (15 Feb 2012) Legislation History, Retrieved 15 Feb 2012, from, http://en.wikipedia.org/wiki/Health_insurance_in_the_United_States, this is a Wikipedia website.
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