Issue Position: Medicare

Issue Position

Issue Position: Medicare

This law is now in its second year of enactment. I opposed this law because it places profits for drug companies ahead of security for Medicare's 43 million beneficiaries. I firmly believe that Medicare is a right and should be protected, but this law is little more than a disguised attack on a proven health insurance system that seniors and persons with disabilities have counted on for almost forty years.

The addition of the Medicare prescription drug law provides Medicare beneficiaries with inadequate drug coverage that is sparse compared to the coverage. This year, Medicare beneficiaries with annual drug costs between $2,400 and $5,451 are required to pay their entire prescription costs out of their own pockets - a so-called "doughnut hole" that is more like a coverage chasm. It is not fair to make seniors pay premiums - with no cap on future premium increases- when they receive no coverage for part of the year.

In addition, the Medicare prescription drug law effectively prevents Medicare beneficiaries from buying cheaper drugs in Canada and other countries. The law also prohibits the federal government from negotiating lower drug costs for Medicare beneficiaries in order to line the pockets of drug manufacturers.

Democrats have pledged to address these two serious problems. On the fifth legislative day of the new Congress, the U.S. House of Representatives passed H.R. 4, the Medicare Prescription Drug Price Negotiation Act, by a vote of 255-170. I was a co-sponsor of this bill. H.R. 4 would repeal the provision in current law that prohibits the Secretary of Health and Human Services (HHS) from negotiating with drug companies for lower prices. Instead, this bill would require the Secretary of HHS to conduct such negotiations with drug companies on behalf of Medicare beneficiaries.

We can and we should harness the purchasing power of the federal government to provide prescription drug coverage for all our Medicare beneficiaries. The states, Fortune 500 companies, and large pharmacy chains all use their bargaining clout to obtain lower drug prices for the patients they represent. The federal government negotiates on behalf of federal employees, veterans and our Armed Forces. Medicare should do the same for its beneficiaries.

Furthermore, to ensure that Congress is able to closely monitor the Administration's progress in this effort, H.R. 4 would require the Secretary of HHS to submit to the Congress a report on the negotiations conducted by the Secretary and report any price discounts achieved by the Secretary as a result of such negotiations.

Rest assured, I want Medicare beneficiaries to have a better prescription drug benefit. Medicare beneficiaries should not have to decide between paying for their prescription medications and paying for heat, rent or groceries. As the 110th Congress move forward, I will certainly keep your views in mind as we look for ways to strengthen Medicare on behalf of its 43 million beneficiaries.

MEDICARE PRESCRIPTION DRUG PLAN
FREQUENTLY ASKED QUESTIONS AND ANSWERS

Should I purchase a Medicare Prescription drug plan?
The new Medicare benefit is voluntary. It depends on your current situation. Whether or not you should enroll in the new Medicare drug benefit depends on whether you have drug coverage now and the quality of your current benefits.
If you currently have drug coverage, you need to find out whether your current plan is "creditable" (as good as or better than Medicare's drug benefit). If you have drug coverage that is as at least as good as Medicare's drug benefit and you're happy with it, you do not have to do anything. You should get a notice telling you if your current plan is as good as Medicare's drug benefit from the sponsor of your drug benefits— this could be your insurance company, your current or former employer, your union, or another group. If you don't get a notice in October, call and ask for it. If you do not have drug coverage now and don't think you need it, you may want to consider purchasing a very basic plan to avoid paying a penalty later.
What if I already have prescription drug coverage...
...through an employer, former employer, or union already?
Check with your former employer about your options before doing anything. They should send you a notice. Again, if you don't get a notice, call and ask. If you are happy with your employer coverage, and it is continuing, you should not need to do anything. If you drop your employer or union health coverage, you may not be able to rejoin it later. If your employer coverage drops, you have 63 days to enroll in a Medicare plan without financial penalty.
...through a Medicare managed care program?
Some people have Medicare managed care plans, which are now called Medicare Advantage plans. Your plan will send you information about your options in October. If you do not want to remain in that plan, you may either enroll in a different Medicare Managed Care plan or return to traditional Medicare and select a private drug plan.
...through Michigan Medicaid?
By law, beginning January 1, 2006, states cannot offer a Medicaid drug benefit to people who are also in Medicare. You will be eligible to receive free premiums as long as you pick a plan with average or below average premiums. If you fail to choose a plan, you will be automatically assigned a plan, but you will be able to change plans monthly if need be (this is the only group that can change plans more than once per year).
...through the Veterans Administration?
Your Department of Veterans Affairs (VA) drug coverage will remain the same, and you probably do not want to enroll in a Medicare private drug plan. VA coverage is more comprehensive than Medicare drug coverage.
In addition, if you ever do want to enroll in the Medicare drug benefit later, VA drug coverage is "creditable coverage," so you will not have to pay a penalty as long as you enroll in the Medicare drug benefit within 63 days of losing VA benefits.
Note: Since January 2003, the VA has cut off new enrollment for some veterans because of budget constraints.
Note: You may want to join a Medicare private drug plan if you live very far from a VA facility and the Medicare private drug plan includes nearby pharmacies in its network, or if you live in a nursing home that does not accept your VA drug benefits.
How do I decide what plan is right for me?
Most importantly, take your time. Once you sign up you can only change plans once per year; so it is important that you carefully examine your options before deciding whether to enroll in a plan and which plan is right for you. Your "Medicare and You" book will give an overview of the plans available in Michigan. There are 18 different insurance companies offering plans in Michigan, most of which offer multiple plans. You can contact Medicare (Medicare.gov, 1-800-Medicare), the individual plans, and the Michigan Medicare/Medicaid Assistance Program (800-803-7174) to receive assistance in finding the best plans for your health needs. I also recommend speaking with your doctors, pharmacists, and family.
What happens if I do not enroll in a plan?
If you have creditable coverage from your employer or union, nothing happens. If you lose that creditable coverage, you have 63 days to enroll in a new plan or pay a higher premium. If you have no prescription drug coverage, your premiums will be higher if you do not enroll when you first become eligible for coverage.
How do I know if I qualify for extra help?
If you get Medicaid, or receive Supplemental Security Income (SSI), you automatically qualify for help with premiums and co-pays. You do not have to apply for this extra assistance. In general, you can apply for help with your premiums if your income is less than $15,315 for an individual / $20,535 for couples and assets are less than $11,710 for individuals and $23,410 for a couple, including burial expenses. If you think you qualify for extra help, you should call the Social Security Administration at 1-800-772-1213 for more information. Keep in mind that applying for the extra help does not enroll you in the Medicare drug benefit. You still have to choose a private drug plan through which to get your drug coverage.
Where will I be able to fill my prescriptions?
Each plan has different pharmacies in their network. Check with the plans you think fit you best to see which pharmacists are accepting the plan. Also, talk with your local pharmacist about which plans he or she is taking.
What do I do if I travel or live in Michigan for only part of the year?
There are eight companies offering national plans that work anywhere in the U.S.
What is the coverage gap, or doughnut hole, that people talk about?
One of the biggest problems of the new benefit is that it requires companies to design their plans with a coverage gap. The basic plan requires people to pay 100% of their drug costs between $2250 and $5100, and continue to pay their premium. Some plans are shrinking or eliminating the coverage gap, but by law plans can only do so if they also raise premiums, deductibles, and copays or eliminate choices. Ask the plans specifically about the coverage gap, or doughnut hole, as it is sometimes called.
Given the increase in Part B premiums, I can't afford the Part D premiums. What do I do?
The new law has no limits on how much Medicare premiums can go up. The monthly premium for Medicare Part B will increase by $10.30 to $88.50, or 13% in 2006. You may qualify for extra help with your drug benefit premiums and deductibles if your income is less than $15,315 for an individual / $20,535 for couples and you have limited assets. There is a state of Michigan program that helps seniors pay their premiums. Contact your local Medicaid office.
I receive my prescription drugs through a drug discount card. What will happen?
If you have drug discount cards, such as EPIC, you should call the company to find out what will happen on January 1, 2006.
If you are comparing plans, here are some important questions to ask:

* How much is the premium (the monthly amount I'll pay for my plan)?
* How much are the copayments or coinsurances (the amount I'll pay at the pharmacy)?
* What is the deductible (the amount I'll pay before my plan starts to cover anything)?
* Does the plan cover all or most of the medicines I take?
* Does the plan cover the most important medicines I take?
* Does the plan cover the pharmacies I use?
* Will I have to pay the full cost of my prescriptions at any point after the deductible?
* Could I risk losing my current coverage if I join this plan?
* What is my plan's network of coverage?
* If I travel regularly, what kind of coverage will I have outside of my area?

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