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Prescription Drug Coverage - A Medicare First

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Prescription Drug Coverage - A Medicare First
By: Rep. Rodney Frelinghuysen (NJ-11)

October 20, 2005

Forty years ago, President Lyndon Johnson signed a law creating Medicare to provide health care to older Americans. Since then, millions have come to appreciate and rely upon the coverage that Medicare has provided for treatment from doctors and hospitals when they get sick.

Over the past four decades, however, health care and medical needs have changed. Thanks to advancements in medical technology, medicine is increasingly focused on prevention, early diagnosis, and prescription medication.

Today, prescription medicines are able to limit the effects of disease or prevent surgery altogether. Seniors who have been diagnosed with heart disease, arthritis, diabetes or any chronic ailment are now able to manage their illness through medication rather than relying on surgery and extended hospital stays.

The problem, however, is that Medicare has not completely kept up with the advances in medicine. When this historic program was created in 1965, it did not cover the cost of prescription medicines. As a result, for example, Medicare will pay $28,000 for ulcer surgery, but not $500 for the prescription medicines to prevent ulcers! In addition, Medicare pays for heart surgery, but not for some of the medicine to help prevent the surgery from being needed in the first place.

Meanwhile, with the rising cost of prescription medicines, many seniors cannot afford to continue taking the multiple medications they need to live healthy and independent lives. Without access to these vital prescriptions, they cannot fully benefit from advances in modern healthcare.

Starting January 1, 2006, Medicare will now include voluntary prescription drug coverage for seniors. Formally known as Medicare Part "D," this new prescription drug benefit is expected to do more to reduce drug prices for seniors than any other reform ever enacted into law.

Under this new benefit, nearly 40 million Medicare beneficiaries, including 1.2 million New Jerseyans, will be able to choose a prescription drug plan that they believe is best for them and offers the most affordable, life-saving, and life-enhancing medicines. For just a small monthly premium and copayment, older Americans who rely on Medicare will be offered a guaranteed choice of drug plans within the traditional Medicare program and by private health care providers. With these available options, Medicare beneficiaries will be able to select from brand name and generic medicines, and then have the option to pick them up at local pharmacies or receive them by mail, as many do now.

Once they have chosen the plan they believe best meets their health care needs, seniors will be able to sign up for this benefit beginning November 15 and start receiving prescription drug coverage on January 1, 2006.

In New Jersey, 17 health care organizations will offer prescription drug plans to Medicare beneficiaries, including three that have premiums of less than $20 a month. According to the Centers for Medicare and Medicaid (CMS), the federal agency responsible for overseeing the new prescription drug benefit, New Jerseyans who rely on Medicare will also be able to get drug coverage with additional benefits and even lower total "out-of-pocket" costs by enrolling in Medicare Advantage plans. The Medicare Advantage option will include one statewide Preferred Provider Organization (PPO) plan and three Health Maintenance Organizations (HMOs) to provide prescription drug coverage for no additional cost.

For seniors covered by New Jersey's Pharmaceutical Assistance to the Aged and Disabled (PAAD) program, I worked hard to ensure PAAD beneficiaries can seamlessly transition from PAAD to Medicare. Further, I am making sure the state is doing everything in its power to help seniors maintain their existing PAAD benefits under the new Medicare prescription drug program. Currently, the state is also reviewing the medication of PAAD recipients and then using that information to help them select a Medicare drug plan that best suits their health needs.

With more information about the new drug benefit being sent to New Jersey seniors, there is no better time to sit down with loved ones covered by Medicare or PAAD and help them review their prescription needs. For those who are caregivers, sons and daughters to older Americans on Medicare, I encourage you to review the detailed information that is being sent by CMS or private health care providers and help seniors choose a plan that addresses their individual concerns about cost, coverage, and convenience.

To learn about the Medicare prescription drug benefit or to get personalized, local assistance, all Medicare beneficiaries in New Jersey can contact their County Office on Aging or a counselor at New Jersey s State Health Insurance Assistance Program (SHIP). Seniors are also encouraged to contact Medicare directly by calling 1-800-MEDICARE or visiting

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