There were no doughnut holes Monday at the Heritage Senior Center, but they were nonetheless on the minds of seniors who came to hear Health and Human Services Secretary Kathleen Sebelius speak about the impact of the new healthcare law on Medicare benefits.
The "doughnut hole" is the nickname for a big gap in seniors' Medicare prescription coverage that the healthcare law will close over several years.
"It's something that's been talked about and debated for years," said Sebelius, who is traveling the country to explain the healthcare bill to consumers.
Sebelius said the aim of the road show is to correct "misperceptions" about the law, passed by Congress and signed by President Barack Obama this year.
Guaranteed Medicare benefits
The law expands Medicare benefits, allowing annual wellness checkups, and eliminates co-payments for preventive screenings such as mammograms beginning in 2011, according to AARP. Under the old law, "you get a wellness checkup when you enter the program, but at no other time," Sebelius said.
On co-pays, she said some amounted to a financial barrier.
The law cuts federal payments to Medicare Advantage, supplemental plans run by private organizations. It freezes the maximum that Medicare pays these plans for 2011 and phases in cuts in 2012 based on relative costs for services in each county, according to the Kaiser Family Foundation. Beginning in 2012, plans with high quality ratings will receive bonuses. Plans will be rewarded for bidding at less than Medicare's maximums per county.
"Choices will continue in both Medicare and Medicare Advantage," Sebelius said.
The doughnut hole
Medicare's prescription drug benefit covers seniors for their drug spending up to $2,700 in a year, lapses after that and picks up coverage again at $6,154: the doughnut hole.
An estimated 8 million seniors reach that gap, Sebelius said. "We know for a lot of people that's just an enormous burden," she said.
Under the new law, seniors who reach the doughnut hole this year will automatically be sent a check by Medicare for $250, Sebelius said. "You don't have to apply for it," she said.
Beginning next year, seniors who hit the hole will get a 50 percent discount on brand-name drugs, provided by the drug industry, Kaiser says. Doughnut hole Medicare coverage starts to phase in next year for generics and in 2013 for brand-name drugs.
By 2020, Medicare Part D enrollees who are in the doughnut hole will be responsible for 25 percent of the costs of generics and brand-name drugs, compared with 100 percent this year, Kaiser says.
Tougher on fraud
The government is "getting very tough on fraud and abuse," under the new law, including more stringent requirements for Medicare entry and stiffer fraud penalties, Sebelius said.
Medicare pays providers $40 billion annually, Sebelius said. "There are some who come into the Medicare program specifically to rip people off," she said.
// var ranNum = Math.round(Math.random()*1000000); document.write('http://content.yellowbrix.com/images/content/cimage.nsp?ctype=full_story&story_id=147604452&id=thirdage&ip_id=McClatchy-Tribune+Business+News&source_id=Fort+Worth+Star-Telegram+%28Fort+Worth%2C+Texas%29&category=Healthcare&random=' + (ranNum));// ]]>//
