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Medicare Drug Program News
Medicare Releases 2007 Drug Plans Available in Each
State
Links below will take
readers to their state plans available for enrollment Nov. 15
September 29, 2006 – The Medicare drug programs
available for 2007 in each state were released today by the Centers for
Medicare and Medicaid Services. Check the link in the sidebar on this
page to find the information for your state. Open enrollment begins
November 15. Those satisfied with their current plans do not have to
take any action but CMS says in 2007 there are new options with lowers
costs and more comprehensive coverage.
The monthly premium beneficiaries will pay in 2007
will average $24 if they stay in their current plan -- about the same as
in 2006, says Medicare.
While some people will see an increase in their
current plan premiums, they have the option to switch plans. Nationally,
83 percent of beneficiaries will have access to plans with premiums
lower than they are paying this year, and beneficiaries will also have
access to plans with premiums of less than $20 a month.
Beneficiaries will have more plan options that
offer enhanced coverage, including zero deductibles and coverage in the
gap for both generics and preferred brand name drugs. Plans are adding
drugs to their formularies.
Nationwide the average number of drugs included on
a plan formulary will increase by approximately 13 percent, and plans
will also use utilization management tools at a lower rate.
There will also be new tools from Medicare to help
beneficiaries make a choice.
Surveys, according to CMS, consistently show over
80 percent of Medicare beneficiaries are satisfied with their current
coverage and drug plans. As a result of the Medicare prescription drug
benefit, more than 38 million seniors and people with disabilities now
have some form of drug coverage.
"The Medicare prescription drug benefit, passed by
Congress and signed into law by the President, is saving seniors an
average of $1,200 a year, and it just keeps getting better," HHS
Secretary Mike Leavitt said. "In 2007, there will be more plans with
coverage in the gap, more drugs covered, and more help from Medicare in
choosing the plan that's best for you."
During the 2007 bidding process, strong competitive
pressure resulted in bids (costs of coverage) that average 10 percent
less than in 2006. According to guidance from the CMS, each drug plan or
health plan needed to show meaningful variation in their plan choices,
including only two basic coverage options per region.
CMS also encouraged plans to offer a third option
only if it included enhanced benefits, such as providing coverage in the
coverage gap ("donut hole") or covering excluded drugs.
"With next year's drug coverage, we want to build
on the high level of beneficiary satisfaction in 2006 by strengthening
the drug benefit in key ways," said CMS Administrator Mark B. McClellan.
M.D., Ph.D. "As a result of robust competition and smart choices by
seniors, plans are adding drugs, removing options that were not popular,
and providing more options with enhanced coverage."
"If you're satisfied with your coverage, you do not
have to do anything during the Open Enrollment period. If you are
considering a change, Medicare has new tools to help," McClellan said.
Across the country, nearly all beneficiaries
enrolled in Medicare prescription drug plans will be able to remain in
the plan in which they enrolled for 2006, since almost all Part D
sponsors are either continuing their current plans in 2007 or
streamlining and consolidating their 2006 plans, CMS reports.
They will be able to choose from plans that offer
enhanced benefits or services, such as coverage in the gap and little or
no deductible. Beneficiaries will have a wide range of plans that have
zero deductibles, some of which also offer other enhanced benefits.
There are also options that cover generics and preferred brand name
drugs through the coverage gap for as low as $38.70, and generally for
under $50.
Beneficiaries with limited incomes who qualify for
the extra help will have a range of options available for comprehensive
coverage. Beneficiaries who qualify for the full Medicare subsidy will
pay no premiums or deductibles in these plans. Nationally, over 95
percent of low income beneficiaries will not need to change plans to
continue to receive this coverage for a zero premium.
There are eight new national organizations offering
drug plans to beneficiaries, in addition to the nine national
organizations that were available in 2006. The list of national plans
can be found by
clicking this link.
Medicare Advantage
In general, CMS says, beneficiaries will also have
greater access to Medicare Advantage health plans next year, generally
with lower costs for drug coverage.
These plans offer an opportunity for additional
benefits beyond those covered in the original Medicare program, with
savings that average around $82 a month for hospital and physician
benefits.
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Important Dates |
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• October 1:
Plans begin marketing
• Mid-October:
2007 Plan Data and enhanced Plan Finder available
• October 31:
Annual Notice of Change (ANOC) and Medicare & You Handbook must
be in the mail to beneficiaries
• November
15th: Open Enrollment Begins
• December 8th:
Optimum Date for Early Enrollment to Ensure Timely Processing
• December
31st: Open Enrollment Ends |
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In addition to these savings, Medicare Advantage
plans provide overall care coordination, and more effective use of drugs
that lead to savings in other health care costs. As a result, the cost
of drug coverage in Medicare Advantage plans is about $6 a month lower
on average nationally in 2007 than in 2006. In addition, most
beneficiaries will have access to plans that provide basic drug coverage
for $0, and many will have access to plans that also provide coverage in
the gap for $0.
In addition to prescription drug plans, Medicare
beneficiaries in 39 states will have access to the first Medical Savings
Account plans and related consumer-directed plans ever available in
Medicare. These plans provide Medicare beneficiaries with more control
over their health care utilization and health care costs, while
providing them with important coverage against catastrophic health care
costs.
Beneficiaries who want to consider other options
will have access to help from many sources in the fall including:
● A notice of any coverage changes from their
drug plan, coming at the end of October;
● The enhanced Medicare Drug Plan Finder will be
available in mid- October;
● 1-800-Medicare (1-800-633-4227) which will be
available 24/7;
● The Medicare & You 2007 handbook, the annual
handbook that explains Medicare coverage, which beneficiaries will
receive in October; and
● Local organizations such as the State Health
Insurance Assistance Programs (SHIPs) and thousands of other Medicare
partner organizations that will provide personalized assistance
throughout the fall.
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