You wouldn’t know it from reading the major dailies, since they have widely failed to report it, but while Congress wrestles over partisan talking points over whether online healthcare exchanges have been successful or not since they first launched on Oct. 1, The Centers for Medicare & Medicaid Services reported Monday that health care reform efforts at the center of the political storm in Washington are producing out-of-pocket savings for Medicare beneficiaries across the naton of more than $8 billion in cumulative savings in the prescription drug coverage gap known as the “donut hole.”
Big savings on drug costs
According to CMS, since the Affordable Care Act provision to close the prescription drug donut hole took effect, more than 7.1 million seniors and people with disabilities who reached the donut hole have saved $8.3 billion on their prescription drugs. In the first nine months of 2013 nearly 2.8 million people nationwide who reached the donut hole this year have saved $2.3 billion, an average of $834 per beneficiary. These figures are higher than at this point last year (2.3 million beneficiaries had saved $1.5 billion for an average of $657 per beneficiary).
CMS also reported that there will be no growth in 2014 Medicare Part B premiums and deductibles compared to last year. Bending the cost curve has been a fundamental in the design of the Affordable Care Act. Reducing the rate of growth is a long term goal, but short-term cost containment is necessary in the overall discussion about deficits and debt.
The health care law gave those who reached the donut hole in 2010 a one-time $250 check, then began phasing in discounts and coverage for brand-name and generic prescription drugs beginning in 2011, CBS said in a media release. The Affordable Care Act will provide additional savings each year until the coverage gap is closed in 2020, it said.
As for the standard Medicare Part B monthly premium, it will be unchanged at $104.90 in 2014, the same as it was in 2013. The premium has either been less than projected or remained the same, for the past three years, CMS said, adding that the Medicare Part B deductible will also remain unchanged at $147. The last five years have been among the slowest periods of average Part B premium growth in the program’s history.
“We continue to work hard to keep Medicare beneficiaries’ costs low by rewarding providers for producing better value for their patients and fighting fraud and abuse,” CMS Administrator Marilyn Tavenner said. “As a result, the Medicare Part B premium will not increase for 2014, which is good news for Medicare beneficiaries and for American taxpayers,” said Tavenner, who appeared Tuesday at a House committee hearing on the ACA.
People with Medicare don’t need to sign up for the new Health Insurance Marketplace, as they are already covered by Medicare. Moreover, the Marketplace won’t affect Medicare choices, and no matter how an individual gets Medicare, whether through Original Medicare or a Medicare Advantage Plan, they still have the same benefits and security they have now, CMS said.
Medicare Parts A and B Premiums and Part A Deductible
By law, the standard Part B premium represents roughly one-fourth of the average cost for beneficiaries aged 65 and over, plus a contingency margin to provide for possible variations between actual and projected costs. Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items.
Beginning in 2007, beneficiaries with higher incomes have paid higher Part B monthly premiums. These income-related monthly premiums, which affect less than 5 percent of people with Medicare, also will remain the same as they were in 2013.
CMS also announced today that the Medicare Part A premium, which pays for inpatient hospital, skilled nursing facility, and some home health care services, will drop $15 in 2014 to $426. Although about 99 percent of Medicare beneficiaries do not pay a premium for Part A since they have at least 40 quarters of Medicare-covered employment, enrollees age 65 and over and certain persons with disabilities who have fewer than 30 quarters of coverage pay a monthly premium in order to receive coverage under Part A. Beneficiaries who have between 30 and 39 quarters of coverage may buy into Part A at a reduced monthly premium rate which is $234 for 2014, a decrease of $9 from 2013.
The Medicare Part A deductible that beneficiaries pay when admitted to the hospital will be $1,216 in 2014, an increase of $32 from this year’s $1,184 deductible.
The deductible covers beneficiaries’ costs for up to 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries must pay $304 per day for days 61 through 90 in 2014, and $608 per day for hospital stays beyond the 90th day. For 2013, per day payment for days 61 through 90 was $296, and $592 for beyond 90 days. For beneficiaries in skilled nursing facilities, the daily co-insurance for days 21 through 100 in a benefit period will be $152.00 in 2014, compared to $148.00 in 2013.
Open enrollment begins
CMS recently announced the start of the Medicare Open Enrollment, which begins today, October 15th and ends December 7th. People with Medicare are encouraged to review their current health and prescription drug coverage options for 2014. Medicare’s Open Enrollment is not part of the Affordable Care Act’s new Health Insurance Marketplace, and people with Medicare do not need to do anything with Marketplace plans.
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