Medicare Prescription Drug, Improvement, and Modernization Act of 2003

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Medicare Prescription Drug Improvement and
Modernization Act of 2003
Department of Health Human Services
December 30 2003
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MEDICARE TODAY

• 41 million beneficiaries
• 284 billion in expenditures
• Need for supplemental coverage

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RATIONALE FOR REFORM

• More choices and better benefits
• Modernize Medicare to reflect changes to the
  health care system
• Improve access to care

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KEY COMPONENTS OF THE LAW

• Medicare-Approved Drug Discount Card
• New Preventive Benefits
• Prescription Drug Benefit
• Medicare Advantage Program
• Assistance for Rural and Other Providers to
  strengthen access to care for people with
  Medicare

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MEDICARE-APPROVEDDRUG DISCOUNT CARD

• Estimated savings of 1025 on many drugs
• Enrollment as early as May 2004
• 600 to provide immediate relief to certain
  low-income people with Medicare

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Available January 2006
NEW MEDICAREPRESCRIPTION DRUG BENEFIT

• 250 beneficiary deductible
• Medicare will pay 75 of drug costs up to 2250.
  The beneficiary will pay 25 of these costs
• Beneficiary will pay100 of drug costs between
  2250 and 3600 in out-of-pocket spending
• After 3600 Medicare will pay approximately 95

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Extra Help for People with Low Income

• People below 100 of the Federal poverty level
  will be entitled to Medicare and full Medicaid
  coverage
• Income limits will be set in 2005
• Other people with low income and limited assets
  will get help paying premiums and deductibles

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MEDICARE ADVANTAGE PROGRAM

• New Medicare Advantage program with better
  benefits and more choices
• Payments to Medicare Advantage plans to increase
  in 2004

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MEDICARE ADVANTAGE PROGRAM

• Important new plan choices begin in 2006
• Most important new option - Regional preferred
  provider organizations (PPO). PPOs are among the
  most common and popular plans right now for
  Americans not eligible for Medicare.

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ASSISTANCE FOR RURAL PROVIDERS

• 25 billion in increased reimbursement
• Improve access to doctors hospitals ambulances
  and home health care for people in rural areas

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PAYMENTS TO NON-RURAL PROVIDERS

• Part A
• Part B

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OTHER IMPORTANT PROVISIONS
New Preventive Benefits Available January 2005

• Welcome to Medicare Physical Exam for New
  Enrollees
• Cardiovascular Screening Blood Tests
• Diabetes Screening Tests

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OTHER IMPORTANT PROVISIONS

• Contracting reform
• HHS to conduct appeals process
• Changes in Medigap coverage
• Competition program
• Income-related Part B premium

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COMMUNICATING WITH THE PUBLIC

• Beneficiaries
• Providers
• Congress
• Governors and State Legislators
• Advocates
• Other stakeholders

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OPEN DOOR
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SOME MAJOR IMPLEMENTATION DATES

• January 2004 Increase payments to rural
  hospitals Physician payments increased
• March 2004 Increased Medicare Advantage payment
  rates
• Enrollment as early as May 2004 Drug Discount
  Card
• January 2005 Preventive benefits Physician
  scarcity bonus payments
• January 2006 Prescription Drug Benefit
  Regional Medicare Advantage Plans (PPOs)

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FOR MORE INFORMATION

• 1-800-MEDICARE
• www.medicare.gov
• www.cms.hhs.gov

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