Making Rx Drugs More Affordable for Seniors
The “doughnut hole” is beginning to close. Almost 9,000 Vermont seniors started receiving a one-time $250 rebate check last Thursday as the new federal health care law closes a gap in Medicare coverage for prescription medicine.
Nationwide, more than 3 million people a year fall into the so-called doughnut hole, the gap in coverage for drug costs between $2,830 and $4,550.
About 40 seniors were on hand at the Champlain Senior Center in Burlington’s Old North End to hear Senators Bernie Sanders and Patrick Leahy talk about the new benefits last week. “There is no question, this bill is a major step forward,” Sanders said, “but we still have work to do.”
The first checks were mailed late last week for people whose out-of-pocket expenses already total more than $940 for the year. People covered under Medicare Part D should receive a check automatically.
Susan McBroom, 68, of Burlington arrived early for the press conference to learn about the legislation. “I came because I’m interested in hearing about this health care bill and how it’s going to affect us,” she said, adding she followed the debate and is please progress was made. “I think everyone should have health care.”
Starting in 2011, people affected by the coverage gap will receive a 50 percent discount on brand-name drugs. By 2020, the doughnut hole will be eliminated entirely. In addition, starting in 2011, increased discounts for both generic and brand-name drugs will save seniors more than $700. The savings will grow to more than $3,000 annually by 2020.
Faith Emerson, a retired nurse, traveled from Shelburne with some of her friends to hear from Vermont’s senators Monday morning. “I’m extremely pleased with the health promotion and the disease prevention because that will prevent illnesses that are killing seniors today,” she said, listing heart disease, diabetes and obesity.
The health care law signed March 23 by President Barack Obama also made health care more secure and more affordable by curbing excessive Medicare Advantage payments to private insurance companies, by cracking down on fraud and abuse and by increasing the Medicare payroll tax on the wealthiest Americans. It is estimated that Medicare premiums will drop by $45 per year for 80,000 Vermont seniors thanks to better oversight of the Medicare Advantage program.
This is a very exciting time,” said Greg Marchildon, AARP’s Vermont state director, who also attended the press conference. “Finally, we have made really significant progress.”
Among other improvements, there no longer will be deductibles or co-payments required for an annual checkup or for other preventive services. For low-income seniors, access to no-cost drug plans will be expanded and co-payments will be eliminated for those on Medicare and Medicaid who receive home and community-based care.
While many members of AARP are too young to qualify for Medicare, the new health care law offers benefits to those in their 50s and early 60s who retire early. A new program that began June 1 will benefit 6,000 Vermont retirees with health insurance through their former employers. To encourage companies to continue health care coverage, their former workers are eligible to be reimbursed for up to 80 percent for claims from $15,000 to $90,000 per person.
Vermont’s senators played leading roles in shaping other aspects of the health care law.
Under a Sanders provision cosponsored by Leahy, affordable primary health care will be dramatically expanded through community health centers like the eight already serving more than 100,000 Vermonters. Twenty percent of those over 65 get their primary care at community health centers.
Leahy led the charge, with support from Sanders, to ensure Vermont will get an estimated $100 million to $300 million in additional Medicaid reimbursements during the next decade. The increase means Vermont will not be penalized for expanding Medicaid coverage to more people before the new health care law took effect.
