Medicare Rights Center - Medicare Watch

Welcome to MEDICARE WATCH, a biweekly electronic newsletter of the Medicare Rights Center

Note to our Readers: Congress’s efforts to pass comprehensive health reform legislation have led to rapid developments in Medicare policy. We have decided to suspend regular publication of Medicare Watch and instead publish periodic special editions that will provide up-to-date information on how health reform legislation could impact Medicare. Today’s edition features a side-by-side comparison of how the Senate and House health care bills will impact key aspects of Medicare.

The side-by-side comparison below has been updated to reflect the bills as passed by the House and the Senate. There are significant differences in the details of the two bills, particularly in the way each piece of legislation affects Medicare. Lawmakers are now trying to reconcile these differences to produce a final bill for President Obama to sign. How Congress decides these and other issues in the coming weeks will greatly impact people with Medicare.

Impact on Medicare	Patient Protection and Affordable Care Act (Senate Bill)	Affordable Health Care for America Act (House Bill)
Prescription Drugs	Requires 50 percent discount on brand-name drugs in the doughnut hole, effective July 1, 2010. (The doughnut hole is the $3,600 gap in the drug benefit when consumers pay full price.) Discount does not apply to individuals with incomes above $85,000 and couples with incomes above $170,000 per year Reduces coverage gap by $500 in 2010 only	Requires 50 percent discount on brand-name drugs in the doughnut hole, effective July 1, 2010 Phases out doughnut hole completely by 2019 by shrinking the gap each year starting in 2010 Secures price concessions from drug manufacturers Allows Medicare to negotiate lower drug prices Lifts the 36-month limit on coverage of drugs to prevent rejection of a kidney transplant
Preventive Services	Eliminates deductibles and coinsurance for preventive services recommended by the U.S. Preventive Services Task Force Provides coverage of annual wellness visit and personalized prevention plan at no charge	Eliminates deductibles and coinsurance for preventive services Moves coverage of all vaccines, including shingles vaccine, to Part B, improving access and reducing coinsurance
Assistance for Low-Income People with Medicare	Eliminates prescription drug copayments for certain Medicaid recipients receiving home- or community-based long-term care	Eliminates prescription drug copayments for certain Medicaid recipients receiving home- or community-based long-term care Expands eligibility for Extra Help (helps pay drug premiums and copayments) and Medicare Savings Programs (helps pay Medicare premiums, deductibles and coinsurance) by more than doubling the amount of allowable savings and other financial assets people can have Extends through December 2012 the Qualified Individual (QI) program, which helps low-income people with Medicare pay for their Part B premiums Pays some Medicare coinsurance and deductibles for people with disabilities under 65 earning up to 150 percent of the federal poverty level ($16,245 individual/$21,855 couple) with limited assets
Doctors	Provides 10 percent bonus for primary care	Related bill eliminates 21 percent pay cut in 2010 and cuts scheduled for 2011 and following years Provides 5-10 percent bonus for primary care
Care Coordination	Provides incentives for doctors to join Accountable Care Organizations that coordinate care from specialists and improve patient health	Provides incentives for doctors to join Accountable Care Organizations that coordinate care from specialists and improve patient health Establishes “Medical Home” pilot to improve access to primary care services, coordination of specialist care and patient health
Hospitals and other facilities	Saves $147 billion over ten years by reducing annual payment increases Provides incentives to reduce readmissions due to infections or other preventable causes	Saves $173 billion over ten years by reducing annual payment increases Provides incentives to reduce readmissions due to infections or other preventable causes
Private “Medicare Advantage” Health Plans	Saves $120 billion over ten years by setting payment based on plan bids Provides bonus payments to plans that meet broadly defined quality or care coordination criteria Prohibits plans from charging enrollees more than Original Medicare for certain medical services Requires plans to use bonus payments to reduce cost-sharing for medical services	Saves $170 billion over ten years by pegging payment to costs under Original Medicare Provides bonus payments to plans that provide high-quality care based on specific performance standards Prohibits plans from charging enrollees more than Original Medicare for any medical services Limits plan profits and administrative expenses to 15 percent of Medicare payments and enrollee premiums
	Creates single Annual Enrollment Period (AEP) for drug and health plan changes from October 15 - December 7 Allows Medicare Advantage enrollees to enroll in Original Medicare during first 45 days of the new year	Creates single Annual Enrollment Period (AEP) for drug and health plan changes from November 1- December 15
Medicare Payment Advisory Board	Establishes an Independent Payment Advisory Board with mandate to implement Medicare provider payment changes to meet savings targets. Limits Congress’s ability to overturn or amend payment changes Board cannot change Medicare eligibility or reduce benefits or premium subsidies. Allowed to make limited changes to how drug plan premium subsidies are calculated	No similar provision
Means Testing Medicare	Raises drug plan premiums for individuals earning over $85,000 and couples earning over $170,000 Freezes inflation indexing for Medicare-related premiums for people with high incomes	No similar provision
Medicare Part A Payroll Tax	Increases the Medicare Part A payroll tax by 0.9% for individuals earning over $200,000 and couples earning over $250,000	No similar provision
Financial Solvency	Adds nine years to the life of the Part A Trust Fund	Adds five years to the life of the Part A Trust Fund

MRC’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.

The Medicare Rights Center would like to hear about your experience, or that of someone you know, enrolled in a Medicare private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed.

The Medicare Rights Center is a national, not-for-profit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.

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