Five reasons to be thankful you have Medicare in 2015

Dec. 22--This year marked Medicare's 50th birthday and more than 55 million seniors and people with disabilities can afford the care they need to remain healthy because of Medicare.

The Affordable Care Act has strengthened the Medicare program, helping produce exceptionally slow growth in per beneficiary costs while improving benefits. This includes:

--Savings on prescription drugs: 9.4 million people with Medicare have saved more than $15 billion on their prescriptions, an average of $1,598 per beneficiary.

--Free preventive services: 39 million people with Medicare took advantage of free preventive services under the law, and nearly 4.8 million people took advantage of the Annual Wellness Exam.

--Longer life for the Medicare Trust Fund: The Medicare Hospital Insurance Trust Fund will remain solvent through 2030- an improvement of 13 years compared to 2009 (pre-ACA).

--Slow Growth Rate: Growth in per beneficiary Medicare is exceptionally low. Just 2.3 percent in 2014 and is below the growth rate of per capita Gross Domestic Product and about one-half of the average growth rate from 2000-2010.

PART D

DOUGHNUT HOLE IS

SHRINKING

When the Medicare Prescription Drug program was created in 2003, the law allowed for a coverage gap that has come to be called the "Donut Hole."

When you entered the Donut Hole, you became responsible for 100 percent of the cost of a covered drug until you spent enough on medications to reach the level of "Catastrophic Coverage."

At that point, your prescription drug plan would again share the cost of the covered drug.

This coverage gap was a financial burden to many Medicare beneficiaries.

After the passage of the Affordable Care Act in 2010, discounts and subsidies started to apply during the Donut Hole, which will eventually cause the Donut Hole to be eliminated by 2020.

In 2015, Part D enrollees receive a 55 percent discount on the total cost of their brand-name drugs purchased while in the donut hole.

The 50 percemt discount paid by the brand-name drug manufacturer will still apply to getting out of the donut hole.

Enrollees will pay a maximum of 65 percent co-pay on generic drugs purchased while in the coverage gap.

QUALITY DATA

HELPS CONSUMERS CHOOSE HEALTH

CARE PROVIDERS

New quality measures have been added to Physician Compare (https://www.medicare.gov/physiciancompare/search.html) for group practices and Accountable Care Organizations, and for the first time, individual health care professionals.

These measures focus on the quality of care provided by Medicare physicians and other health care professionals.

Hospital Compare (https://www.medicare.gov/hospitalcompare/search.html) includes information on more than 100 quality measures and more than 4,000 hospitals.

The web site has been refreshed and updated to include new data and several new measures.

CONGRESS FIXES

MEDICARE'S DOCTOR PAYMENTS

Medicare's troubled physician payment formula became history in 2015.

In a rare bipartisan achievement by Democrats and Republicans, the bill known as the "doc fix," overhauls a 1997 law that aimed to slow Medicare's growth by limiting reimbursements to doctors.

This resulted in a wave of doctors threatening to stop accepting Medicare.

The bill blocked a 21 percent cut in Medicare payments that were due to take effect in April 2015.

It also alters the program that dictates how physicians will be paid in the future, by providing financial incentives for physicians to bill Medicare patients for their overall care, not individual office visits.

The "doc fix" bill also included other health measures like funding for therapy services, ambulance services and rural hospitals, as well as continuing a program that allows low-income people to keep their Medicaid coverage as they transition into employment and earn more money.

The deal also would permanently extend the Qualifying Individual, or QI program, which helps low-income seniors pay their Medicare premiums.

SENIORS WIN

IN BUDGET DEAL

The budget deal hammered out between the White House and congressional leaders in October 2015 blunted an unprecedented increase in 2016 Medicare premiums for millions of seniors and prevented a Social Security program for the disabled from becoming insolvent next year.

About 30 percent of the more than 50 million seniors in Medicare Part B, which covers outpatient visits, were facing a 52 percent increase in premiums.

The budget deal prevented that and instead will raise those premiums by 15 percent in 2016. It would also limit an expected increase in deductibles for all enrollees.

May you be healthy and Medicare-wise in 2016!

(Joel Mekler is a certified senior adviser.)

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(c)2015 New Castle News (New Castle, Pa.)

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