Medicare Monitor

Medicare Monitor

The Palm Beach Post's veteran Washington correspondent, Larry Lipman, tracks policy makers and interest groups who are shaping the future of the federal health insurance program for the elderly.

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Medicare is the federal health care system that covers about 36 million people age 65 and older, plus 7 million disabled. It has four parts:

Part A Covers inpatient hospital care as well as nursing home, home health and hospice care. Nearly all elderly and disabled Americans qualify for Part A coverage.
Financed by a 2.9 percent payroll tax divided equally between employees and employers.

Part B Covers outpatient care, doctor’s services, durable medical equipment, home health visits and preventive care. Part B coverage is voluntary, but roughly 40 million are enrolled.
Financed by beneficiary premiums and federal general revenue. Current monthly premiums are $93.50. Starting this year, individuals whose taxable income is more than $80,000 will pay a higher premium.

Part C Medicare Advantage managed care plans provide health care normally covered by Medicare Parts A and B. They may also provide some other benefits, including prescription drugs, not covered by traditional Medicare. Oart C is voluntary; about 7 million beneficiaries are enrolled.
Financed by Medicare and beneficiary premiums, which vary among plans.

Part D Medicare prescription drug plans come in two types, those that just cover prescription drugs and those that cover drugs as part of a broader managed care benefit. Part D is voluntary. About 9.2 million beneficiaries are in stand-alone drug plans and about 5.1 million are in managed care drug plans.
The plans are private and financed by Medicare and beneficiary premiums, which vary among plans.
-- Larry Lipman

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Home > Medicare Monitor > Archives > 2008 > April > 08

Tuesday, April 8, 2008

Part D thresholds increase for 2009

By Larry Lipman | Tuesday, April 8, 2008, 12:18 PM

Medicare beneficiaries will pay more out of pocket for their prescription drugs next year, according to figures released by the Center for Medicare and Medicaid Services.

The Part D standard benefit deductible will increase from $275 to $295 and the initial coverage limit — the threshold amount shared by the insurance company and the beneficiary — will increase from $2,510 to $2,700.

Once that amount is reached, beneficiaries will be on their own. This is the so-called doughnut hole. It currently ends when a beneficiary has spent $4,050; next year it will end when the beneficiary has spent $4,350.

Generic drugs will cost slightly more, although far less than brand-name drugs. They’ll increase from a minimum charge of $2.25 to $2.40 per prescription.

Meanwhile, CMS announced that private Medicare Advantage managed care plans will receive a 3.6 percent payment increase next year.

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