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As the Medicare Quality Improvement Organization of Arizona, Health Services Advisory Group has received numerous inquiries about the Medicare Prescription Drug Improvement and Modernization Act of 2003.

In an effort to educate the public on the new regulations, HSAG is working with the Centers for Medicare & Medicaid Services (CMS) to distribute the publication "Facts About Upcoming New Benefits in Medicare" (PDF, 1.33MB), a concise two-page flyer outlining the new law strengthening Medicare, while expanding the scope of patient benefits.

According to CMS, key elements of the Medicare Modernization Act include:

Medicare-Approved Drug Discount Cards

• Medicare-Approved Drug Discount Cards will be available in 2004 to help patients save 10% to 25% on prescription drugs. Medicare will contract with private companies to offer new drug discount cards until a Medicare prescription drug benefit starts in 2006.

Medicare Advantage

• Medicare Advantage is the new name for Medicare+Choice plans. Medicare Advantage rules and payments are improved to give patients more health plan choices and better benefits. Medicare Advantage plan choices will be expanded to include regional preferred provider organization plans (PPOs) that can help patients save money by choosing from doctors and providers on a plan’s “preferred” list. PPOs are currently among the most common and popular plans for working Americans.

New Preventive Benefits

• One-time initial wellness physical exam within six months of the day you first enroll in Medicare Part B.
• Screening blood tests for early detection of cardiovascular (heart) diseases.
• Diabetes screening tests for people with Medicare at risk of getting diabetes.
• These benefits add to the many preventive services that Medicare already covers, such as cancer screenings, bone mass measurements and vaccinations.

Tax-Free Health Savings Accounts

• Starting immediately, Americans will be able to set aside money each year, tax free, in Health Savings Accounts. The savings accounts can be used to pay for medical expenses, and money not spent would stay in the account and gain interest tax-free, just like an Individual Retirement Account (IRA). A health insurance deductible must be at least $1,000 for a single person and at least $2,000 for family coverage.

Prescription Drug Plan Starts in 2006

All people with Medicare will be able to enroll in plans that cover prescription drugs. Plans might vary, but in general, this is how they will work:

• Patients will choose a prescription drug plan and pay a premium of about $35 a month.
• Patients will pay the first $250 (called a “deductible”).
• Medicare then will pay 75% of costs between $250 and $2,250 in drug spending. Patients will pay only 25% of these costs.
• Patients will pay 100% of the drug costs above $2,250 until they reach $3,600 in out-of-pocket spending.
• Medicare will pay about 95% of the costs after patients have spent $3,600.
• Some prescription drug plans may have additional options to help pay the out-of-pocket costs.
• Extra help will be available for people with low incomes and limited assets.

For more information on Medicare reform, read "The Facts About Upcoming New Benefits in Medicare" (PDF, 1.33MB).

If you still have questions on the new regulations or have other Medicare related-questions, visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227).

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