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Drug Rebates On The Way

May 31, 2010 By: Nadia Category: HealthCare, Medtipster, Prescription News

www.Medtipster.com Source: Los Angeles Times, 5.28.2010

Senior citizens who hit the so-called doughnut hole in Medicare’s drug benefit will begin getting $250 rebate checks in two weeks, the Obama administration announced Thursday — providing one of the first tangible benefits of the recently enacted healthcare law.

The rebates, designed in part to bolster support for the controversial law, are the first steps in a decade-long phase-out of the unpopular gap in Medicare Part D drug coverage.

Seniors now enrolled in a Medicare Part D plan pay 25% of the cost of their prescription drugs until the total bill reaches $2,830. At that point, enrollees must pay the full cost of their prescriptions until their total out-of-pocket spending reaches $4,550. Catastrophic coverage then kicks in and enrollees pay 5% of drug costs for the rest of the year.

Department of Health and Human Services officials said Thursday that the first 80,000 seniors who hit that coverage gap, or “doughnut hole,” will be sent checks on June 10, five days before the deadline.

Checks will then go out monthly until the end of the year as more seniors fall into the gap. Health and Human Services Secretary Kathleen Sebelius said Thursday that the department estimated slightly more than 4 million seniors would ultimately get rebates.

“Seniors do not have to do anything to get this check. They don’t have to sign anything. They don’t have to apply for it,” Sebelius said, warning recipients not to be fooled by scam artists seeking personal information by claiming it is necessary to process rebates.

Starting in 2011, the rebate will be replaced by a discount. Seniors whose expenses fall within the doughnut hole will qualify for a 50% discount on drugs. That will be gradually phased up to a 75% discount in 2020, effectively eliminating the coverage gap.

Thursday’s announcement comes as the Obama administration works to highlight benefits of the new healthcare law in the face of persistent public wariness.

Since President Obama signed the law in March, administration officials have secured commitments from insurance companies to immediately begin offering parents who buy their own insurance the option of including their adult children under 26. Employers who provide coverage may choose to make the option available, but it is not mandatory until October.

The administration is also working with states to create new high-risk pools this summer to allow people who have been denied coverage because of preexisting medical conditions to get insurance. However, there are questions about whether there is enough money to do this.

The new healthcare law’s biggest changes — including the creation of regulated insurance markets, the requirement that everyone have health insurance, and the ban on insurance companies denying coverage to sick people — do not go into effect until 2014.

Health Secretary Warns of Insurance Scams

April 07, 2010 By: Nadia Category: Medtipster, Prescription News

www.medtipster.com blog article source: www.nytimes.com – Author: Jackie Calmes

Health Secretary Warns of Insurance Scams

The secretary of health and human services, Kathleen Sebelius, wrote to state officials on Tuesday to urge that they take action against “scam artists” reportedly marketing fake insurance policies to exploit the new law overhauling the health care system.

“Unfortunately, scam artists and criminals may be using the passage of these historic reforms as an opportunity to confuse and defraud the public,” Ms. Sebelius said in a letter to state insurance commissioners and attorneys general.

In the letter and in a speech at the National Press Club, she described reports of people setting up toll-free telephone numbers and going door-to-door peddling phony policies, in some cases falsely claiming that the new law established a limited enrollment period for buying government-subsidized insurance.

Ms. Sebelius compared the alleged scams to reports during the H1N1 flu epidemic of sales of counterfeit flu treatments, and called on the state officials to investigate and prosecute any reported cases of insurance rip-offs.

She also said her department was alerting seniors groups to beware of fraudulent sales pitches. The insurance exchanges to be established under the law do not take effect until 2014, although states can get federal aid in the meantime to set up insurance pools for high-risk individuals to buy policies more cheaply than they can on their own.

In her speech, Ms. Sebelius described additional steps that her department is taking this week to implement the health insurance overhaul that President Obama signed into law last month. The department is issuing guidelines for private Medicare Advantage plans to include cost-sharing protections for seniors and new options for Medicaid to cover low-income adults.

She also announced a “Medicare dashboard” on the department’s Web site where users can search Medicare data on spending for inpatient hospital care and sort it by state, hospital and condition “to give consumers, purchasers and providers the health information they need to make smarter choices.”

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