n passing health care reform, Congress included provisions that are beneficial to seniors. Among those are the following:
- A phase out of the Medicare Part D “donut hole” or “coverage gap” by 2020
- The elimination of Part D cost-sharing for full-benefit dual eligible beneficiaries (those eligible for both Medicare and Medi-Cal/Medicaid) receiving home-based and community-based services
- Increased federal funding for states that provide home-based and community-based services for seniors with Alzheimers rather than only providing care through nursing homes
- Beginning next year, Medicare coverage without cost for preventive care services, such as colorectal screenings, mammograms and an annual wellness visit and creation of a personalized prevention and assessment plan
- An estimated 9-year extension of the Medicare Trust Fund beyond the previously-estimated 2017 depletion
Seniors are living longer and healthier, in large part due to prescription medications which sometimes consume a significant portion of the average senior’s budget. Medicare Part D is a prescription drug program, which pays part of the costs of a person’s prescription drugs for a monthly premium, at least until the person reaches the “donut hole”. In the 2010 Medicare Part D plans, the “donut hole” starts when the retail cost of the medications (not what the senior pays) reaches $2,830 and continues until the retail cost of the medication reaches $6,440, which is when the Medicare Part D beneficiary has spent $4,550 in out of pocket costs for their medications. The $4,550 does not include the portion of their prescription expenses paid by the insurance carrier or their monthly premiums. The existence of the “donut hole” creates quite a financial burden for many seniors. Beneficiaries reaching the “donut hole” in 2010 will receive a one-time $250 rebate. Over the next decade the “donut hole” will be phased out until it is eliminated in 2020.
Some of the additional benefits for seniors are an increase in primary care doctors, nurses, and physician assistants to provide better access to care through expanded training opportunities, student loan forgiveness, and bonus payments; increased support for community health centers; community health teams to coordinate patient care; and programs directed to reducing re-admissions to the hospital when patients are discharged.
A version of this article originally appeared in the Bulletin of the Alameda County Bar Association.
