Title: Medicare Prescription Drug, Improvement, and Modernization Act of 2003
1Medicare Prescription Drug, Improvement, and
Modernization Act of 2003
Department of Health Human Services
December 30, 2003
2MEDICARE TODAY
- 41 million beneficiaries
- 284 billion in expenditures
- Need for supplemental coverage
3RATIONALE FOR REFORM
- More choices and better benefits
- Modernize Medicare to reflect changes to the
health care system - Improve access to care
4KEY COMPONENTS OF THE LAW
- Medicare-Approved Drug Discount Card
- New Preventive Benefits
- Prescription Drug Benefit
- Medicare Advantage Program
- Assistance for Rural and Other Providers to
strengthen access to care for people with
Medicare
5MEDICARE-APPROVEDDRUG DISCOUNT CARD
- Estimated savings of 1025 on many drugs
- Enrollment as early as May 2004
- 600 to provide immediate relief to certain
low-income people with Medicare
6Available January 2006
NEW MEDICAREPRESCRIPTION DRUG BENEFIT
- 250 beneficiary deductible
- Medicare will pay 75 of drug costs up to 2,250.
The beneficiary will pay 25 of these costs - Beneficiary will pay100 of drug costs between
2,250 and 3,600 in out-of-pocket spending - After 3,600, Medicare will pay approximately 95
7Extra Help for People with Low Income
- People below 100 of the Federal poverty level
will be entitled to Medicare and full Medicaid
coverage - Income limits will be set in 2005
- Other people with low income and limited assets
will get help paying premiums and deductibles
8MEDICARE ADVANTAGE PROGRAM
- New Medicare Advantage program with better
benefits and more choices - Payments to Medicare Advantage plans to increase
in 2004
9MEDICARE ADVANTAGE PROGRAM
- Important new plan choices begin in 2006
- Most important new option - Regional preferred
provider organizations (PPO). PPOs are among the
most common and popular plans right now for
Americans not eligible for Medicare.
10ASSISTANCE FOR RURAL PROVIDERS
- 25 billion in increased reimbursement
- Improve access to doctors, hospitals, ambulances,
and home health care for people in rural areas
11PAYMENTS TO NON-RURAL PROVIDERS
12OTHER IMPORTANT PROVISIONS
New Preventive Benefits Available January 2005
- Welcome to Medicare Physical Exam for New
Enrollees - Cardiovascular Screening Blood Tests
- Diabetes Screening Tests
13OTHER IMPORTANT PROVISIONS
- Contracting reform
- HHS to conduct appeals process
- Changes in Medigap coverage
- Competition program
- Income-related Part B premium
14COMMUNICATING WITH THE PUBLIC
- Beneficiaries
- Providers
- Congress
- Governors and State Legislators
- Advocates
- Other stakeholders
15OPEN DOOR
16SOME MAJOR IMPLEMENTATION DATES
- January 2004 Increase payments to rural
hospitals Physician payments increased - March 2004 Increased Medicare Advantage payment
rates - Enrollment as early as May 2004 Drug Discount
Card - January 2005 Preventive benefits Physician
scarcity bonus payments - January 2006 Prescription Drug Benefit
Regional Medicare Advantage Plans (PPOs)
17FOR MORE INFORMATION
- 1-800-MEDICARE
- www.medicare.gov
- www.cms.hhs.gov
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