New Health Care Law Creating Big Savings for Senior Citizens: CMS Data
Through July about 1.3 million with Medicare save on donut hole drug discounts; 18.9 million get
free preventive care - links to info to help you save
Sept. 8, 2011 – More senior
citizens and people with disabilities on Medicare are seeing a big drop in important health care costs because of provisions in the Affordable
Care Act, according news today from the Centers for Medicare & Medicaid Services.
The savings are due to discounts on brand-name drugs in Medicare Part D changes to “donut
hole” coverage and the new free preventive care added by the health care bill.
"Today's news confirms that the Affordable Care Act is saving money for millions of seniors
and people with disabilities who are enrolled in Medicare," said CMS Administrator Donald M. Berwick, M.D.
"These new benefits are encouraging patients to talk to their doctors about their care, and to
get the preventive services they need.”
So far this year, over 18.9 million people enrolled in traditional Medicare have used
preventive services with no cost to them. Many of these services will help prevent chronic diseases that can cost Medicare billions to treat.
Also, thanks to the Affordable Care Act, more Americans on Medicare are getting help affording
prescription drugs -- nearly 1.3 million people have received a 50 percent discount on their brand name prescription drugs when they hit the
donut hole, saving a total of $660 million so far this year.
For people who hit the coverage gap (known as the “donut hole”):
● 1.28 million have received discounts on brand-name drugs this year through the end of
July, up from 899,000 through the end of June and 478,000 through the end of May;
● These discounts have totaled $660 million in savings for seniors and people with
disabilities so far this year; up from $462 million through June and $260 million through May;
● Individuals who have received this discount saved an average of $517 so far this year.
In addition, today CMS announced that more seniors are taking advantage of preventive
services, most of which are available at no cost to them:
● 18,907,851 people with Original Medicare, or 55.6 percent of those enrolled in the
program, received one or more free preventive services this year, through the end of August.
● During the same time period, 1,295,373 Americans with Original Medicare have taken
advantage of the new Annual Wellness Visit, up from 1.06 million through the end of July and 780,000 through mid-June.
Benefits for Next 10 Years
discounts and savings will I have over time in the coverage gap?
Over the next 10
years, you pay less in the coverage gap until it’s closed by 2020. By 2020, you will pay only 25% for covered brand-name and generic drugs
during the gap, the same percentage you pay from the time you meet the deductible (if your plan has one) until you reach the out-of-pocket
spending limit (up to $4,550 in 2011).
You Will Pay This Percentage for Brand-name Drugs in the
You Will Pay This Percentage for Generic Drugs in the
More information in “Closing the Coverage Gap— Medicare
Prescription Drugs Are Becoming More Affordable”
Under the Affordable Care Act, people with Original Medicare can receive recommended
preventive benefits and a new Annual Wellness Visit without paying a co-payment or any cost-sharing.
Share the News, Share the Health!
In June, Medicare launched Share the News. Share the Health!, a campaign to raise awareness
about the importance of prevention for people with Medicare and their health care providers.
As part of the campaign, television and radio public service announcements are airing
nationwide and regional events are being held around the country to make sure Medicare beneficiaries know that these services are available to
CMS has reached out to doctors through a “Prevention Advisory,” and other health care
provider-directed materials on Medscape, a respected website for continuing medical education.
State, County, Zip Coverage Gap Discount Program
Since the Coverage Gap Discount Program began on January 1, 2011, CMS has been analyzing Prescription Drug Event (PDE)
data to understand how many discounts have been provided in the coverage gap and for which classes of prescription drugs.
The "Coverage Gap Discount Data Spreadsheet" contains three documents.
The first document
shows the total number of beneficiaries (by state) receiving a gap discount, the total gap discount amount, the average gap discount amount by
beneficiary, and the count of PDEs with a gap discount. Click to this
What Problems Are People in Donut Hole Buying Drugs?
CMS chart of activity
for first half of 2011 shows amounts being spent by Medicare participants in donut hole to treat various problems.
chart for larger view)
The second document shows the year-to-date coverage gap discount data by zip code with the city name, county name, and
state included. The third document shows the year-to-date coverage gap discount data by county code with the state and county names included.
The final document "Total Coverage Gap Discount Amount by Drug Therapeutic Use" under "Downloads" is a pie chart showing
the total coverage gap discount amount by drug therapeutic use.
>> For state-by-state information on the number of people who are benefiting from this discount
in 2011, Click
>> For more information about how the Affordable Care Act closes the donut hole over time,
>> For state-by-state information on utilization of free preventive services and the
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