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Medicare News

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.


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"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.

Donut Hole Benefits for Next 10 Years

What additional 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 Coverage Gap

You Will Pay This Percentage for Generic Drugs in the Coverage Gap































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 them.

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 spreadsheet.

For 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.

(click 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

More Links:

>> For more information about how the Affordable Care Act closes the donut hole over time, Click

>> For state-by-state information on utilization of free preventive services and the Annual Wellness Visit

>> For more information on Medicare’s Share the News. Share the Health! prevention campaign or call 1-800-MEDICARE.

More Helpful Information from Medicare

Your Guide to Preventive Services

Staying Healthy

Are You Up-To-Date on Your Preventive Services?

Welcome to Medicare Preventive Visit–6 Things You Should Know

Welcome to Medicare Preventive Visit–Q&A

Women and Heart Disease

Questions to Ask About Medicare Preventive Services

Welcome to Medicare - Question & Answers

6 Things You Need to Know About the “Welcome to Medicare” Preventive Visit


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