Nearly 3.5 million people saved more than $706 on prescriptions in 2012

By Kathleen Sebelius, Secretary of Health and Human Services

Posted March 21, 2013, Crossposted from healthcare.gov

In the three years since the Affordable Care Act became law, the slower growth of health care costs is saving money in Medicare and the private insurance market, helping to curb previously skyrocketing premiums and making Medicare stronger.

The nonpartisan Congressional Budget Office recently estimated that Medicare and Medicaid spending would be 15 percent less — or about $200 billion— in 2020 than was previously projected, thanks to this slower growth. Medicare spending per beneficiary rose by just 0.4% in 2012, while Medicaid spending per beneficiary actually dropped by 1.9% last year. We are making Medicare stronger, too, by spending smarter, promoting coordinated care, and fighting fraud. Not only does this ensure that taxpayer dollars are spent wisely.  It means that those who count on Medicare — our grandparents, parents, our friends, and neighbors – will have it for years to come.

Today, we are announcing that thanks to the Affordable Care Act, more than 6.3 million seniors and people with disabilities on Medicare have saved more than $6.1 billion on prescription drugs since the health care law was enacted three years ago. This is the result of the law’s closing of the prescription coverage gap known as “the donut hole.”

Nearly 3.5 million people with Medicare saved an average of more than $706 each on their prescriptions in 2012.

In the case of Helen Rayon of Pennsylvania, the savings on her medications is enough to help her contribute to the education of her grandson. She says: “I take seven different medications. Getting the donut hole closed … gives me a little more money in my pocket.” Watch a video to learn more about Helen.

David Lutz, a community pharmacist from Hummelstown, PA, described his elderly customers, “splitting pills, taking doses every other day, missing doses, stretching their medications.”  But he says this has begun to change with the savings resulting from the Affordable Care Act, and that’s good for their health as well as their budgets.

After the law was passed, the Affordable Care Act provided a one-time $250 check for people with Medicare who reached the Part D prescription drug coverage gap in 2010. Since then, individuals in the donut hole have continued to receive savings on prescription drugs. In 2013 individuals in the donut hole are saving over 50% off of the cost of branded drugs. The savings on both brand name and generic drugs will continue to increase until the coverage gap is closed in 2020.

Along with savings on their medications, American seniors have also benefited from access to vital preventive services — such as mammograms, cholesterol checks, cancer screenings, and annual wellness visits — with no Part B coinsurance or deductibles. In 2012, more than 34 million seniors and people with disabilities with Medicare received at least one free preventive service. Having easier access to preventive services without worrying about the cost helps seniors stay healthier and identify health conditions before they become more serious and costly.

Helen works as a health-and-wellness coordinator at a senior center, arranging for health and fitness activities for seniors older than herself.  She knows they struggle with the costs of staying healthy. “If it weren’t for the health care reform, many of our seniors would not get to a doctor,” to get a check up, Helen says. “It is expensive for us to keep good health.”

Affordable Care Act initiatives are also ensuring that if Medicare beneficiaries do end up in the hospital that their care is coordinated and they stay out of the hospital once they’re discharged. This also gives Medicare beneficiaries – and other taxpayers – more value for their health care dollars. In fact, hospital readmissions in Medicare have fallen for the first time on record, resulting in 70,000 fewer readmissions in the last half of 2012.

The Affordable Care Act is helping us keep our moral commitment to ensure that our grandparents and other seniors get the high-quality, affordable health care and security they need and deserve.

To learn more about how the Affordable Care Act is saving seniors on prescription drug costs by closing the donut hole coverage gap, visit www.hhs.gov/news/press/2013pres/03/20130321a.html

Follow Secretary Sebelius on Twitter at @Sebelius.

This spring, put prevention into practice

The onset of spring is a reminder of new beginnings – the longer hours of daylight, sprouting tulips and warmer weather are all indicators of a new season, and a new reason to be proactive with your health.  One simple way to manage your health is to practice preventive care. Because preventive services can find health problems early, when treatment works best, it’s a crucial step in maintaining a healthy lifestyle.

Your Preventive Services with Medicare

If you have Medicare, then you have access to a variety of preventive tests and screenings, most at no cost to you. If you’re new to Medicare, your “Welcome to Medicare” preventive visit is now covered for free during your first 12 months of Part B coverage. This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including certain screenings, shots, and referrals for other care, if needed.

If you’ve had Part B for longer than 12 months, you can get a yearly wellness visit to develop or update a personalized prevention plan based on your current health and risk factors.  In addition to these important wellness visits, Medicare covers screening tests for diabetes, colon cancer, breast cancer, osteoporosis and heart disease, just to name a few.

So as you tend to your garden this spring, make a commitment to tend to yourself too. Practice preventive care to ensure you stay healthy, live longer, and delay or prevent many diseases.

Join the fight against Medicare fraud

Medicare fraud affects everyone. You can team up with Medicare to help.

Our Senior Medicare Patrol volunteers are teaching people like you how to spot, report, and stop fraud, and protect themselves from identity theft.

Here are some things you can do:

  • Guard your Medicare and Social Security numbers. Treat them like you would treat your credit cards.
  • Hang up the phone if someone calls and asks for your Medicare number, Social Security number, or bank or credit card information. We will NEVER call and ask for this information, and we will NEVER call you or come to your home uninvited to sell Medicare products.
  • Be suspicious of anyone who offers you free medical equipment or services and then requests your Medicare number. It’s illegal, and it’s not worth it!
  • Do not let anyone borrow or pay you to use your Medicare ID card or your identity.
  • Check your Medicare claims for errors. Look at your Medicare Summary Notice (MSN) or statements from your Medicare plan. You can also check www.MyMedicare.gov or call 1-800-MEDICARE (1-800-633-4227) as soon as your claims have been processed. The sooner you see and report errors, the sooner we can stop fraud. TTY users should call 1-877-486-2048.
  • Call 1-800-MEDICARE to report any suspected fraud.

Learn more about spotting and reporting fraud, and get tips on protecting yourself from identity theft.

Find out about Senior Medicare Patrol activities in your area.

Get regular screenings for colorectal cancer

Did you know colorectal cancer is the second leading cause of cancer-related deaths in the United States among cancers that affect both men and women? If everyone 50 or older got screened regularly, as many as 60% of deaths from this cancer could be avoided.

In most cases, colorectal cancer develops from precancerous polyps (abnormal growths) in the colon or rectum. Fortunately, screening tests can find these polyps, so you can get them removed before they turn into cancer. Screening tests also can find colorectal cancer early, when treatment works best.

It’s National Colorectal Cancer Awareness Month – do what you can to reduce your risk for colorectal cancer. If you’re 50 or older, or have a personal or family history of colorectal issues, make sure you get screened for colorectal cancer regularly. Don’t worry about the cost—Medicare covers a variety of colorectal cancer screenings, and you pay nothing for most tests.

Need help with your health care costs?

Susan, a woman in her mid-80’s, went to her local SHIP for help with her finances and healthcare decisions. Susan hasn’t had prescription drug coverage since 2011, and she currently isn’t getting any help to pay her prescription drug costs. Susan spoke with a SHIP counselor about her situation and learned she could get Extra Help with paying her prescription drug costs. Susan’s now enrolled in a plan where she can afford her medications.

If you have limited income and resources, like Susan, you may be eligible for “Extra Help” or one of Medicare’s savings programs. These programs may help you save on premiums, deductibles, copayments, or prescription costs.

Get help with one of our 4 savings programs

Medicare offers 4 kinds of programs that may help with your costs.

1.     Qualified Medicare Beneficiary (QMB) Program

2.     Specified Low-Income Medicare Beneficiary (SLMB)

3.     Qualified Individual (QI) Program

4.     Qualified Disabled and Working Individuals (QDWI)

Applying for Extra Help is simple and free.

Don’t go without your prescriptions even if you’re having trouble paying for them. If you have limited income or resources, you may be eligible for Extra Help to help pay Medicare prescription drug costs, like premiums, deductibles and copayments.

Take a minute to see if you qualify to get help with your health care costs – it could mean money in your pocket.

Bundled payments, DMEPOS, regulatory reform, and ESRD

By Jonathan Blum, Acting Principal Deputy Administrator and Director, Center for Medicare 

In the past few days, the Centers for Medicare and Medicaid (CMS) announced four critical initiatives that are designed to enhance health care delivery for millions of Medicare beneficiaries by improving care or lowering costs, or both.  Taken together the announcements illustrate the breadth and diversity of efforts underway to ensure a better, stronger, more patient-centered Medicare program.

Last week, we announced a new health care delivery system reform, made possible by the Affordable Care Act, to test how bundling of payments for episodes of care, for example a heart attack or stroke, instead of paying for each test or procedure or physician’s visit, can result in more coordinated, higher quality care for beneficiaries.  By bundling payments for services that beneficiaries receive during an episode of care, CMS hopes to encourage doctors, hospitals, and others  to work together to improve care and health outcomes, while also lowering Medicare costs.  Over 500 organizations, nationwide, have already signed-on to participate.

We also announced a major expansion of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.  In its first year of operation, competitive bidding, where prices are based on suppliers’ bids, saved the Medicare program, and taxpayers, over $202 million, while maintaining access to quality products for Medicare beneficiaries in the nine areas of the country where the program launched.   It’s a great example of the Administration’s determination to put the brakes on runaway healthcare costs.  With this expansion in the program, Medicare beneficiaries in 91 major metropolitan areas will save an average of 45 percent on certain DMEPOS items beginning in July.  Between 2013 and 2022, we estimate that the expansion of the DMEPOS program will save Medicare $25.7 billion, while saving beneficiaries, who pay a percentage for medical equipment and supplies, $17.1 billion through lower prices.

This week, we issued a proposed rule which will help health care providers and hospitals to operate more efficiently by getting rid of regulations that are outdated, obsolete, or excessively burdensome.  Many of the rule’s provisions streamline requirements that health care providers must meet in order to participate in the Medicare and Medicaid programs, without jeopardizing patient safety, and they will save providers nearly $676 million annually.  Just as important, by eliminating burdensome requirements, health care providers can improve the quality of health care delivery for Medicare beneficiaries by spending more time focusing on patient care and less time filling out forms.

Finally this week, we announced the Comprehensive End-Stage Renal Disease (ESRD) Care Initiative.  It will help identify, test and evaluate new ways to improve care for Medicare beneficiaries living with ESRD.  We’ll be working with the health care provider community to care for a population that significant and complex health care needs.  Through better care coordination, beneficiaries can more easily navigate the multiple providers involved in their care, ultimately improving their health outcomes.

These four initiatives demonstrate that CMS is employing new and novel tools and programs, thinking outside the box and beyond the usual way of doing things, in order to improve health care delivery for people with Medicare and, in the process, strengthen the Medicare program for current and future beneficiaries.

This Valentine’s Day give your heart some love

Although popular love songs might tell you otherwise, a broken heart can’t kill you – but heart disease can.  Heart disease is the leading cause of death in the United States. 

You might not be able to avoid Cupid’s arrow, but you can take steps to lower your risks and prevent heart disease.  Start by scheduling an appointment with your doctor to discuss whether you’re at risk for heart disease. 

Medicare will cover a cardiovascular screening at no cost to you every 5 years.  The screening includes tests to help detect heart disease early and measures cholesterol, blood fat (lipids), and triglyceride levels. 

If you and your doctor discover that you’re at risk for a heart attack or stroke, there are steps you can take to help prevent these conditions.  You might be able to make lifestyle changes (like changing your diet and increasing your activity level or exercising more often) to lower your cholesterol and stay healthy.

Luckily, you don’t have to face these challenges alone. The national Million Hearts campaign has pledged to help prevent 1 million heart attacks and strokes over the next 5 years. You can join them, and get information and resources you need to learn how to take care of your heart and live a healthy life.

February is American Heart Month, and a healthy heart is the best Valentine’s Day gift you could ever give yourself, or the people who love you. 

Making a Heart Healthy Resolution

Richard Gilfillan, Director, CMS Center for Medicare and Medicaid Innovation

It’s the New Year, which means it’s time for those annual resolutions, whether it’s eating right or tackling a new skill.  But none may be more important than making the resolution to get heart healthy in 2013.

Did you know heart attacks and strokes are the first and fourth leading cause of death in the U.S.? The Million Hearts™ initiative, launched in 2012, is aiming to prevent 1 million heart attacks and strokes by 2017. CMS and the Centers for Disease Control and Prevention are working with other federal agencies, communities, health systems, non-profit organizations and private-sector partners to help educate Americans on how to make a long-lasting impact against cardiovascular disease.

If you’re at risk for, or are already suffering from, heart disease, now’s the time to practice the “Million Hearts ABCS”:

  • Aspirin for people at risk
  • Blood pressure control
  • Cholesterol management and
  • Smoking cessation

Medicare can help you take control of many of the major risk factors for heart disease. People with Medicare can get cardiovascular screenings, counseling to stop smoking, and blood pressure and weight checks during their yearly wellness visit with their doctor.

Make a New Year’s resolution and give your loved ones one more gift they’ll be sure to treasure—a healthier you in 2013. Help prevent a heart attack or stroke by joining the Million Hearts™ initiative.

Protect yourself – Get screened for cervical cancer

Cervical cancer and human papilloma virus (HPV) affect thousands of women each year. Regular screening tests like pap tests and pelvic exams can help find cancer and other health problems early and improve recovery and survival rates. Talk to your doctor about scheduling your next test!

Find out more about Medicare’s pap test and pelvic exam coverage.

For more information about HPV, check out the American Cancer Society’s HPV Frequently Asked Questions.

To learn more about Cervical Cancer, go to the American Cancer Society’s Web site for Cervical Cancer Information.

At risk for glaucoma? Find out before it’s too late

At risk for glaucoma? Find out before it’s too late

Do you have diabetes, a family history of glaucoma, or are you African American and age 50 or older? If so, your risk of getting glaucoma may be higher. With the start of a new year, it’s the perfect time to schedule a regular eye exam to check for glaucoma. You can prevent vision loss by finding and treating problems early.

Find out more about Medicare’s glaucoma screening coverage.