Saving money on health costs with some Extra Help

If you’ve ever found yourself skipping a day of your medication or cutting your pills in half to make your supply last a little longer, there’s help. Medicare has a special program called “Extra Help.” If you have limited income and resources you can sign up to get help paying things like monthly premiums, annual deductibles, and prescription copayments in your Medicare drug plan.  Even if you’re not sure you’d qualify, it’s worth filling out an application to see.

Many people with Medicare may be eligible for the Extra Help program but don’t even know it. Are you or a family member one of them?

It’s easy and free to apply for Extra Help. Here’s how:

Don’t wait – apply today to see if you qualify for some extra help with your health costs.

Medicare Open Enrollment: 4 ways to protect your identity and information

  1. Guard your information.
  2. Be wary of giveaways.
  3. Don’t lend your identity.
  4. If you spot something, say something.

These are 4 simple ways to protect your identity and personal information from Medicare fraud, but they can be difficult to do if you’re caught off guard.

During Medicare Open Enrollment – between now and December 7 – you can expect to hear a lot about Medicare. You might be hearing a lot about the Health Insurance Marketplace this fall. That’s because the Marketplace Open Enrollment period overlaps with the Medicare Open Enrollment period.

The Marketplace is designed to help people who don’t have any health coverage. If you have health coverage through Medicare, the Marketplace won’t have any effect on your Medicare coverage. In fact, it’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan.

Open Enrollment is a great time for you to review and compare your Medicare choices and make sure you have the coverage that fits your needs. Unfortunately, it’s also a popular time for Medicare fraud schemes.

Here are a few reminders to keep you safe from those who might not have your best interests in mind:

1.     Guard your Medicare and Social Security numbers – treat them like you’d treat your credit cards.

You’ll be hearing so much about Medicare during Open Enrollment, that it may not surprise you to get phone calls or visits to your house from people selling Medicare plans.

It’s illegal for someone to call and ask for your Medicare number, Social Security number, or bank or credit card information.  A Medicare representative or a private insurance plan working with Medicare will never call and ask for this information, and we will never call you or come to your home uninvited to sell Medicare products.   And remember, it’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan.

2. Be suspicious of people offering free medical equipment or services.

Anyone who offers you free medical equipment or services and then requests your Medicare number is tricking you – if it’s really free, they don’t need your Medicare number. It’s illegal, and it’s not worth it!

3.     Don’t let anyone borrow or pay you to use your Medicare card or your personal information.

If someone asks you for your Medicare number, stop and think. If you wouldn’t feel comfortable giving that person your credit card number, don’t give them your Medicare number.

4. Most importantly, if you suspect Medicare fraud, let us know! Call 1-800-MEDICARE (1-800-633-4227).

Learn more at Remember, a little preparation goes a long way. If you experience a Medicare fraud scheme – walk away, hang up, close the door, or say “no thanks.”

Medicare Open Enrollment: convenience matters

Have you ever pumped gas into your car from a station just around the corner from home even though it’s a bit more expensive than the one in town? Most of us have made decisions to do or not do something based on convenience.

The same is true when it comes to choosing a health plan: convenience matters. So in addition to cost, coverage, and benefits, here are some other things you may want to consider as you compare Medicare options this year:

Doctor and hospital choice

You want to be comfortable with the people you’re working with, especially when it comes to something as private as your health. Do the doctors you know accept your coverage? Where are the doctors’ offices? What are their hours? Do they often keep you waiting?

Pharmacy access

Is the pharmacy you use included in your drug plan’s network?  Do they use e-prescribing? Can you get refills by mail? Remember that plan networks can change from year to year. If it’s important to you to stay with the same pharmacy, it’s worth checking to make sure they’ll still be in your plan’s network.


Maybe you travel a lot, or spend part of the year in a different state. If you do, make sure you know whether your coverage will travel with you.


Ask yourself whether you’re truly satisfied with your medical care. Not all health care is created equal, and the doctors, hospitals and facilities you choose can impact your health. Look for plans with a 5‑star performance rating — the right expertise and care may help speed your recovery and improve your outcomes.

Your time is valuable — and so is your health. Only you know what mix of coverage and convenience is most important to you and your family.

We’re working hard to make sure you have choices in the way you get the Medicare benefits you’ve earned – and we want you to be comfortable. Use the Medicare Plan Finder to look at all of the health and drug plan options in your area.

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

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

Follow Secretary Sebelius on Twitter at @Sebelius.

Protect yourself and those you love—get your free flu shot

It’s that time of year again.  With the beginning of fall comes the beginning of flu season. 

Get your flu shot early and stay healthy!  It’s free for people with Medicare, once per flu season in the fall or winter, when given by doctors or other health care providers (such as senior centers and pharmacies) that take Medicare.

Schedule your flu shot today!

More Americans Accessing Improved Medicare Coverage

By Don Berwick, Administrator, Centers for Medicare & Medicaid Services

Millions of Americans are enjoying improved Medicare coverage thanks to the Affordable Care Act. More people are getting preventive services to keep them healthy, and people with high prescription drug costs are seeing the coverage gap “donut hole” starting to close. Here are the latest numbers from the past few months:

  • July:
    • Through the end of July, 1.28 million Americans with Medicare have received discounts on brand name drugs in the Medicare Part D coverage gap — up from 899,000 through the end of June and 478,000 through the end of May.
    • These discounts have saved seniors and people with disabilities a total of$660 million, including $199 million in July alone!

For state-by-state information on the number of people who are benefiting from this discount in 2011, visit this page.

  • August:
    • Through the end of August, over 18.9 million people with Original Medicare, or 55.6 percent, have received one or more free preventive services.
    • During the same time period, over 1.2 million Americans with Original Medicare have taken advantage of Medicare’s new free Annual Wellness Visit, up from 1.06 million in July.

For state-by-state information on the numbers of people who are utilizing preventive services in 2011, visit this page.

Over the coming years, provisions of the Affordable Care Act will help close the coverage gap completely. Here is a sense of what people with Medicare can look forward to:

  • 2013: Paying less and less for your brand-name Part D prescription drugs in the coverage gap.
  • 2020: The coverage gap will be closed, meaning there will be no more “donut hole,” and people with Medicare will pay only 25% of the costs of their drugs until they reach the yearly out-of-pocket spending limit.

The chart below shows what people with Medicare prescription coverage will pay over time:

Medicare Prescription Drug Coverage Over Time

chart showing Medicare Prescription Drug Coverage Over Time

Improving Care for People with Medicare

By Don Berwick, M.D., Administrator of the Centers for Medicare & Medicaid Services. Crossposted from

If you or a loved one has ever had the unfortunate experience of having a chronic or serious illness, you’ve experienced the frustration of our fragmented health care system. Just when you are feeling your worst, there you are in the doctor’s office or hospital room, repeating the same information time and time again, sitting through the same medical test more than once, and trying to track down lost or unavailable medical charts. These are all aspects of our current health care system we could each do without.

This can be a particular problem for the more than half of Medicare beneficiaries with five or more chronic conditions such as diabetes, arthritis, and kidney disease. These patients often receive care from multiple physicians and in multiple sites. A failure to coordinate care can lead to patients not getting the care they need or receiving duplicative care. This lack of coordination also increases their risk of suffering medical errors, such as receiving prescriptions for medications that ought not to be taken together. It can also cause complications that lead to needless hospital stays. Nearly one in five Medicare patients discharged from the hospital is readmitted within 30 days – a readmission many patients could have avoided if their care outside of the hospital had been better coordinated.

Improving coordination and communication among physicians and other providers and suppliers will help improve the care Medicare beneficiaries receive, while also helping lower costs. Numerous studies have shown that better care often costs less, because coordinated care helps to ensure that the patient receives the right care at the right time.

Thanks to the Affordable Care Act, the Department of Health and Human Services (HHS) today released proposed new rules to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs are designed to create and support a team of health care providers who treat individual patients by working together across care settings.

Over the last months, CMS has conducted extensive outreach to patient advocates, doctors, nurses, hospitals, health plans, employers, and other interested stakeholders to hear their thinking about the best way to shape this effort. We will continue to seek feedback on the proposed rules released today so that the final rules reflect the broadest consensus on how to improve care for people with Medicare and to provide a model for private payers to draw upon. We look forward to working with patients and care providers to build the most patient friendly and cost-effective health care system achievable

Under the proposal, ACO teams of doctors, hospitals and other health care providers and suppliers working together would coordinate and improve care for patients with Original Medicare. ACOs would have to meet high quality standards in five key areas:

•Patient/Caregiver Experience of Care
•Care Coordination
•Patient Safety
•Preventive Health
•At Risk Population/Frail Elderly Health

An ACO will be rewarded for providing better care and investing in bettering the health and lives of patients. ACOs are not just a new way to pay for care. They are a new model for the organization and delivery of care. Accountable Care Organizations are designed to lift the burden of fragmented and disconnected care from patients, while improving the partnership among patients, doctors, hospitals and other providers of care in making health care decisions.

To read more on this, check out the fact sheet. You can also read my blog at the New England Journal of Medicine.

Your Start to a Healthy Future Begins with a Physical Exam

By Donald Berwick, M.D., Administrator, Centers for Medicare & Medicaid Services

If you’re new to Medicare, take charge of your health and wellness with a thorough physical exam.

Getting an in-depth physical exam is a smart and easy way for you and your doctor to set a starting point for your personalized health care. It’s your roadmap for effective, efficient and timely health care, and it will help lower our healthcare system’s per-person costs.

Medicare covers two types of physical exams—one when you’re new to Medicare and one each year after that.

“Welcome to Medicare” physical exam

Medicare covers a one-time “Welcome to Medicare” physical exam if  you get it within the first 12 months you have Part B.  Beginning in 2011, you can get this exam for free if your doctor accepts assignment.

Your comprehensive “Welcome to Medicare” physical exam includes:

  • A review of your medical and social history including risk factors you can change
  • A physical exam that includes measuring your height, weight, blood pressure, visual acuity screen, and body mass index
  • Education, counseling, and referrals based on the results of your physical exam
  • A brief written plan, such as a checklist, for getting appropriate screening and/or other Medicare Part B preventive services
  • A review of your potential risk factors for depression

Yearly “wellness” exam

Thanks to the new healthcare law, Medicare also covers a  yearly “wellness” exam (once you’ve had Part B for longer than 12 months and if it has been at least 12 months from your “Welcome to Medicare” physical examination) which will help you develop or update a prevention plan, based on your current health and risk factors. You’ll pay nothing for the exam as long as your doctor accepts assignment (agrees to be paid directly by Medicare and accepts the amount Medicare approves for the service).

So get the most from your new Medicare benefits and stay in control of your health: Don’t delay.  Schedule your physical exam today!

NOTE: This blog was updated on January 5, 2011.

What is the Donut Hole?

By Jonathan Blum, Deputy Administrator and Director for the Center of Medicare at the Centers for Medicare and Medicaid Services


A number of visitors to have told us they’d like to know more about the Medicare “donut hole” in the Part D program.

If you aren’t familiar with Medicare, it is a health insurance program for people 65 or older, people under 65 with certain disabilities, and people with End-Stage Renal Disease (permanent kidney failure). People with Medicare have the option of paying a monthly premium for outpatient prescription drug coverage. This prescription drug coverage is called Medicare Part D.

In 2010, basic Medicare Part D coverage works like this:

  • You pay out-of-pocket for monthly Part D premiums all year.
  • You pay 100% of your drug costs until you reach the $310 deductible amount.
  • After reaching the deductible, you pay 25% of the cost of your drugs, while the Part D plan pays the rest, until the total you and your plan spend on your drugs reaches $2,800.
  • Once you reach this limit, you have hit the coverage gap referred to as the “donut hole,” and you are now responsible for the full cost of your drugs until the total you have spent for your drugs reaches the yearly out-of-pocket spending limit of $4,550.
  • After this yearly spending limit, you are only responsible for a small amount of the cost, usually 5% of the cost of your drugs.

You may have read in the 2010 Medicare & You Handbook that there are some Medicare Part D plans that offer coverage in the donut hole—but these plans may charge a higher monthly premium. (There are also some Part D plans that are “enhanced” and offer fixed co-pays (for example $5, $10, and $20) for prescription drugs instead of the deductible and 25% cost-sharing that was described above. These plans also may charge a higher monthly premium.)

For those that qualify, there is also a program called Medicare Extra Help that helps you pay your premiums and have reduced or no out-of-pocket costs for your drugs.

Needless to say, for most people with Medicare Part D, the donut hole presents serious financial challenges. Some people have had to choose between their rent or groceries and their prescription drugs.

But, the recent health reform law – the Affordable Care Act – has some important changes that will help to relieve this burden for the people with Medicare that hit the donut hole each year (and are not already on a program called Medicare Extra Help,):

  • This year, if you enter the Part D donut hole, you will receive a one-time, $250 rebate check. The mailing of these checks began in June. If you are eligible and do not receive your check, call your Part D plan first and then 1-800-Medicare.
  • Starting in 2011, you will receive a 50% discount on brand-name drugs in the donut hole, and you will start to pay less and less for your generic Part D drugs in the donut hole.
  • Starting in 2013, you will pay less and less for your brand-name Part D prescription drugs in the donut hole.
  • By 2020, the coverage gap will be closed, meaning there will be no more “donut hole,” and you will only pay 25% of the costs of your drugs until you reach the yearly out-of-pocket spending limit.

Throughout this time, you will get continuous Medicare Part D coverage for your prescription drugs as long as you are on a prescription drug plan.

If you would like more information on the one-time rebate check, feel free to check out this brochure or call 1-800-MEDICARE. (Please note that you do not need to do anything to receive this rebate check and should not provide any personal information such as Medicare, Social Security or bank account numbers to anyone calling about the rebate.)


Securing Medicare

Don Berwick, M.D., Administrator of the centers for Medicare and Medicaid Services

I am pleased today to bring good news to you about the health and future of Medicare.  As a result of the Patient Protection and Affordable Care Act, as amended, the financial outlook for Medicare is substantially improved compared to prior evaluations.  This improvement is not without some important qualifications, but it nonetheless represents a very positive change in the expected operations of the Medicare trust funds.

In 2009, Medicare provided health insurance coverage to 46.3 million people.  Total Medicare expenditures were $509 billion and income was $508 billion.  The average Medicare benefit per enrollee was $11,743.  These Medicare expenditures were slightly lower than estimated in last year’s Trustees Report.  Within the total, Part A and Part D spending were each slightly lower than estimated, while Part B outlays were slightly higher. Medicare expenditures in 2009 represented 3.5 percent of Gross Domestic Product.  Last year, these costs were projected to increase steadily (and rapidly) to over 11 percent of GDP by the end of the long-range, 75-year projection period.  In the new report, based on the cost-containment efforts of the Affordable Care Act, Medicare is projected to represent 6.4 percent of GDP in 2084.

Other good news?  The Hospital Insurance (Part A) trust fund is projected to be able to pay all benefits on time until 2029—12 years longer than last year’s estimate of 2017.  And the long-range actuarial deficit for HI is only one-sixth of its prior level—specifically, 0.66 percent of taxable payroll versus 3.88 percent.

These favorable changes depend critically on a specific ACA provision, which will slow the rate of growth in Medicare payments to most categories of providers by about 1.1 percent annually in anticipation of improvement in productivity.  It is important to note that the effect of these adjustments will reduce payment rates over time, and it is possible that providers would not be able to slow their cost growth correspondingly.

However, as someone who has spent my career improving care for patients, I have seen firsthand the substantial improvements in quality and cost-effectiveness that can be achieved by health care providers.  As a result of this provision, providers will have strong financial incentives and many other supports to find more efficient ways to care for patients that not only reduce costs but more importantly improve quality.

Our agency intends to work with providers to support these improvements and carefully monitor the impact of this provision on access to high quality care for all beneficiaries. Despite the uncertanties, the picture is far more positive than last year – with the Affordable Care Act, we can make the future of Medicare secure.