Millions of Seniors Saving Money on Prescription Drugs, Thanks to the Affordable Care Act

By Nancy-Ann DeParle. Crosspost from The White House Blog

Over the weekend, a report by the Associated Press detailed how the Affordable Care Act is dramatically reducing drug costs for seniors who hit the prescription drug coverage gap known as the donut hole. This year, seniors are benefiting from a 50 percent discount on brand-name drugs in the donut hole. And the discount and other provisions in the law are saving money for seniors. As the AP reported:

The average beneficiary who falls into the coverage gap would have spent $1,504 this year on prescriptions. But thanks to discounts and other provisions in President Barack Obama’s health care overhaul law, that cost fell to $901, according to Medicare’s Office of the Actuary, which handles economic estimates.

So far this year, more than 2.2 million people with Medicare have saved more than $1.2 billion on their prescriptions. The Associated Press spoke with two of them:

For retired elementary school teacher Carolyn Friedman, it meant she didn’t need a loan to pay for drugs that keep her epilepsy under control.

“What a change for the better,” said Friedman, 71, of Sunrise, Fla. “This year it was easier to pay my bills, whereas last year I had to borrow money to pay for my medications when I was in the doughnut hole.”

Joan Gibbs thought her pharmacy had made a mistake. Her total cost for a brand-name painkiller in the doughnut hole came out lower than her co-payment earlier in the year, at a time her plan was picking up most of the tab.

“I reluctantly called the insurance company,” said Gibbs, 54, who lives near Cleveland. “If they had made a mistake, I knew they would catch it sooner or later. I was very surprised that it turned out to be such a good discount.”

Gibbs is on Medicare because of an auto-immune disorder and other medical problems that left her unable to work.

Thanks to the Affordable Care Act, seniors will receive bigger discounts in the years ahead. By 2020, the donut hole will be closed completely.

And even if you don’t hit the donut hole, there’s still good news for beneficiaries with Medicare Part D.  Prescription drug premiums will not rise next year, and thanks to health reform, seniors can get preventive services like mammograms and other cancer screenings for free.

Nancy-Ann DeParle is the Assistant to the President and Deputy Chief of Staff

Medicare Open Enrollment: Your Time Is Valuable

By Jonathan Blum, Deputy Administrator and Director for the Center for Medicare

Have you ever gotten a great deal to try a new restaurant or dry cleaner, only to realize that it just wasn’t worth the hassle? Maybe it was on the other side of town, or the hours weren’t convenient, or there were too many exceptions.  We all like to get a good deal, but convenience is a big part of the value.

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. The health care law brought more benefits and better choice to the Medicare program, but only you know what mix of coverage and convenience is most important to you and your family.

That’s why we’re working hard to make sure you have choice and control over the Medicare benefits you’ve earned.  Look around for all the Medicare information out there.  And visit our Open Enrollment center, where we’ve gathered everything you need, including a video on how the Medicare Plan Finder works, to walk through your options.

Medicare Open Enrollment: 3 C’s for Thanksgiving Dinner

Kathy Greenlee, Assistant Secretary for Aging

It happens in my family every year during the December holidays: as we push our chairs back from dinner, my aunt asks if she should change her Medicare plan. “I have to do it by the end of December, you know,” she says. 

This year, my aunt needs to make any changes to her Medicare coverage even sooner – by December 7 – because Open Enrollment ends earlier.

If you usually help your loved ones review and compare their Medicare coverage over the holiday season, take advantage of Thanksgiving to have that important talk. If you wait until the December holidays this year, it’ll be too late – Medicare Open Enrollment ends this year on December 7

Speaking of Thanksgiving, there’s a lot to be thankful for when it comes to Medicare. Thanks to the health care law, Medicare is stronger than ever, with better choices, expanded benefits, and lower overall costs.

As you gather around the table to help a family member or friend review their Medicare coverage, remember the “3 Cs”:

       1.    Cost:  Finances seem to be in the news every day, and on everyone’s minds these days.  Open Enrollment is the time to compare plans total cost –the lowest premium health plan option might not necessarily be his or her best choice overall.

       2.    Coverage:  While health care needs can be hard to predict, looking backward can help.  Think about the past year of health – does your loved one have new or different health concerns that may require different services and benefits in the coming year?   Look for plans with a 5‑star performance rating — the right expertise and care may help speed your recovery and improve your outcomes.  Rest assured that no matter what plan you pick, the Affordable Care Act provides access to a variety of preventive services and screenings, at no cost.

       3.    Convenience:  We hear so much about the “sandwich” generation – those of us who get our children on the bus in the morning, work all day, and stop by to take care of our parents in the evenings.  Your time is valuable, so make sure you and your loved one consider things like office hours, pharmacy availability and whether the doctors prescribe electronically.  A little time thinking about these things now could save you a lot of running around next year.

Our goal by December 7 is that every single American with Medicare has health and drug coverage that meets their needs. So, push back your chair after Thanksgiving dinner and get online – visit our Open Enrollment center where we’ve gathered everything you need, including a video on how the Medicare Plan Finder works, to walk through your options. Or, visit Ask Medicare – specially designed for caregivers — for resources to make your job as a caregiver easier.

If you’d prefer a more personal touch, call or visit one of the thousands of wonderful volunteers staffing the State Health Insurance Assistance Programs across the country.  I’m thankful for their dedication to helping people with Medicare review their options and find a plan that meets their needs.

This Thanksgiving, I’ll be talking with my aunt about her Medicare coverage, so please take the time to talk to your loved one about their Medicare too.  I know she’s thankful for the peace of mind that Medicare provides.  And I’m just as thankful for all of the information that’s available to help me make sure she’s making the best choice.

Medicare Open Enrollment: Extra Benefits & Preventive Services

By Jonathan Blum, Deputy Administrator and Director for the Center for Medicare

I belong to a gym I really like. It has all the equipment I use – weights, cardio machines, a pool. But what really sold me on membership were the extra features and services: personal training and convenient parking, among others.

Extra benefits can be a big plus in health coverage, too.

A full 99% of people with Medicare have access to Medicare Advantage Plans in 2012, and these plans often offer extra benefits that Original Medicare doesn’t cover. Medicare Advantage Plans may offer vision, hearing, or dental coverage, or extend coverage while you travel. Most Medicare Advantage Plans also include prescription drug coverage.

Even better, Medicare Advantage Plan premiums are predicted to be 4% lower in 2012, on average, than they are in 2011. It’s worth it to compare.

Folks in Original Medicare will enjoy more benefits this year, too. Thanks to the Affordable Care Act, EVERYONE with Medicare has access to a variety of preventive tests and screenings, most at no cost to them. That’s right – no cost.

Covered services include screening tests for colon cancer, breast cancer, osteoporosis and heart disease, just to name a few.  Just during the first half of this year, 20.5 million people with Original Medicare got one or more free preventive services through the end of July. 

Medicare also covers an Annual Wellness Visit each year. This is a great chance to sit down with your doctor and take the time you need to talk about your needs — and address small health concerns before they become big ones.

To help you track these services, take this checklist to your next doctor’s visit. This comprehensive list spells out the Medicare-covered preventive services and lets you keep track of when you got a particular test or service, and when you’re due for your next one.  You also can get preventive service reminders on

 Just as you and I might look for different things in a gym, we almost certainly also need different kinds of health coverage. Only you know what extra benefits and services are most important for you and your family.

That’s why we want to make sure you have choice and control over the Medicare benefits you’ve earned.  Look around for all the Medicare information out there. And visit our Open Enrollment center, where we’ve gathered everything you need, including a video on how the Medicare Plan Finder works, to walk through your options.

More Reasons to Say Thanks this November

By Julia Eisman, HHS New Media Communications Director. Crosspost from

Every day we receive letters, emails, tweets and Facebook messages from people around the country that have been touched by the health care law – like a parent whose child is no longer denied coverage due to a pre-existing condition or a senior who has received a 50% discount on prescription drugs.

There are a lot of ways that the law, signed 20 months ago, has provided significant relief to families throughout the country, easing worries and ensuring that focus is on health, not on fighting with insurance companies over the phone. Chances are, someone in your family is seeing new rights and benefits.

In the spirit of Thanksgiving, during the month of November on our Twitter and Facebook pages we’ll be highlighting these benefits and sharing some of the stories we’ve heard from people around the country who have been helped by the law. We also want to hear from you, so we encourage you to tell us your story about how you’ve been helped by benefits in the law. Share on Twitter with the hashtag #ThanksHCR. You can find us on Twitter at: @HealthCareGov.

To give you an idea, here are a few new benefits we have thanks to the health care law:

Thanks to health reform, insurers cannot deny coverage to children due to pre-existing conditions.

Thanks to health reform, preventive services will be available for millions for free.

Thanks to health reform, being a woman will soon no longer be considered a pre-existing condition.

Thanks to health reform, people with Medicare get discounts on prescription drugs and a free annual wellness visit, AKA more time with their doctor.

Thanks to health reform, young adults under 26 can stay on their parents’ health insurance.

Thanks to health reform, insurers can no longer raise rates with no accountability.

Thanks to health reform, insurers must spend most of your premium dollar towards your health care instead of on advertising or big CEO salaries. If they don’t, they must provide refunds to you.

And the list goes on…

Many of the items in the law are common-sense provisions that end the worst insurance company abuses. From new consumer rights like appealing denied insurance claims, to new benefits like prescription drug rebates for Seniors, there are a lot of reasons to be thankful.

Join us on Twitter this November in saying thanks and share your story.

Go to @HealthCareGov, and let’s get started!

Medicare Open Enrollment: Making the Best Choice for You

By Jonathan Blum, Deputy Administrator and Director Center for Medicare

We’ve all had the experience of making outdoor plans for a weekend that’s supposed to be gorgeous, only to cancel when the weather turns out to be 48 degrees and drizzly. Despite our best planning, uncertainty is just a fact of life.

Health can be as unpredictable as the weather. It’s hard to know what you’ll feel like next week, much less what health care you’ll need next year – yet that’s exactly what you need to predict when you’re shopping for health coverage during Medicare Open Enrollment.

We know future needs can be hard to forecast, but taking stock of current circumstances can help. Maybe your family situation is different this year, or you have new health concerns. Maybe you’ve been traveling a lot, so you want a flexible plan that offers coverage in multiple states.

If you’ve recently retired —or even if you’re still working — you may have other health insurance options. If you do, make sure you understand exactly how that other coverage works with Medicare.

The good news is that now more than ever, you can find a plan tailored to your unique needs. There are better prescription drug plan choices, with premiums that generally have held steady from last year. A full 99% of people with Medicare have access to Medicare Advantage Plans. Even better, Medicare Advantage Plan premiums in 2012 are 4% lower, on average, than they were this year.

The Affordable Care Act delivered better choices and more benefits to the Medicare program. So no matter which plan you pick, you’ll have access to benefits like these:

• A 50% discount on covered brand-name drugs if you hit the Part D prescription drug coverage gap (“donut hole”)

• A free Annual Wellness Visit, so you can sit down with your doctor and talk about your health concerns and the best ways to stay healthy

• A host of preventive tests and screenings — including cancer screenings — most at no cost to you

It’s worth it to take a look and compare coverage. We recently learned about a man in central Arkansas who’s had Medicare Part D since 2009. Last year, our State Health Insurance Assistance Program (SHIP) counselors helped him compare his Part D drug coverage with other plan options. They found a new plan that covered more of the prescriptions he needs. The Medicare Plan Finder can help you compare plans – check out our video on how the Plan Finder works.

So this year, this gentleman has been spending only $18.90 for 3 prescriptions each month — which saves him more than $720 a month. That’s real money.

As you start comparing coverage for yourself, you’ll find Medicare in the mail, on TV or the radio, in the paper, and on your computer. You’ll be hearing so much about Open Enrollment that it may not surprise you to get phone calls or visits to your house from people selling Medicare plans.

Remember to keep yourself and your personal information safe [link to blog #4 on fraud when posted]- we’ll never call and ask for your Medicare number or bank information, and we’ll never come to your home uninvited to sell Medicare products. Visit to learn what to do if this happens to you.

While you can’t always predict everything in life, you can do your best to be prepared. Medicare will be there to help you, stronger than ever.

Medicare Open Enrollment: Looking at Costs

By Jonathan Blum, Deputy Administrator and Director for the Center of Medicare

In today’s world, we’re all a little more conscious of costs.  Maybe we clip a few more coupons, eat out less, or compare ads to find the best price on something before we buy. 

Cost is a primary driver in any marketplace, and health care is no different. We know you want to get the best value possible from your health care coverage. Wouldn’t most of us like to get more and pay less for things that are important to us?

The good news is, the health care law has gone a long way toward lowering overall costs in the Medicare program.  But getting good value out of your health insurance still requires you to make smart choices.

There may be dozens of Medicare plans in your area, all with different costs and levels of coverage.  How much are each plan’s premiums and deductibles? How much will you pay for the benefits and services you’re likely to use? Is there a limit on what you’ll have to pay out-of-pocket for the year?

Prescription drug coverage is another part of the cost puzzle. How much will your prescriptions cost under each plan?  Does the plan cover the drugs you take? Remember that this year, thanks to the Affordable Care Act, everyone who reaches the Part D coverage gap (or “donut hole”) will benefit from a 50% discount on covered brand-name drugs.

Finding the right plan can save you hundreds — or even thousands — over the course of a year. In Florida, State Health Insurance Assistance Program (SHIP) counselors used the Medicare Plan Finder to help one senior find a drug plan that covered all but one of her 17 medications, saving her $510 a month in co-payments. 

Only you can determine what mix of benefits and costs will work best with your needs and budget. Shopping around can make a huge difference. Sometimes that shopping takes more time or can feel overwhelming.

That’s why we want to help you take control over your Medicare coverage.  Look around for all the Medicare information out there, visit our Open Enrollment center, and watch a video about how the Medicare Plan Finder works. After you’ve narrowed your options, you can call the plans you’re interested in to get more details about their benefits and services, or check out their websites.

Whether groceries, health insurance, phone plans or anything else, you want value for your dollar.  Make sure you have the most up-to-date information out there.