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Problems and Solutions to the Implementation of Medicare Part D

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Problems and Solutions to the Implementation of Medicare Part D

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Introduction

What Is Medicare Part D?
The Medicare Part D program provides beneficiaries with assistance paying for prescription drugs. The drug benefit, added to Medicare by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, (MMA), began in January 2006. Unlike coverage in Medicare Parts A and B, Part D coverage is not provided within the traditional Medicare program. Instead, beneficiaries must affirmatively enroll in one of many hundreds of Part D plans offered by private companies. The Annual Enrollment Period for Part D runs from November 15 – December 31.

Eligibility

Anyone who has Medicare Part A (Hospital Insurance) and/or enrolled in Part B (Medicare Insurance) can join a Medicare prescription drug plan. To enroll, a person must live in the service area of the plan. Unlike Medicare Part A and Part B where a person is automatically enrolled, you have to take action. You have to enroll in a plan to get the coverage. Standard Benefit 2008

Beneficiary pays the first $275 (Deductible).
Beneficiary pays 25% of the next $2,235. (25% of $2,235 = $558.75) - Initial Benefit Period Donut Hole "Threshold" = $2,510. That is, what the beneficiary and the plan have spent ($275 + $2,235 = $2,510) Beneficiary pays 100% of the next $3,216.25. (The "Donut Hole") "Catastrophic Coverage" begins after the beneficiary has spent $4,050 (this is the total out-of-pocket spending requirement) ($275 + $558.75 + $3,216.25 = $4,050). Minimum cost sharing in Catastrophic Benefit Period: $2.25 (Generic) and $5.60 (Brand) (Source: “Center for Medicare Advocacy, Inc.”, 2007)

Issues

Most Americans agree that affordable drug coverage under Medicare has been needed for some time. But instead of a solution to a growing problem, Congress gave the country a prescription-drug plan that achieves few of its original goals. The current problems with Medicare Part D are largely a direct result of the undemocratic way in which the plan was authored and...

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