LIVING WELL Magazine

By: Mark Johnson R.CPhT, Axtell Rite-Value Pharmacy, for SENIOR Magazine (Texoma edition)

A few months ago the President signed into law a Health Care Reform bill. Not many know a whole lot about the bill, but here are some of the things that might effect those of you who are retired and those who are about to retire.

The Affordable Care Act gives America’s seniors greater control over their own health care.

More than 8 million seniors in 2007 hit the donut hole, which is the gap in prescription drug coverage in Medicare Part D. This year a $250 rebate is provided to Medicare beneficiaries who hit the donut hole. Beginning in 2011, the Act institutes a 50% discount on brand name drugs in the donut hole, and the Act will completely close the donut hole for all prescription drugs by 2020.

Payments to Medicare Advantage plans are phased down to bring them more in line with the costs in the original Medicare program. Bonus payments for plans improve quality and enrollee satisfaction, and reduce payments to plans with undocumented, inflated risk adjustments. Medicare’s guaranteed benefits are not affected, and reducing these unwarranted subsidies will save Medicare more than $150 billion over ten years.

Fights waste, fraud, and abuse by reforming payments to reduce unnecessary hospital admissions and health-care acquired infections. Together, these proposals will extend the financial health of Medicare by nine years. Not a penny of Medicare taxes or trust funds will be used for health reform.

Deductibles, copayments, and other cost-sharing for preventive care are eliminated while free annual wellness checks will be provided starting in 2011 where today, seniors must pay 20% of the cost of many preventive services and office visits. A voluntary long-term care insurance program is created which will provide a cash benefit to help seniors and people with disabilities obtain services and supports enabling them to remain in their homes and communities.

Innovations such as medical homes and care coordination to improve the quality of care that seniors receive will better spend the more than 90% of Medicare costs that today go to treating chronic conditions.

Payments to hospitals and other care facilities will be linked thus promoting coordinated care after discharge from the hospital and encourage real hospital discharge planning and transitional care.

Quality of care reporting across the health care delivery system should help beneficiaries make more informed choices among providers for care they may need and reduce the one-in-seven hospitalized Medicare patients who today experience a complication. Incentives to reward providers that meet quality goals or show significant progress in improving patient outcomes will be provided. This focus on quality improvement will move our health system toward one that rewards better care rather than more care.

Be Well and Be Well Informed!

Mark Johnson is with Axtell Rite-Value Pharmacy and may be reached at 903-564-3216.