For the approximately 250,000 Mainers enrolled in Medicare, the federal health reform legislation passed on Sunday by the U.S. House of Representatives, with changes pending in the U.S. Senate, promises immediate relief as well as some longer-term benefits, according to a researcher at the University of Southern Maine in Portland.
“Medicare consumers will feel the difference right away,” said Andrew Coburn, professor of health policy and management at the Muskie School of Public Service at USM. On Monday, Coburn was completing a preliminary analysis of the signed bill and the reconciliation “fixes” pending in the Senate.
Overall, Coburn said, the changes are likely to be beneficial for seniors. The changes include:
• Beginning this year, seniors who fall into the “doughnut hole” of the Medicare Part D prescription drug plan will be eligible for a $250 rebate. The gap opens when individuals have exceeded the limit of $2,830 in covered drugs during a calendar year and must pay out of their own pockets for additional medications. Once spending reaches a total of $4,350.25, the federal benefit resumes. Starting in 2011, discounts on brand name and generic drugs will increase for those in the Medicare doughnut hole, and the gap itself will be eliminated altogether in 2020.
About 86 percent of Mainers enrolled in Medicare also carry Part D coverage, which must be purchased separately.
• Mainers enrolled in Medicare Advantage plans, which provide more comprehensive medical benefits than regular Medicare and are offered by private insurance companies, may not be directly affected by the decreased reimbursements that will be paid to some of those plans. Because Medicare Advantage plans in Maine are highly rated in terms of efficiency, utilization and quality, the variable reimbursement changes may be barely felt here, Coburn said.
About 16,000 Mainers are enrolled in Medicare Advantage plans.
• Coburn said the legislation calls for an investigation into regional differences in Medicare reimbursements. This could pave the way for increased payments to Maine hospitals and doctors, who say they have among the lowest reimbursement rates in the nation.
The new law also will provide incentives for the Medicare program to participate in studies that have the potential to improve care. It supports medical education and training programs in underserved areas like Maine, Coburn said.
Separately, the legislation calls for a number of specific cuts to Medicare providers such as doctors, hospitals, nursing homes and home care agencies. Coburn said those reductions may be offset by expanded coverage through Medicaid and private insurance plans and improvements in the overall health of older Americans.
Graham Newson, executive director of the Maine Association of Agencies on Aging, said the national health reform bill is “a good step for seniors.” The organization, which represents five nonprofit Agencies on Aging in Maine, did not take an official position on the legislation. Newson said advocates for seniors must remain vigilant as the changes wrought by the bill play out over time, with opportunities for adjustment and correction as needed.
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