To facilitate better understanding of the rules and regulations of the new drug benefits offered under Medicare, government health officials are revising the Medicare handbook for beneficiaries.
“The handbook goes out in the fall to all Medicare beneficiaries. We sent out an early draft to a wide range of policy experts outside the agency, ranging from insurers to liberal advocacy groups,” said Gary Karr, spokesman for the Centers for Medicare and Medicaid Services.
An earlier draft of the 2006 Medicare handbook is under revision after several inaccurate and complicated statements baffled not only beneficiaries but also Medicare officials. Several groups, including members of Congress, insurance providers, beneficiaries lobbies and insurance regulators, had called for easier and more comprehensible explanations of new benefits under the scheme.
The preliminary handbook fell short in the explanation of many features. It had also jumbled benefits offered by two different Medicare schemes – one involving private health maintenance organizations and the other more popular traditional fee-for-service scheme. While the latter enjoys a beneficiary base of 36 million, the former has only 100,000 enrolments. The handbook made no clear distinction between the two and mentioned both as ‘fee-for-service plans, available nationwide’.
“Some complained that we were mixing the details of the two programs too closely. We will also be providing more details about payments and coverage on prescription drugs,” said Karr, adding that the handbook would contain ‘a more detailed description’ of drug prescription benefits.
The previous handbook also failed to adequately explain the gap in coverage. For example, after a beneficiary makes a payment of US$ 250 deductible, Medicare pays 75 per cent of the next US$ 2,000 towards the cost of drugs. But the next US$ 2,850 is borne entirely by the beneficiary and not by Medicare. This was not adequately explained in the previous handbook.
A federal health insurance program, Medicare targets the population of those above the age of 65 years and some disabled people. Under various schemes, Medicare covers hospitalization costs, doctors’ fees, and costs involved in outpatient hospital care, medical equipment, and certain other medical services.
The new drug plans mentioned above result from the Medicare Prescription Drug Improvement and Modernization Act, which was passed by the Congress in December 2003.
