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News and Information Article
WASHINGTON, Sept. 21 // -- Approximately three million
seniors will reach the Medicare Part D "coverage gap" while most seniors
will avoid it due to health insurance plans implementation of
cost-containment strategies that are lowering beneficiaries out-of-pocket
costs. Thats according to a new estimate released today by Americas
Health Insurance Plans (AHIP) of member organizations that participate in
Medicare Part D. The estimate takes into account the experience of Medicare
Part D plans and their projections for the number of beneficiaries that
will hit the "coverage gap" during the remainder of the year.
(Logo: http://www.newscom.com/cgi-bin/prnh/20040830/AHIPLOGO )
The AHIP estimate also is confirmed by the results from a recent survey
of seniors conducted by Ayres, McHenry & Associates which found that eight
percent of self-enrolled seniors have reached the "coverage gap," while
nearly two-thirds say they do not expect to reach the "coverage gap." The
estimate also is in line with a PricewaterhouseCoopers study which found
that approximately 3.4 million Medicare beneficiaries would hit the
"coverage gap" in 2006.
AHIPs estimate, based on actual health insurance plan data, shows that
about 10 percent of Medicare Part D beneficiaries have reached the gap to
date, with a total of approximately three million expected to do so this
year. This estimate is below other reported estimates, some of which have
been based on 2004 projections that do not reflect the coverage packages
offered in the market and chosen by beneficiaries this year.
Karen Ignagni, President and CEO of AHIP, said that this estimate
reflects a series of health insurance plans accomplishments in delivering
a successful benefit. Ignagni said beneficiaries are taking advantage of
negotiated drug prices, the increased use of generic drugs when
appropriate, step therapy and disease management programs, and mail-order
services that have helped many avoid or delay the coverage gap. Ignagni
also cited other progress:
* More than 39 million Medicare beneficiaries have coverage;
* Part D premiums are 38% lower than expected;
* Plans are offering lower than expected deductibles, with many plans
offering no deductible;
* Seniors are saving on average 50%, or $1,100 a year and up to $1,500 if
they reach the gap;
* Competition and health plan tools will help save taxpayers $30 billion
over five years;
* At least one health care plan in each state covers a portion of the
"coverage gap."
"For the first time Medicare beneficiaries, many of whom had no drug
coverage in the past, are taking advantage of tools and techniques deployed
on their behalf by health insurance plans in the Part D program," said
Ignagni. "Health insurance plans have exceeded expectations by ensuring
that millions of beneficiaries receive prescription drugs at lower
out-of-pocket costs than previously predicted and by preventing millions
from ever reaching the gap."
Ignagni said health insurance plans efforts are paying off for seniors
and that their success is measured by growing customer satisfaction. The
Ayres, McHenry & Associates survey found:
* Seventy percent of Medicare Part D enrollees would recommend that others
sign up for the new Medicare prescription drug benefit;
* Fifty-eight percent of enrollees say they are saving money with the new
benefit;
* Two-thirds of enrollees think passing the Medicare prescription drug
plan was a good idea;
* Sixty-nine percent of seniors say the time and effort they put into
evaluating the many drug plans was worth it; an increase of 12
percentage points since the December poll; and,
* Eighty-eight percent have had no problems using the new benefit.
While most beneficiaries will not reach the "coverage gap," health
insurance plans already are assisting those who have. Part D sponsors are
reaching out directly to beneficiaries who are about to reach the "coverage
gap" to raise their awareness. Plans also are encouraging beneficiaries to
use their plan cards when they go to pharmacies while in the gap because
recent data have shown that doing so can save them up to 35 percent off
retail prices at the pharmacy counter.
"While the gap in coverage will impact far fewer people than
anticipated, health insurance plans already are providing assistance for
those who have reached it," Ignagni said.
Ignagni said that other plans are working with state pharmacy
assistance plans to coordinate care and ensure that low-income
beneficiaries who qualify for these programs are taking advantage of them.
In addition, sponsors are providing information about other sources of
assistance, including assistance programs offered by pharmaceutical
manufacturers or charities, to help beneficiaries that encounter the
"coverage gap" meet their prescription drug needs.
Americas Health Insurance Plans -- Providing Health Benefits
to More Than 200 Million Americans
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