Medicare Prescription Drug Benefits are available for anyone with Medicare, regardless of income. There are many different Medicare Prescription Drug Plans in Texas. These Medicare Presciption Drug Benefits are approved by Medicare, but administered by private companies.

A crucial part of deciding which Medicare Part D Houston Texas drug plan to join involves knowing which Medicare Prescription Drugs Benefits are covered by the different plans. The only easy way to compare drug plans is on the Internet. Unfortunately, many senior adults do not have access to this important tool. That is why senior centers in Texas have been equipped with a high speed Internet connection in order to help senior adults make their decision about Medicare Prescription Drug Plans.

The Medicare Part D Houston Texas has a Compare "Medicare Prescription Drug Plans" and Enroll in a Medicare Part D Houston Texas Prescription Drug Benefits link which anyone can use to find out which of the Medicare Prescription Plans best fits their needs and pocketbook. This comparison tool is needed since not all drug plans cover every drug, and the monthly premium and deductible varies depending on the plan chosen.

Because there are out-of-pocket costs associated with the new Medicare prescription plans, Medicare, via the Social Security Administration, has an application for people who might be eligible for financial assistance. This application, called "Extra Help", assists people with the Medicare Part D Houston Texas monthly premium, deductible, and co-pay. The Extra Help application is available from Medicare Part D Houston Texas or contact us to request an application. Most local senior centers have copies of the application, as well.

If you have questions about Medicare prescription drug coverage call Paul Thordsen at 281-353-8992 or the Senior Health Insurance Program . A Medicare Part D Houston Texas program is below.

Protecting Yourself Against Fraud & Identity Theft

To help protect yourself when dealing with plans and others about Medicare Prescription Drug Benefits:

1. Keep all personal information, such as your Medicare number, safe.
2. Protect your Medicare number as you would your credit card information.
3. Don'' give out your personal information until you are sure that a person is working with Medicare Part D Houston Texas and their product is approved by Medicare.
4. Know the rules about when someone can ask for your personal information.

Here are some rules from Medicare Prescription Plans to help protect you:

1. Medicare Prescription Plans have been enrolling people with Medicare since November 15, 2005.
2. Approved plans will have a "Medicare-Approved" seal on their materials.
3. People who are really working with Medicare Prescription Plans can't come to your home uninvited to sell or endorse any Medicare Prescription Benefits, but they can call you about their plan.
4. Medicare Part D Houston Texas drug plans can't enroll you into a drug plan over the telephone unless you call them, or unless you are adding Medicare Prescription Drug Benefits to a Medicare Advantage Plan or other Medicare Health Plan you already have.
5. Medicare Prescription Plans can't ask for payment over the telephone or Internet. Those selling Medicare Prescription Drug Benefits must send you a bill if you enroll over the telephone or Internet.

Medicare Part D Houston Texask to read the entire quick facts sheet on identity theft and fraud.

1. Until December 31, 2005, beneficiaries have been able to choose between at least two Medicare-approved Rx drug discount cards in each state. Most states including Texas will have a large number of approved cards available.
2. Discount cards will be phased out by May 15, 2006.
3. The Rx drug discount cards will not cost more than $30 a year. Medicare will make this annual payment for low-income beneficiaries.
4. Low-income beneficiaries may receive a credit for drug assistance. Qualifying for the credit will depend on whether the beneficiary already receives outpatient prescription drug coverage from certain other sources. There is either a 5% or 10% co-pay with the credit.
5. Estimates of savings to beneficiaries is between 15% and 25% per prescription.
6. Medicare Prescription Plans Texas to determine which Medicare-approved discount card is best for you.

What you can do now...

Medicare Prescription Drug Benefits to find out more about how to use the online compare tool. Medicare Prescription Plans to compare & enroll in Medicare prescription drug plans.

Low and moderate income individuals can apply for "Extra Help" financial assistance for the Medicare Prescription Drug Plan (Medicare Part D Houston Texas). Obtain an application from your local Social Security office. Use this link to find out more about Medicare Part D Houston Texas below.

People on Medicare who already have prescription drug coverage through a former employer or a Union should have already received a letter stating whether their coverage will continue and, if it will continue, whether the coverage is "as good as" Medicare. KEEP THIS LETTER! Use this link Medicare Prescription Drug Benefits.

Summary of Medicare Prescription Drug Coverage

1. Congress passed legislation which set up Medicare Prescription Drug Plans to meet the individual needs of the beneficiary. In order to meet individual needs, the process that Medicare uses requires the beneficiary to make a choice from among several options.
2. • Medicare Prescription Drug Plans will be administered through many different plans developed by private companies, Unions, churches, etc. These companies have submitted their plan for approval to Medicare.
   • Beneficiaries may choose one drug plan from the Medicare- drug plans (or Medicare Advantage HMO or PPO plans&$41; that offer drug coverage in the beneficiary's locale. There may be as many as 20 different drug plans in Texas from which beneficiaries will choose the plan which best fits their needs.
   • Plans may not cover all prescription drugs or have the same monthly premium cost.
   • • There are 112 different illness/injury/affliction categories. Drug plans must offer at least two prescription drugs in each category. Therefore, not every drug may be covered by all Medicare Prescription Drug Plans. Beneficiaries should choose the plan that includes all of their prescription drug needs.
     • The different drug plans can offer their plans at a different monthly premium than the standard Medicare plan.
3. The initial Medicare Prescription Drug Plan drug benefit enrollment period began November 15, 2005 and lasted until May 15, 2006.
4. Although these figures may differ depending on the plan you enroll in, the standard prescription drug benefit in 2006 is:
5. • Beneficiaries pay a monthly premium, on average of about $32 for the standard Medicare Prescription Plans &$40;some will be lower and others may be higher). The exact premium amount will depend upon which Medicare prescription drug plan beneficiaries choose.
   • Beneficiaries are not required to enroll in Medicare Part D Houston Texas, but if they enroll later they will pay a hogher premium for Medicare Prescription Drug Benefits.
   • • Medicare Beneficiaries who decide to enroll later than their initial enrollment period will have their monthly premiums cost 1 percent more per month that they wait to enroll ( for example, if a beneficiary waits 6 months past their initial enrollment period to enroll, their monthly premium will always pay 6 percent more than what others pay).
     • The premium penalty does not apply to beneficiaries who have comparable coverage from another source (such as retirement health plans) which have certified in writing as at least "as good as Medicare".
     • • Beneficiaries with a group health plan which include prescription drug coverage will receive a letter from their plan administrator which announces whether their group drug coverage will be continued, and if so, whether it is as good as Medicare's coverage ... or if their group drug coverage will end and whether their health plan will offer subsidies to retirees to supplement Medicare Prescription Drug coverage out-of-'pocket costs.
       • Retirement health plans with drug coverage which is as good as Medicare can receive subsidies in order to discourage the retirement health plan from dropping their drug coverage for their beneficiaries.
   • Beneficiaries pay $250 annual deductible before Medicare pays anything.
   • Beneficiaries pay 25% of the costs of the next $2,000 of drug expenses (beneficiary pays $500 of next $2,000 of drugs costs plus all of the first $250 of drug costs for a total of up to $750).
   • After $2,250 of drug costs, there is no coverage until the beneficiary has paid another $2,850 worth of drug expenses (beneficiary pays up to $3,600 for up to $5,100 in drug costs).
   • Catastrophic coverage begins after beneficiary has paid $3,600 of out-of-pocket expenses ($5,100 total drug costs). The beneficiary pays the greater of $2 for generic, $5 for brand name drugs, or 5 percent of the costs, whichever is greater.

4. 'Extra Help' financial assistance is available for low and moderate income individuals
5. • Beneficiaries of Medicaid and Medicare ( eligible) will automatically receive the following benefits. Medicaid eligible individuals who have Medicare can receive these benefits if they apply for "Extra Help"
   • • No monthly premium or annual deductible.
     • Beneficiary co-pays $1 for generic and $3 for brand name drugs up to k,600 out-of-pocket.
     • After $3,600 out-of-pocket, Medicare pays all other drug costs.
   • Beneficiaries below 135 percent of the poverty level with assets below $6,000 for a single person and $9,000 for couples will receive these benefits if they apply for 'Extra Help'
   • • No monthly premium nor annual deductible.
     • Beneficiary co-pays $2 for generic or $5 for brand name drugs up to $3,600 out-of-pocket.
     • After $3,600 out-of-pocket, Medicare pays all other drug costs.
   • Beneficiaries below 150 percent of the poverty level with assets below $10,000 for single person or $20,000 for couples will receive these benefits if they apply for 'Extra Help'
   • • Monthly premium based on sliding fee scale.
     • $50 annual deductible.
     • After the deductible, beneficiary pays 15 percent of drug costs up to $3,600 out-of-pocket.
     • After $3,600 out-of-pocket, beneficiary pays $2 for generic or $5 for brand name drugs.
   • Apply for 'Extra Help' at your local Social Security office or use their online tool to apply for Extra Help. have 'Extra Help' paper applications and can help with the application process.
6. Medicare prohibits the selling, issuance, or renewal of existing Medigap supplemental plans H, I, & J which includes drug coverage to Medicare Prescription Drug Plan enrollees. This prohibition would not apply to renewal of these Medigap policies for persons who do not enrolled in the Medicare Prescription Drug Plan drug benefit. Persons enrolling in the Medicare Prescription Drug Plan drug benefit during the initial enrollment period could enroll in a Medigap supplemental plan without drug coverage. Also, persons could choose not to enroll in a Medicare prescription drug plan and continue with plans H, I, & J with the drug coverage, however if they switch to a Medicare prescription drug plan after their initial enrollment period they will have a penalty added to their premium.
7. • Medigap issuers are required to notify holders of plans H, I & J of these changes 60 days prior to the initial Medicare Prescription Drug Plan drug benefit enrollment period.
   • New Medigap supplemental plans may be allowed in Texas. More information about these plan will be issued later.
8. There are no provisions in the Medicare drug benefit law to contain drug costs. In fact, the legislation prohibits Medicare from using its purchasing power to negotiate lower drug prices for beneficiaries.
9. Re-importation of drugs from Canada is allowed, but only if their safety is certified by the Secretary of the U.S. Department of Health and Human Services (which has not happened to date)'.

1. Raised annually by the same percentage as the annual Medicare Part B premium increase (for example, if the annual Part B premium increases 5%, then the Part B deductible will increase by 5%, also%#41;. The Part B deductible is estimated to be $115 in 2006, increasing to $166 in 2013.
2. Higher income beneficiaries will pay an even higher annual premium for Part B. The annual premium for beneficiaries with incomes:
3. • under $80,000 ($160,000 for couples) is 25% of Part B costs.
   • between $80,000 and $100,000 is 35% of Part B costs.
   • between $100,000 and $150,000 is 50% of Part B costs.
   • between $150,000 and $200,000 is 65% of Part B costs.
   • over $200,000 is 80% of Part B costs.
4. The income levels above are doubled for married couples.
5. Beneficiaries can appeal if their family situation has changed e.g., death of spouse, divorce).
6. Medicare provides an initial voluntary physical when becoming eligible for Medicare.
7. Covers new preventive benefits: screening for diabetes, cardiovascular disease, and treatment in the home of primary immune deficiency diseases.
8. Improves payments for mammography.
9. Provides a disease management program to assist beneficiaries with chronic illnesses.

Demonstration plan and competition for Medicare Advantage (Part C managed care)

Rural package

The largest, most comprehensive rural package ever considered by Congress. All significant provisions in both bills including:

1. Labor share at 62% started in 2005.
2. Low volume hospitals: Number of discharges is 800. Payment adjustment is based on empirical relationship between discharges and costs. Must meet 25 mile limitation.
3. Redistribution of unused graduate medical education payments to rural hospitals and small city hospitals.

Hospitals

1. The hospital payments would be reduced by 0.4% in Fiscal Year 2005, 2006, or 2007 if the hospital did not furnish quality data to the Center for Medicare Services (CMS). No effect on baseline.
2. • Hospitals would submit data to CMS for a specified set of indicators related to the quality of care provided to Medicare patients. The indicators would build on CMS' experience with the ongoing Hospital Quality Incentive Data initiative being conducted with the major hospital trade groups.
3. IME: 5.8 in FY 2005, 5.55 in FY2006, 5.35 in FY 2007.
4. Specialty Hospitals: There would be an 18 month moratorium of the self-referral whole hospital exemption for new specialty hospitals. 'New hospitals' do not include existing hospitals or those under construction as specified in the S.1, effective the day the House files the bill. Existing hospitals can add up the greater of 5 beds or 50% of the beds on their current campus. During the moratorium period, MedPAC would conduct an analysis of the costs of the specialty hospitals and whether the payment system should be refined. The Secretary would examine referral patterns and quality of care issues.
5. Technology integration package at $600 million. Improvements on national and local coverage policy and expansion of clinical trials.
6. Illegal immigrants: $1 billion mandatory spending for hospitals, ambulances and physicians providing services under an EMTALA related admission.

Physicians

1. The 4.5% cut in 2005 would be blocked. Instead, physicians would receive a 1.5 percent update in 2005.
2. 1.0 on work geographic payment adjuster (GPCI) in 2004 through 2006.
3. Physician scarcity bonus payment 2005-2007.

Home health

1. No co-payment.
2. MB -0.8 for 2004-06. Continue current outlier policy of allocating no more than 3% for outliers.

Other

1. Durable medical equipment rates will be frozen for three years from 04-06. The rates for the top 5 services will be adjusted to reflect prices paid under the FEHBP plans. Competitive bidding for the largest MSAs begins in 2007 phasing up to 80 MSAs in 2009. Competitive bidding prices applied nationwide for those selected services.
2. Ambulance payments based on the regional floor and the adjustment for low population rural areas plus a 1 percent across the board for urban areas and 2% across the board for rural areas for two and a half years.
3. Community health centers safe harbor is included. Carve-out of community health center physicians from the skilled nursing facility PPS. Federally Qualified Health Centers would receive wrap-around payment if MA plans pay less than FQHC costs.
4. Seven year freeze on laboratory payments.

Average Wholesale Price (AWP) reform

1. The Secretary would have authority to increase or decrease reimbursement based on market surveys.
2. Average sales price (ASP) plus an additional percentage beginning in 2005.
3. Competitive bidding as a physician choice beginning in 2006.
4. Secretary has the authority to adjust reimbursement for a drug, where the ASP is found to not reflect widely available market prices.
5. Manufacturers would be required to report ASP data. Manufacturer reporting of false ASP information would be a violation of the False Claims Act.
6. The DHHS Inspector General would be required to regularly audit manufacturer submitted ASPs and compare them with widely available market prices and Medicaid Average Manufacturer Prices (AMP).
7. • Increases practice expense reimbursements for drug administration.
   • Examines existing codes for drug administration and exempt any revisions from budget neutrality requirement.
   • Allows for supplemental surveys on practice expenses for drug administration, and exempt any resulting changes from budget neutrality.
   • Requires MedPAC review of payment changes as they affect payment and access to care by January 2006 for affected specialties.

Medicare spending 'cost containment'

1. Transparency in accounting for entire Medicare program.
2. Mechanism to require congressional response of the Medicare program if general revenue contributions exceed 45% of program spending.

Medicaid

Low DSH states will get a 16 percent annual bump up for five years.

Tax provisions

1. Clarifies that employers do not have to provide 1099 Forms to service providers if services are paid for with a debit, credit or stored-value card.
2. Created a tax45;free Health Savings Accounts for qualified medical expenses for people with medical insurance with a high deductible ($1,000 in 2004).
3. The 28 percent employer subsidy for equivalent retiree prescription drug coverage is excludable from taxation.

Hatch-Waxman reforms

Ends existing loopholes in the Hatch - Waxman law by making changes to the 30 month stay and 180 day provisions. New drug applicants will receive only one 30 month stay per product for patents submitted prior to the filing of a generic drug application. In addition, modifies rules relating to generic company ' s 180 day exclusivity. Specifically, it enables multiple companies to qualify for the 180 day exclusivity if they all file their application on their first day of eligibility. Additionally, contains provisions relating to declaratory judgments which are designed to accelerate generic company:%39;s ability to enter the marketplace.