Published January 13, 2015
Components of the Medicare prescription drug proposals offered by President Bush, House and Senate Democrats:
—The proposal does not specify deductibles, premiums or copays.
—Low-income older people would get $600 annual subsidies to help buy prescriptions.
—Participants could stay in traditional fee-for-service Medicare, where the government pays 80 percent and the patient pays the remaining 20 percent. Beneficiaries would get a discount drug card that would offer at least a 10 percent discount when buying prescriptions. There also would be some government help when drug costs get really high, although the Bush plan does not specify an amount. Traditional Medicare has limited preventive benefits, such as mammogram coverage.
—Beneficiaries could also join "Enhanced Medicare," which would use preferred provider organizations, or PPOs, to offer a drug benefit. PPOs are similar to HMOs but less restrictive. Essentially, patients in PPOs are allowed to seek outside doctors, but incentives such as lower costs are offered if they see certain doctors. Participants in this plan also would have the discount drug card and protection from high out-of-pocket costs. Enhanced Medicare also would offer full coverage of preventive benefits such as cancer screenings.
—A third option would allow beneficiaries to join what would be known as "Medicare Advantage." This plan would operate similar to the current Medicare+Choice program, an HMO component of Medicare that now has about 5 million participants. There would be lower basic fees and a drug benefit, but in exchange participants would have designated doctors and hospitals. Participants also would have access to the discount drug card and full coverage of preventive benefits. There also would be protection from high out-of-pocket drug costs.
House Democrats Plan:
—Would cost between $700 billion and $900 billion over 10 years and would be administered by the government.
—$100 yearly deductible.
—$25 monthly premium.
—Medicare would pay 80 percent of costs; beneficiaries would pay remaining 20 percent.
—There would be a $2,000 yearly limit on out-of-pocket drug spending per beneficiary.
—The poorest seniors would pay no premium or copays. Other low-income seniors would receive help on a sliding scale.
Senate Democrats Plan:
—Would cost $594 billion over 10 years and would be administered by the government.
—Beneficiaries would pay $25 monthly premiums and $10 copayments on generic drugs and $40 copayments on brand-name drugs.
—Out-of-pocket drug costs would be capped at $4,000 a year.