The Democratic Plan
The Democratic prescription drug plan would add a new Part D in Medicare
that provides voluntary prescription drug coverage for all Medicare
beneficiaries beginning in 2005. Because the plan would be part of the
Medicare program, the benefits would be guaranteed. The basic benefit
would have a $25 monthly premium, with a deductible of $100 per year.
After the first $100 in expenditures, beneficiaries would be responsible
for 20% of drug costs, with Medicare covering the remaining 80% of costs.
All costs would be covered after a beneficiary spent $2,000 out-of-pocket.
The Republican Plan
The Republican bill does not guarantee any specific benefit. Instead, the
Republican bill provides subsidies to insurance companies to provide
private insurance to seniors. Individual insurers may design the coverage
and set the premium. The assistance shown in the tables would only be
available to beneficiaries who can find a private plan that offers the
benefit described in the Republican bill. This benefit is described as
follows: the benefit would have a $33 monthly premium, with a deductible
of $250 per year. Beneficiaries would pay for all of the first $250 worth
of drugs used, then pay 20% of the cost of between $251 and $1,000, and
50% of the costs of drugs from $1,001 to $2,000. After $2,000 worth of
drugs are used by seniors, the plan would provide no further cost sharing
until the beneficiary spent $3,700 out-of-pocket. All costs would be
covered after a beneficiary spent $3,700 out-of-pocket. However, any
amounts reimbursed by a third-party payer would not count towards meeting
this catastrophic limit.
Information for Low-Income Seniors
Under the Democratic proposal, seniors with incomes below 150% of the
poverty level will pay no premium. Seniors with incomes between 150% and
175% of the poverty level will receive a sliding scale premium subsidy.
Both groups will pay nominal or no cost-sharing. Under the Republican
proposal, seniors with assets of more than $4,000 will receive no
additional assistance. Seniors with incomes below 150% of the poverty
level and assets of less than $4,000 will pay no premium. Seniors with
incomes between 150% and 175% of the poverty level and assets of less than
$4,000 receive a sliding scale premium subsidy. In both cases seniors pay
a flat fee of $2.00 or $5.00 per prescription. But once these seniors use
over $2,000 worth of drugs the Republican plan offers no assistance in
paying for the cost of drugs until they have spent $3,700 out-of pocket.
This $3,700 must be paid by the individual, and any assistance from an
employer-sponsored plan or other plan, or assistance from any charity,
does not count toward the limit.
|
