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In response to the Medicare Modernization Act, the federal government has been working for years to develop a Medicare Drug Benefit that is affordable and equitable to meet the ever-growing needs of our senior citizens. In 2004, the Medicare drug card was introduced to provide prescriptions at a reduced cost. In 2006, the full drug benefit will be introduced as part of the Medicare Part D program.


This new legislation provides key initiatives:


[black small square] Drug coverage will be available to all Medicare beneficiaries.


[black small square] There will be a comprehensive prescription plan to assist low-income beneficiaries.


[black small square] It will provide an enhanced drug coverage package to retired workers whose existing unions and employers have discontinued their prescription coverage.


[black small square] A coordinated prescription program has been developed for dual-eligibility beneficiaries that will save states' Medicaid dollars while improving many states' existing drug program.


[black small square] More healthcare options will be introduced to give Medicare beneficiaries a choice of the "fee-for-service" program or a plan that provides additional benefits through a preferred provider organization.



The New Prescription Drug Benefit

The prescription drug benefit program guarantees each and every Medicare beneficiary a drug plan that is similar to those in private insurance programs, has no annual maximum benefit, and coverage that won't run out. This information is based on the median spending of $2,400 per beneficiary in 2006. The out-of-pocket expense is based on the average prescription price of $65.00 and copay ranging from $2.00 to $3.50 (Table 1).

Table 1 - Click to enlarge in new window Expense, Spending, and Savings of Medicare Drug Benefit Coverage

This program also introduces a new rule that allows employers and unions a choice of options for their retired workers. It will provide a subsidy for the drug coverage for these former employees while assisting the employers in continuing this much-needed coverage.


For more information, go to the Medicare Web site at or to call 1-800-MEDICARE. There are also free publications that can be mailed upon request.


State Medicaid programs will also benefit. Starting in 2006, all dually eligible beneficiaries (individuals covered by both Medicare and Medicaid) will receive prescription drug coverage through Medicare instead of state Medicaid programs. Although this will significantly reduce the pharmacy expenditure currently paid for by the Medicaid program, states are still required to pay a percent of the cost of the prescription coverage. The good news is that this percentage is only a fraction of the existing cost and could free up Medicaid dollars for other services, such as home health and hospice.


So....why do you, a home health nurse, need to know about Medicare Part D and the new drug plan? Because it impacts your home health patients!! Many patients often choose between their prescriptions, groceries, or utility services. By educating our clients on this new program, we may be able help them come closer to meeting their basic needs and taking all their medications as prescribed. Maybe we will even see fewer hospitalizations and healthier seniors!!


Free Web Site Provides Access to and Information on Advance Directives From All 50 States


The importance of having advance directives has come to the forefront with the Terri Schiavo case. The term advance directive describes two types of legal documents that enable you to plan for and communicate your end-of-life issues in the event you are unable to communicate:


* A living will allows you to document your wishes concerning medical treatments at the end of life.


* A medical power of attorney (or healthcare proxy) allows you to appoint a person you trust as your healthcare agent (or surrogate decision maker), who is authorized to make medical decisions on your behalf.



The National Hospice "Caring Connections" Web site provides excellent information for all the steps of the process and allows access to the Advance Directives laws in all 50 states. The site will walk you through the various steps of the process, including an overview of your state's law; how to talk about end-of-life issues with your family, doctor, and religious leader; and more. The site is supported by a grant from the Robert Wood Johnson Foundation and is available to anyone. Both of the following Web site addresses that follow will take you to the Caring Connections site.


Comprehensive Information on Advance Directives (for all 50 states) is available on the National Hospice "Caring Connections" Web site at:


Advance Directives Forms, for any 50 states, from National Hospice "Caring Connections" can be downloaded at: