Medicare changes that take effect in the coming months will have a substantial effects on patients and hospitals.
Medicare is a federal program that provides health insurance for people older than 65 and people with disabilities. Medicare's sister program, Medicaid, is a joint venture between states and the federal government. It provides health care for the needy. States decide how Medicaid will be distributed, and the federal government reimburses a portion of the costs.
Medicare has seen a lot of changes and reforms since its inception in the 1960s. The newest round of changes takes effect Oct. 1.
One of the most notable changes is to the way hospitals are funded, particularly acute care facilities such as The Memorial Hospital in Craig.
Hospitals that report information about their quality of care to the federal government will receive additional funding. The funding is given to hospitals just for reporting and isn't based on the results of the reports.
Perhaps the biggest change to Medicare is the prescription drug benefit that takes effect Jan. 1, 2006.
The drug benefit will pay a portion of the costs of prescription drugs, in some cases as much as 95 percent of the cost.
The program requires a $250 annual deductible, and patients to pay a percentage of the costs of their prescriptions. That percentage increases as the cost increases, meaning patients pay 25 percent of the cost from $250 to $2,250 and 100 percent of the cost from $2,251 to $3,600.
The new program is supposed to limit out-of-pocket spending to $3,600 annually.
Medicare participants must enroll in the new prescription drug benefit program between Nov. 15, 2005, and May 15, 2006. If participants miss the registration window, they may have to pay higher premiums.
But some people have raised concerns that Medicare participants, particularly seniors, don't know enough about the program yet to take full advantage of it.
Cindy Weston, a pharmacy technician at the City Market pharmacy in Craig, said she expects the new program to be rough at first because patients don't understand how it works.
"We actually don't know enough about it yet, either," Weston said about herself and her colleagues.
Customers have been asking questions about the program, Weston said. She has pamphlets and some numbers about the program to give out, but other than that, the pharmacy doesn't have a lot of information about the issue.
The AARP is in the middle of a campaign to get information out about the prescription drug benefit.
"Our big motto is 'When in doubt, fill it out,'" said Morie Pierce, associate state director of the Colorado AARP.
The "fill it out" refers to the multitude of forms Medicare recipients will receive in the mail in coming months.
Pierce said the forms are important because they get people in line for the benefit.
AARP is advertising in newspapers and magazines and sending mail to recipients explaining the new program.
Pierce and Weston said that they expect the program to work well when Medicare recipients get through the initial kinks.
Brandon Johansson can be reached at 824-7031 or firstname.lastname@example.org