17 million received free Medicare preventive services in first half of 2011

Patients hitting the Part D doughnut hole saved $461 million through discounts on brand-name drugs.

By Charles Fiegl — Posted Aug. 11, 2011

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More than half of patients with traditional Medicare coverage received one or more preventive services since January without having to pay out-of-pocket costs, officials for the Centers for Medicare & Medicare Services said.

The health system reform law allowed the Medicare program to waive patient fees for certain preventive care starting in 2011. As a result, the program is seeing more patients take advantage of preventive services covered by the Medicare program, said CMS Administrator Donald M. Berwick, MD.

From January to July, 17.3 million Medicare patients received one or more preventive services under the traditional fee-for-service program. The care included more than 3 million mammograms, a 6% increase from the same period in 2010, according to CMS. The number of colorectal cancer screenings increased 3.6%, to 1.2 million services.

Physicians and other health professionals also have provided about 1 million annual wellness visits, a new service offered under the reform law at no out-of-pocket cost to enrollees.

The free services will help keep patients healthy and enable them to live longer, Dr. Berwick said during an Aug. 4 conference call with reporters. Preventive services can reduce morbidities and allow patients to manage chronic conditions, he said.

The government pays more whenever preventive services are offered with no additional patient cost-sharing. Most Medicare services come with a 20% co-pay. But that equation does not account for potential savings realized by keeping patients out of the hospital, Dr. Berwick said.

"Savings that may not accrue to the health care system may accrue to employers as people stay healthier and work longer, for example," he said. "Prevention is well worth the investment."

CMS has calculated the savings expected for patients in the Medicare drug program next year. Dr. Berwick announced the average monthly premium for a Part D enrollee will be $30 in 2012, which is down from $30.76 in 2011. Out-of-pocket costs are expected to be lower because of discounts on brand-name drugs, more generic drug options and competition among Part D plans, he said.

Through the end of June, 899,000 Medicare patients have benefited from a 50% discount on brand-name drugs after falling into the Part D doughnut hole -- a gap in coverage where patients pay out of pocket for drugs until federal catastrophic coverage kicks in. The discount, mandated by the health reform law, has allowed patients to save $461 million so far this year.

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