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We are dedicated to making Medicare's program work well for all beneficiaries. Your feedback from your own or your client's concerns and experiences with Medicare, will guide our Medicare advocacy efforts with key policy and decision-makers in both California and nationally with the Centers for Medicare and Medicaid Services (CMS) and Congress.

  • 11Aug

    Did you know that 1 in 5 hospital inpatients return to the hospital within 30 days of leaving? To make the transition from the hospital as smooth as possible for you or a loved one, learn about Medicare discharge planning requirements, appeal rights, and coverage of post-hospital care. Below are 3 tips, plus additional action points to make sure you get the hospital care you require while in the hospital and are well prepared with a discharge and post-hospital care plan when you leave.

    Point 1: Understand hospital discharge planning and know if you qualify.
    Discharge planning helps ensure that you and your caregivers have the information, resources, and care you need as you transition from the hospital to your home or other living arrangement. A discharge plan should identify your post-hospital care needs and the most appropriate next setting for your care. All hospitals must follow certain guidelines when preparing hospital inpatients for discharge. Although Medicare recommends that all inpatients receive an in-depth discharge plan, hospitals must only provide discharge plans to Medicare patients who were screened and found to be at high risk of complications . Keep in mind that Medicare discharge planning requirements and recommendations apply whether you have Original Medicare or a Medicare Advantage Plan. Also, note that Medicare recommends but does not require discharge planning if you are a hospital outpatient.

    Point 2: Know how to appeal if you think the hospital is discharging you too soon.
    You should appeal the hospital’s decision to discharge you if you think you are being told to leave too soon. To appeal, first consult the Important Message from Medicare notice, which the hospital should provide you at least once during your inpatient hospital stay. Among other things, the notice tells you how to request a review of your case by the Beneficiary and Family-Centered Care Quality Improvement Organization, often called the Quality Improvement Organization (QIO).

    To begin the appeal, call the QIO listed on your notice by midnight of the day of your discharge. The QIO should make a decision within 24 hours. If the appeal is successful, you can remain in the hospital, and Medicare or your Medicare Advantage Plan will continue to cover your care. You are not responsible for the cost of your care during this first appeal, even if you are unsuccessful. If you are unsuccessful, there are additional levels of appeal you can use – but you may have to pay for the care you receive if those appeals are unsuccessful.

    Point 3: Understand Medicare’s requirements for post-hospital care.
    Hospitals must maintain an accurate, up-to-date list of Medicare participating facilities and providers that can provide appropriate post-hospital care. Follow-up care can include placement in nursing homes, skilled nursing facilities, long-term acute care centers, and rehabilitation facilities. If you are returning home, you may get referrals for therapy services, home health care agencies, or hospice care. It is important to understand the coverage requirements for each type of post-hospital care to maximize your coverage and minimize out-of-pocket costs.

    Regardless of whether you are being discharged to a facility or to your home, be sure to ask the hospital staff if you qualify for Medicare coverage of follow-up care. If you qualify for a discharge plan, the hospital must arrange transfers to skilled nursing facilities and provide referrals to home health and hospice agencies that accept your Medicare coverage. Hospital staff must also educate you, your family, and/or your caregivers about your care needs if you are returning home, and provide a clear list of instructions for your care, including all medications you will need.

    If you are an Original Medicare beneficiary, you will receive a Medicare Summary Notice (MSN) every quarter that lists the health care services you have received during the previous three months, and their costs. Similarly, if you have a Medicare Advantage plan, you will receive periodic Explanation of Benefits (EOB) from your plan, listing the services you have received and their costs. Review your MSN or EOB carefully to make sure the services and provider locations are accurate. If you think you are being held wrongfully responsible for the cost of a service, contact the billing department of your hospital or post-hospital facility to request a correction. If the hospital is uncooperative or if you are still suspicious, call your  our California Senior Medicare Patrol – or SMP- program for further assistance at 1-855-613-7080.

    Take Action Points:

    1) Ask whether you qualify for a discharge plan if you think that it would be helpful to you when you leave the hospital.

    2) Appeal the hospital’s decision to discharge you if you think you are being discharged too soon.

    3) If you want one-on-one assistance and counseling regarding your hospital transitions – help understanding your discharge plan, the appeals process, or Medicare’s requirements for post-hospital care – contact your local Health Insurance Counseling and Advocacy Program (HICAP) at 800-434-0222.

    4) If the billing for your hospital stay is suspicious, contact your SMP for assistance using the contact information below.

    This info is taken from the July 2015 Medicare Minute, a program of the Administration on Community Living.

  • 04Aug

    Can a nursing home evict you for being “too difficult”, limit the hours your family and friends can come visit, or deny you needed physical therapy services because you’re not improving? The answer to all of these questions is a big NO. Yet many people are uninformed of their rights when in a nursing home, which creates the right environment for some nursing homes to get away with activities that are both illegal and harmful to residents.

    One of our partners, Justice in Aging recently updated their guide, 20 Common Nursing Home Problems and How to Resolve Them. This guide informs people of their rights according to the Nursing Home Reform Law and their entitlement to receive quality health care. Some of the common problems reviewed include:

    • Discrimination against Medicaid eligible residents
    • Failure to take care planning seriously
    • Disregarding patient preferences
    • Failing to provide necessary services
    • Improper use of physical restraints and/or medications
    • Refusing to bill Medicare
    • Imposing visiting hour limits on family and friends
    • Excessive use of feeding tubes

    Please read and share this guide. One of the biggest tips, in addition to being informed, that Justice in Aging gives is to “be a squeaky wheel”! Those who are shy or afraid to ask for anything, generally will receive less care and attention than those who determinedly, politely and confidently ask and request the care for which they are entitled.

    20 Common Nursing Home Problems and How to Resolve Them


  • 27Jul

    Phone scams are ongoing and, like a virus, are always morphing. Yet, even with the constant change, below are some easy tips from the Senior Source newsletter (a publication from Senator Susan Collins, Chairman of the Senate Special Committee on Aging) to help you and your loved ones avoid being victims of fraud and to help stop fraud.

    Remember that con artists:

    • Force you to make decisions fast and my threaten you.
    • Disguise their real numbers, using fake caller-IDs.
    • Sometimes pretend to be the government (i.e. the IRS)
    • Pressure you not to contact your friends or family.
    • Try to get you to provide your personal information, like your Medicare number or other account numbers.
    • Try to get you to give your credit card or other bank account information.

    If you receive any such suspicious calls, hang up and report it to our California Senior Medicare Patrol (SMP) at 1-855-613-7080. See our Fraud & Abuse section for more info on Medicare fraud.

  • 20Jul

    We invite you to join us and our partner organizations to say no to the CUFF Act (S 1758 and HR 2504). This Act would take $4.8 billion in cuts from Social Security and Supplemental Security Insurance (SSI) benefits to pay for a new highway bill. This is unacceptable. Please read and share the Justice in Aging alert below, and contact your Congress people today. Urge them to protect the benefits of our country’s beneficiaries who are most in need and to say NO to the CUFF Act.

    Take Action Now to Stop Congress from Cutting Benefits to Older Americans

    Right now, members of Congress are debating whether to pass the CUFF Act (S 1758 and HR 2504) in order to pay for a highway bill. If passed, it would take $4.8 billion in Social Security and SSI Benefits from low-income older Americans and people with disabilities. We can’t let that happen. A Senate vote on the highway bill is expected this week, possibly tomorrow. The CUFF Act should not be part of it. Your representatives need to hear from you today.

    For more information, read the fact sheet, and Justice in Aging’s Statement for the Record, then call or email your Senators now and tell them to VOTE NO on S 1758, and if you have time, contact your Representative as well.

    To find the names and contact information of your Senators and Representative, simply type in your zip code here. No time to compose a letter? Feel free to use the sample text below. Also download and attach this fact sheet to your note to provide them with more information.

    It is important that your Senators and your Representative hear from you today
    , either by phone or email. Not only will our nation’s poorest older Americans and people with disabilities lose what for many is their only source of income, some people will experience life-threatening loss of health care due to loss of Medicare Part B Coverage.

    Sample Letter:


    I am writing to urge you to VOTE NO on attaching the CUFF Act to the highway bill or using it as a means of paying for any other legislation. If it is passed hundreds of thousands of people will lose Social Security Old Age or Disability Insurance benefits and SSI benefits. These are our nation’s most needy individuals. A significant number of people will become homeless and many will lose their Medicare outpatient (Part B) coverage.

    Creating highway funding by slashing the sole source of income for our nation’s poorest individuals is just bad policy. The CUFF Act will not help law enforcement secure the arrest of people they are seeking for serious crimes as its proponents claim. The Social Security Administration already informs law enforcement of anyone on parole or with an outstanding warrant who turns up in their database. I’ve attached a fact sheet for more information.

    I urge you to vote No on the CUFF Act.

    Sincerely [YOUR NAME]

  • 07Jul

    Last month the Department of Health and Human Services (HHS) announced the largest ever national take down charging 243 individuals for $712 billion in fraudulent billing. Forty-four of those individuals were charged with fraud involving the Part D prescription drug benefit. The Office of Inspector General (OIG) recently released 2 reports on Part D fraud. As prescription drug fraud is on the rise, Part D fraud prevention and oversight is a new OIG priority.

    The first report, Ensuring the Integrity of Medicare Part D, summarizes the OIG’s numerous investigations, audits, evaluations, and guidances related to Medicare Part D, and provides updates on the ways the Centers for Medicare and Medicaid Services (CMS) is addressing OIG-identified weaknesses in the Part D program. It notes that ~39 million beneficiaries receive Part D benefits through more than 2,000 plans sponsored by private companies (as of 2013), and that the Part D drug payments are approximately $121 billion per year. The OIG relies on 3 key players to monitor the integrity of the Part D program: Part D plan sponsors, CMS and the MEDIC (the Medicare Drug Integrity Contractor). Part D plan sponsors monitor and pay Part D claims; CMS oversees the program, and contracts with the MEDIC to perform program integrity functions; and the MEDIC investigates potential fraud and abuse referred to it through external sources, and identifies potential fraud and abuse through proactive methods, such as data analysis.

    From OIG report, Ensuring the Integrity of Medicare Part D,

    The OIG recommends that CMS, MEDIC, and Part D sponsors all increase their efforts to address Part D fraud and abuse. OIG also advises having increased data collection, including expanded reporting requirements and drug utilization review programs, and for the implementation of even more robust oversight efforts, including mechanisms to recover payments from Part D sponsors.

    The second report, Questionable Billing and Geographic Hotspots Point to Potential Fraud and Abuse in Medicare Part D looks at the sharp spending increase on frequently abused opioids in the last 10 years, highlights pharmacy-related fraud schemes related to opioids, and points out “geographic hotspots” for certain non-controlled drugs.

    From OIG report:

    All Part D sponsors, pharmacies and providers should be aware of the OIG’s continuous efforts to identify and combat against potential areas of fraud in the Part D program.  Prescribers in any of the OIG’s current hotspots should also be prepared for increased scrutiny.

    For more information, read the full reports:

  • 01Jul

    Are you new to Medicare and Medicare’s various enrollment periods? If so, it is important to learn the basics of Medicare requirements and options for enrollment to make the most of your coverage and avoid costly mistakes. Below are 3 main points to keep in mind when learning these requirements and options. These are taken from the Medicare Minute program, a partnership of Medicare Rights Center and the Senior Medicare Patrol (SMP).

    Point 1: Understand the rules for enrolling for the first time in Medicare.

    Medicare is the federally administered program that provides health care coverage if you are 65+ or under 65 and have a disability. There are two ways to get Medicare Parts A (hospital insurance) and B (medical insurance): through automatic enrollment by the federal government OR by signing up yourself. If you receive Social Security retirement or disability benefits, you will be automatically enrolled in Medicare when you first qualify. If you are NOT receiving retirement or disability benefits, you need to actively sign up during one of three enrollment periods:

    • Initial Enrollment Period (IEP) – When you are first eligible for Medicare, you have a seven-month period to sign up. This includes the three months before you turn 65, the month you turn 65, and the three months after you turn 65.
    • General Enrollment Period (GEP) – If you miss your IEP, you can sign up from January 1 through March 31 each year. Your coverage will begin July 1 of that year. Note that you may have to pay a higher premium for late enrollment if you miss your IEP.
    • Special Enrollment Period (SEP) – If you or your spouse (or family member, if you are disabled) is currently working and you are covered by health insurance through that current employer or union, you will have an SEP to enroll in Part B while you are working or within eight months of your coverage ending.

    Point 2: Understand your Medicare coverage choices.

    You can choose to receive your Medicare benefits in one of two ways: through Original Medicare OR a Medicare Advantage Plan.

    • Original Medicare is the traditional fee-for-service insurance program offered by the federal government and includes Part A and Part B coverage. To get Medicare drug coverage (Part D) with Original Medicare, you will need to join a stand-alone Medicare Prescription Drug Plan (PDP). Under Original Medicare, you have the option of purchasing supplemental insurance coverage in the form of a Medigap policy. Medigap policies are sold by private companies and can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Note that Medigaps do not help pay for Medicare premiums.
    • Medicare Advantage plans are private health plans that contract with the federal government to administer Medicare benefits. These plans must offer all benefits offered by Original Medicare. They may also offer additional benefits, such as routine vision or dental care. Each Medicare Advantage Plan can charge different out-of-pocket costs and have different coverage rules. Note that most Medicare Advantage plans offer drug coverage as part of their benefits package.

    The Health Insurance Counseling and Advocacy Program (HICAP) can help you compare and evaluate your choices.

    Point 3: Understand when you can change your Medicare coverage.

    Medicare limits how often you can make changes to your Medicare coverage. You can make changes every calendar year during the fall Open Enrollment Period (OEP) from October 15 to December 7. Changes made to your coverage will take effect January 1 of the next year. Before making changes, confirm all the details regarding your new plan with the plan itself. Additionally, you may be able to change your Medicare coverage during the calendar year if you meet certain requirements, such as if you move to a new home or nursing home or if you quality for certain programs that help pay Medicare costs. Finally, if you are unhappy with your Medicare Advantage Plan, you can switch to Original Medicare during the Medicare Advantage Disenrollment Period (MAPD) from January 1 through February 15 each year. Note that Medicare Advantage and drug plans must follow certain rules when promoting their products. It is illegal for plans to send you unsolicited emails, request payment over the telephone, or visit you in your home or nursing home room without an invitation. If you have experienced any of these marketing fraud tactics, you should file a report by calling our California Senior Medicare Patrol (SMP) at 1-855-613-7080.

    4 Additional Points for Taking Action:

    1. Enroll in Medicare during your enrollment period to avoid costly penalties.
    2. Carefully review the details of Original Medicare and Medicare Advantage Plans before choosing your Medicare coverage.
    3. Make changes during the Medicare-approved time frames to avoid gaps in coverage, and report suspicious activity to our California SMP at 1-855-613-7080.
    4. If you want one-on-one assistance and counseling with help understanding enrollment, choosing your Medicare coverage, or making changes to your coverage, contact your local HICAP at 1-800-434-0222.
  • 23Jun

    Many people save up for retirement with visions of traveling, pursuing their dreams and experiencing the items on their “bucket list”. Yet, our country’s elders may need to make a different plan as increasingly more of their retirement nest egg is funneled into rising health care costs. According to a recent study by HealthView Services “2015 Retirement Health Care Costs Data Report,” a couple who retires at 65 can expect to pay an average of $266,589 over the span of their retirement to cover Medicare Part A, B and D premiums and their supplemental insurance policy. That number goes up to $394,954 when including dental, vision and other coinsurance, copayments and deductible costs. Couples who retire 10 years earlier at 55 years of age can expect to pay an average of $463,849.

    Where will all this money come from in a population where 50% of all Medicare beneficiaries have annual incomes below $23,500 as of 2013 data? It will most likely come from the one of the greatest source of income for most beneficiaries, their Social Security checks. According to 2014 data, the report shows that for the average 66-year-old couple retiring in 2015, who are eligible for full Social Security benefits, their total health care costs will use up 67% of their lifetime Social Security benefits. Furthermore, for couples retiring 10 years from now, health care costs are projected to consume 90% of their SS benefits.

    For more details on this report and accompanying charts, view the article, These 5 Charts Predict What Retirees Will Pay For Health Care Over the Next 10 Years.

  • 16Jun

    As a part of Medicare celebrating its 50th anniversary this year, the Centers for Medicare and Medicaid Services are collecting Medicare stories from beneficiaries across the country. They want to hear how having Medicare has benefited you and/or a loved one and the difference it makes/has made in your quality of life and wellbeing. Below is an announcement and invitation from CMS to hear and collect your stories.

    In 1965, President Johnson signed legislation to establish Medicare for the elderly and Medicaid for low-income adults, children, pregnant women, and people with disabilities. Since then, these programs have transformed the delivery of health care in the United States. They have greatly reduced the number of uninsured Americans and have become the standard bearers for quality and innovation in American health care.

    Chances are, you or a family member either have Medicare or Medicaid or know someone who does. In fact, about 55 million Americans have Medicare this year and more than 70 million have Medicaid in any given month. Has one of Medicare’s many covered preventive benefits helped detect cancer at an early and more treatable stage for you or a parent? Have rehabilitation services provided in a nursing home or in your own home helped you get stronger and return to regular activity after surgery? Has Medicaid helped pay for your parent to live in a nursing home or helped you or your children get treatment for an illness?

    As part of the 50th anniversary celebration for these programs, the federal Centers for Medicare & Medicaid Services is collecting stories of how Medicare and Medicaid have made a difference for everyday Americans. Please visit to share your Medicare or Medicaid story.

  • 09Jun

    Did you know that Medicare beneficiaries can now obtain a replacement Medicare card if they have lost, damaged, or simply need to replace it by using their my Social Security account online? This is the newest expansion on Social Security’s online services through its my Social Security portal.

    This is a new convenience for beneficiaries, and any my Social Security account holder can make this online request. To do it, just log on to your account, and select the “Replacement Documents” tab, and then select “Mail my replacement Medicare card.” After requesting a card, it will arrive in the mail in approximately 30 days.

    According to Social Security, more than 19 million people have currently created an online personal account. In addition to the new service, you can use your account to change your address, adjust your direct deposit, obtain a benefit verification letter, or request a replacement SSA-1099. If you are still in the workforce, you can verify your earnings, and obtain estimates of your future benefits.

    For more information about my Social Security or to establish an account, visit

  • 03Jun

    Your hospital status can affect how much you pay for the services you receive. Knowing how Medicare covers hospital care helps ensure that you ask the right questions to reduce your health care costs. Below are some coverage tips and points to remember complied by the Medicare Minutes program, a partnership of Medicare Rights Center and the Senior Medicare Patrol (SMP).

    Point 1: Know whether you are receiving inpatient or outpatient hospital care.
    It is important to know whether you receive inpatient or outpatient hospital care to understand how your services are covered. Inpatient hospital care is care you receive as a formally admitted inpatient. Staying overnight in the hospital in itself does not make you a hospital inpatient. You have to be formally admitted into the hospital by an attending physician in order for your care to be considered inpatient hospital care. If you are not admitted into the hospital, the care you receive at a hospital will be considered outpatient care.

    As a reminder, Medicare Part B covers outpatient hospital care, such as observation stays, emergency room visits, and same-day surgeries. An outpatient stay occurs when you are kept in the hospital for monitoring, but you are not admitted as an inpatient. The length of an outpatient stay depends on your medical circumstance. Being an outpatient means that you will be responsible for more of your hospital costs than if you were admitted as an inpatient. You should ask the hospital whether you are an inpatient or outpatient, so you know how your services are covered. Tell your caregivers and family members to ask on your behalf if you are unable to ask about your inpatient status yourself.

    Note that observation services are services used to assess whether you need to be admitted as a hospital inpatient or if you can be discharged. If you are in the hospital, but you are on observation status, you are not considered a hospital inpatient. Knowing whether your hospitalization is considered an observation stay is especially important because observation stays can look and feel like inpatient stays. Observation stays occur when a physician does not expect you to spend more than two days in the hospital and therefore does not admit you as an inpatient. Observation stays can affect the skilled nursing facility (SNF) care you are eligible for after your hospital stay and can lead to higher out-of-pocket expenses. Original Medicare requires a 3-day inpatient hospital stay in the 30 days before you enter a SNF. Know if you meet the three-day requirement before leaving the hospital and entering a SNF. The best way to find out if you are under observation is to ask the hospital staff. Ask family members or caregivers to ask on your behalf if you are unable to ask yourself.

    If you have a Medicare Advantage Plan, it must cover the same level of care as Original Medicare, but you may have different costs and restrictions. Contact your Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222 if you would like to talk about the differences and similarities between Original Medicare hospital coverage and the coverage offered by your plan.

    Point 2: Know the cost-sharing rules for hospital stays, both inpatient and outpatient hospital care.

    If you have Original Medicare and are a hospital inpatient, your Part A costs depend on where you are in your hospital benefit period. A hospital benefit period begins the day you’re admitted as an inpatient and ends when you’ve been home for 60 days. You must meet a deductible for each benefit period of $1,260. If you are an inpatient for over 90 days, you may use your lifetime reserve days: you get 60 non-renewable lifetime reserve days, which have higher coinsurance costs.

    As an inpatient, you owe a separate 20% coinsurance under Part B for all physician services. If you receive outpatient hospital services, you typically also have to pay a copayment for each outpatient service you receive. The costs may include facility fees. You also pay a 20% coinsurance for physician services you receive. Remember that your costs may be different if you have a Medicare Advantage Plan. Call your plan for a breakdown of inpatient and outpatient hospital costs. Call your local HICAP if you need additional assistance understanding the breakdown of costs.

    Point 3: Know the difference between a service received and a billing error.
    If you are an Original Medicare beneficiary, you will receive a Medicare Summary Notice (MSN) every quarter that lists the health care services you have received during the previous three months, and their costs. Similarly, if you have a Medicare Advantage plan and/or Part D drug plan, you will receive periodic Explanation of Benefits (EOB) from your plan, listing the services you have received and their costs. The MSN and the EOB are not bills, but instead let you know the health care services you have received. Review your MSN or EOB carefully to make sure you actually received the services listed. If you discover duplicate orders for medications or lab work, or if you think you or Medicare are being held wrongfully responsible for the cost of a service, contact your hospital’s billing department to request a correction. If the hospital is uncooperative or if you are still suspicious, call our Senior Medicare Patrol – or SMP- program for further assistance at 1-855-613-7080.

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