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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.

  • 27Aug

    Navigating the roads of long-term care and ‘terrain’ of long-term care insurance products can be confusing, especially since these products are not standardized like Medicare supplement insurance (known as Medigap). We’ve recently updated our website sections on long term care and our long-term care fact sheet series which provide great resources for: 1) learning about this area of care; 2) how to plan for it financially; 3) long term care options and insurance products; and 4) a whole section on frequently asked questions.

    Below is an answer to a question we received regarding a beneficiary’s situation that may be pertinent to many people who bought a long-term care (LTC) policy when still fairly young and didn’t look too closely at the details of what the policy covers. Now, many years later, when this particular beneficiary is interested in coverage for some LTC services, she’s realizing that it doesn’t cover the type of care she wants. Her policy only covers nursing home care and respite care, but not any home care or community-based care services. She contacted our office to see if we know of any companies in California who sell home care only policies. Bonnie Burns, our Training and Policy Specialist who is an expert and national consumer advocate in long-term care, responds to her question below.

    Answer:

    There don’t appear to be any companies left selling home care only long term care insurance policies in California. In fact, many of the companies selling long-term care insurance have withdrawn from the market, although some are still some left and selling in California. I suggest you contact an agent in your community who has taken the required training to sell long-term care insurance and work with him or her to find a package of benefits that will wrap around what you already have. I agree with your assessment to keep what you already have and supplement it in some way. It doesn’t seem reasonable to forfeit the premiums you have already invested in this policy if it provides at least some benefits for future care.

    It’s important to know that today most long-term care starts at home, and many people never move beyond home care to institutional care.  But, institutional care can be an impoverishing event so having benefits for it is still very necessary.

    One option, depending on the company that issued your previous coverage, is to ask if that company would be willing to upgrade you to a more current policy and give you some premium credit for what you have already paid.  In California, if a company does that and it’s the same company that issued the previous policy they may be required under state law to give you such a credit.  You’d have to pass medical underwriting, but you would have to for a home care only policy anyway if it was available.

    You can go on the insurance department website and look for companies selling in California. Click on sample rates and fill in the information to get a look at what is being sold. You can also contact your nearest Health Insurance Counseling and Advocacy Program (HICAP) for free, local help.  They won’t be able to recommend a company or agent, but they can help with information to help you make a decision.

    For more information, resources and FAQs, see our website section on Long-Term Care.

     

  • 20Aug

    This short infograph demonstrates both visually and statistically some disturbing facts of Americans being overmedicated, so much so that every 19 minutes someone dies of a medication overdoes. While many commonly taken medications are taken as a way to “enhance” people’s lives by allowing people to sleep better, stay awake longer, get more work done, are people’s lives improving? Or in some cases, are these medications masking symptoms and in turn causing more problems? This info graphic shares some revealing data regarding these questions.

    Medicated to Death

    Source: TopRNtoBSN.com

  • 12Aug

    Below is an interview done by Kaiser Health News about a Medicare pilot program called Medicare Care Choices Model. This program would allow some beneficiaries covered under the Medicare hospice benefit with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS to receive both hospice care and life-prolonging treatments. Under current hospice rules, beneficiaries who choose hospice care must basically say “no” to receiving any type of curative care. Also, to qualify for hospice, a beneficiary’s doctor must certify that the patient has 6 months or less to live.

    Medicare Experiment Could Signal Sea Change for Hospice

    by Michelle Andrews

    Diane Meier is the director of the Center to Advance Palliative Care, a national organization that aims to increase the number of palliative care programs in hospitals and elsewhere for patients with serious illnesses. Meier is also a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City. We spoke about a recently launched pilot program under the health law that allows hospice patients participating in the pilot to continue to receive life-prolonging treatment. This is an edited  version of that conversation.

    Q. There’s a lot of confusion about how hospice care differs from palliative care. Maybe we should start by clearing up what those terms mean.

    A. The short, quick elevator answer is that all hospice care is palliative care – but not all palliative care is hospice. Palliative care is a team-based type of care focused on maximizing the quality of life for people and their caregivers at any stage of illness. It focuses on treating the pain, stresses and symptoms of serious illness. The emphasis is on need, not prognosis or how long you might have to live.

    In contrast, the hospice benefit, which was written into the Medicare statutes about 25 years ago, had a number of limits in it to control spending.

    Diane Meier (Photo courtesy of Mount Sinai Hospital)

    First, two physicians have to certify that the patient will likely be dead in six months if the disease follows its natural course. Second, the patient or family members need to sign a paper giving up regular insurance coverage for disease treatment in order to get access to hospice, a forced either/or choice between life-prolonging treatment and palliative care. It was an attempt to save money. Most people need—and want—both types of treatment.

    But we can’t predict who’s going to die in six months, in part because of the variation in people. We can’t really tell if someone is going to keep motoring along. The other thing is that many people want to keep receiving disease treatment, because it is helping them to get along and keeping up their quality of life. As someone who has counseled many people with serious illnesses, I can tell you it is very painful to tell people they have to sign away their rights to treatment. It’s like hitting a man when they’re down.

    Q. The Centers for Medicare & Medicaid Services recently announced that the agency is launching the Medicare Care Choices Model, a program created under the health law that allows hospice patients with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS to receive not only hospice care but also curative care. Does this experiment signal a noteworthy change in approach toward caring for dying patients?

    A. I think it does. I think it’s a recognition that this forced choice between palliative care and life-prolonging treatment is irrational.

    Unfortunately the way the new benefit was written is that the only people who can be eligible [for the pilot] are those who would be eligible for hospice, that is, people very likely to be dead within a few months. People tend to be pretty damn sick by the time they become eligible for hospice. I’m not really sure what access to curative care means in that context. If these patients could have been “cured” they wouldn’t be eligible for hospice.

    It’s a misnomer to say they’re going to be cured. There are very few diseases that we cure in U.S.medicine. In most cases what we’re talking about is life-prolonging treatment, and in most cases that’s palliative treatment. It makes people feel better. If you have emphysema and I give you broncodilators and steroids to open up your airways, it will prolong your life, and it will also make you feel better.

    Q. I understand that some hospices say they won’t participate in the new program because the CMS payment rate of $400 per beneficiary per month isn’t enough cover their costs, which include coordinating beneficiaries’ care with curative and other providers, and providing counseling and support services for beneficiaries and their families (curative care services are covered by the regular Medicare program). Is that rate too low to provide the necessary services?

    A. You can do something that’s fairly telephone intensive for $400. You can have staff get training in symptom management and have them talk to family members, which are usually the ones who are calling with questions. The problem is if you have to dispatch a human being to the person’s home. It’s difficult to do that for $400. And when someone calls after hours you often need to do that. It’s really hard to provide 24/7 visiting capacity with that amount of money.

    Remember: These patients are not stable, they are the sickest patients in our health care system. They need a lot of hand holding. Availability and responsiveness are key and  that’s expensive.

    The patients in this demonstration project may be much more complicated to take care of than regular hospice patients. Not only are they dealing with the consequences of disease but with the consequences of treatment, the side effects of chemo, for example. Hospice staff are not accustomed to working with patients who want continued disease treatment.

    I think it’s going to be challenging but I think it will lead to some really creative solutions. Hospice organizations may look to build out a more comprehensive safety net by partnering with other community providers like Meals on Wheels or local aging services or transportation providers. And that would be really good.

    Q. What does the research show about people who receive both hospice or palliative care and life-prolonging treatment?

    A. There are now several studies that show that patients who receive both palliative care and life-prolonging care actually live longer than those who receive life-prolonging treatment alone.It makes sense. People aren’t in excruciating pain, they’re not depressed, their families feel confident in their ability to care for their loved one. And if, very importantly, people are able to avoid the very real risks of hospitals, it’s no surprise that they live longer.

    They’re not getting less life-prolonging treatment with palliative care, they’re having less crisis. They reduce emergency care use because they don’t need it and that saves money.

    If palliative care were a drug, I’d be rich.

    Q. What could that mean for this new CMS pilot program?

    A. Let’s say hospices can do this for $400. Think about the pressure to scale that up to people whose prognosis is two years or three years or even longer.

    So I can see why CMS is being really cautious. It’s going to be important to demonstrate that if you take people and do this, that it won’t break the bank. My prediction is that it will actually be less expensive to provide both approaches at the same time precisely because it will lead to less need for costly emergency and crisis care.

    Q. What’s next on the horizon for palliative care?

    A. We’ve gotten pretty far with integrating palliative care into hospitals. More than 60 percent of hospitals with more than 50 beds nationwide have programs. But most people are living at home. Right now it’s very hard to access palliative care if you’re not on hospice or in the hospital. In the next 10 years, we need to integrate palliative care into home care, cancer center care, dialysis units, nursing homes and other settings.

  • 04Aug

    Yes, it’s the first full week in August and that means it’s also National Simplify Your Life week. Oftentimes, busy lives, full work schedules and long to-do lists, along with a multi-tude of technologies to help us get all these tasks organized and done, are a common theme for many. And while we may be up to great things and doing important service in the world, sometimes the complexities of life can feel burdensome, heavy and lead to stress and unhappiness. Simplifying our lives in a variety of ways can help bring back that natural element of levity, freedom, joy and exuberance that is always a part of our true inner nature. While there are many ways to simplify, one way to easily peal away from the hold of busy-ness and complexities and tap into our inner nature is to step outside.

    Nature is one of our greatest assets. Across the ages, we have read, known of many great poets, writers, artists, teachers, inventors that have gone out into nature for inspiration, clarity, and renewal. There is a reason why sages from spiritual traditions around the globe all come from the mountains to share their teachings. John Muir, a beloved writer and father of our National Park system shares that “the clearest way into the Universe is through a forest wilderness.” He also says that “Everybody needs beauty as well as bread, places to pray in and play in, where nature may heal and give strength to body and soul.”

    A hiker sits atop Trolltunga, or "troll's tongue," a famous rock formation in southwestern Norway. (Photo: Shutterstock)

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

    In Norway, the 2nd happiest country on the planet according to UN rankings (U.S. is ranked 17th), they have a particular “simple” philosophy that greatly enhances their happiness and wellbeing. That is “friluftsliv”…while it may be a mouthful, and is not so easily translated into English, it literally means “free air life”. It refers to an uplifting ambience that arises from our outdoor dynamic relationship and enchantment with nature. Some Norwegians say this word describes a way of life that is spent exploring and appreciating nature. Their country’s population is small and their wild lands and mountains are all surrounding. Nature and ‘friluftsliv’, time exploring and appreciating nature,  is an integral part of people’s life in that country. It is a philosophy, a way of being that doesn’t require any technology or to-do lists, but instead is a willingness, a joyful curiosity and love of stepping outdoors to step into nature and into our inner nature. John Muir eloquently points to this when he says, “I only went out for a walk and finally concluded to stay out till sundown, for going out, I found, was really going in.”

    So, from this year forward, let’s take the invitation of “National Simplify Your Life” week and step outdoors! This is one, easy, time-tested way to recover our natural joy and freeness and to remember and celebrate our integral connection to our greatest asset, Nature.

     

    This article was inspired, in part, by the article, How ‘Friluftsliv’ Can Help You Reconnect with Nature.

  • 22Jul

    Here’s a brief 2-min TV video on IRS scams that are affecting seniors around the state. Tatiana Fassieux, Program Manager for the Health Insurance Counseling and Advocacy Program (HICAP) in No. California reminds people how to spot such scams and what to do when encountering them. She shares that she also received this scam call. “You will never get valid and true information from a cold call. It’s always a scam,” says Tatiana.

    A few points to remember, include:

    • The Federal government will never call you.
    • Don’t give out personal information over the phone.
    • If you think a legitimate business is calling, look up the number yourself from their official website.
    • Jot down time and date of suspicious calls and report them to our Senior Medicare Patrol at 855-613-7080.

    Here’s another article on an IRS scam to be aware of. Also, see our Medicare Fraud section for more information on fraud and tips to detect, protect and report!

  • 16Jul

    One of our Social Security Public Affairs Specialists for Northern California, Deogracias Santos shares a fun article about how the online program, My Social Security, offers an easy way to add more simplicity to your life. And, with National Simplify Your Life week coming up in the first week of August, this is a great time to get a jump start on some simplicity! :)

    MY SOCIAL SECURITY SIMPLIFIES YOUR LIFE

    By Deogracias Santos

    Social Security Public Affairs Specialist in the Northern Area of California

    So many people buzz through extremely busy and complicated schedules these days. A smartphone in one hand, a computer in front of you, and a digital task list that never seems to end. In addition, to complicate things just a little more, there’s another event you need to add to your list—National Simplify Your Life week. This event takes place August 1 through 7. Put it on your calendar so you don’t forget!

    Most organized people agree that planning ahead is a great way to simplify your life. Whether you’re planning tomorrow’s schedule, next summer’s vacation, or your retirement.

    We have a suggestion that can help you simplify your life when it comes to Social Security. If you haven’t already (it’s probably on your task list), open your own personal my Social Security account.

    What’s my Social Security? It’s a free, secure, online account that allows you immediate access to your personal Social Security information. During your working years, you can use my Social Security to view your Social Security Statement to check your earnings record and see estimates of the future retirement, disability and survivor benefits you and your family may receive based on your earnings. If you already receive Social Security benefits, you can use my Social Security to check your benefit information, change your address and phone number, change your electronic payment methods, and even obtain a benefit verification letter. Check it out and sign up for my Social Security at www.socialsecurity.gov/myaccount.

    After you check your online Social Security Statement, be sure to visit our Retirement Estimator. Like my Social Security, you can use it as many times as you’d like. The Retirement Estimator lets you compute potential future Social Security benefits by changing variables, such as retirement dates and future earnings. You may discover that you’d rather wait another year or two before you retire to earn a higher benefit. To get instant, personalized estimates of your future benefits just go to www.socialsecurity.gov/estimator.

    There are many tools at www.socialsecurity.gov that are simple and convenient to use. Open a my Social Security account today by visiting www.socialsecurity.gov/myaccount and simplify your life.

  • 08Jul

    We’re getting several reports of fraudulent providers and durable medical equipment (DME) suppliers who are offering beneficiaries “free” services or equipment in exchange for their Medicare numbers. “Free” is the red flag. If the services or treatments were truly free, no Medicare number would be needed. Fraudsters ask for these numbers because then they can sell them to other crooks and/or bill Medicare directly for services and equipment beneficiaries don’t ever receive.

    Things to remember:

    • If your Medicare number is requested for a “free” service or item, it is not free as advertised. It is most likely a scam. Medicare is often billed. If Medicare denies payment, you could be stuck with a bill for something you never received. If the fraudster bills Medicare with your number for too many services or too much equipment, your Medicare number may be flagged as an “over-utilizer.” This could make it hard to get the services and supplies you may need in the future if/when you need them.
    • Beware of people who say they know how to get Medicare to pay for something. Medicare pays for services and items based on medical necessity — meaning a service or item you really need for your medical condition. Also, most durable medical equipment requires a prescription from your doctor. People making these offers will have no concern or mention of either of these requirements.
    • If it’s “too good to be true,”…it probably isn’t true! When it comes to scams and fraud, this is a good rule of thumb to follow.
    • Beware of phone scams where callers claim to be from Medicare, Social Security, the IRS or other government entity and ask for your Medicare number or other personal information. These entities won’t call you. They already have your Medicare number and will not ask you for it or other personal information.

    If you or someone you know comes across such scams, let us know. Together we can stop fraud! Call the Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222, or the Senior Medicare Patrol at 1-855-613-7080.  Thank You!

     

  • 03Jul

    Here are a couple pictures of Paula Holden, our SMP Regional Liaison, and Dan Boutwell, the Rite Aid Wellness Ambassador, at last week’s Savvy Senior event in Northern CA. Paula and Dan worked together to form what is now a flourishing and expanding outreach partnership, called Health In Pharmacies (HIP). The HIP program involves volunteers with the Health Insurance Counseling and Advocacy Program and Senior Medicare Patrol (HICAP/SMP) and Rite Aid and Walgreens pharmacies around the state. HICAP/SMP volunteers set up outreach tables and offer free information on Medicare and Medicare fraud prevention in participating Rite Aid and Walgreens pharmacies on certain days of the month. Both Dan and Paula who have started this whole trend were at this outreach event last week and visited each other’s tables.

    Paula Holden, SMP Regional Liaison and Dan Boutwell, Rite Aid Wellness Ambassador

    The HIP program is spreading in both Northern and Southern California and currently is operating in at least 10  Rite Aid stores and  4 Walgreens stores. We are finalizing a HIP tool kit to help our partners get “hip” and start this HIP outreach in their own area. More info on that soon!

    Here’s an article about how this partnership all began: SMP Forms Fruitful Community Outreach Partnership with Local Pharmacy.

  • 25Jun

    The traditional phone scam keeps morphing and now shows up as email scams, post office scams, delivery scams, bank scams…it seems the morphing is endless! But all of these scams do have something in common. They are fishy. And as one of my colleagues says, “If it looks like fish, smells like fish, then it’s fishy and is best to avoid.” Below are a few brief examples of some of these “fishy” scams to watch out for. Knowing the shapes and sizes they come in helps identify a range of scam morphing phenomena and will help you and others both avoid and report them.

    FedEx Delivery Scams

    The wife of one of our Senior Medicare Patrol volunteers recently received an email from “FedEx”. They claimed they were trying to deliver a package to the house and wanted to verify her address and other personal information. Well this was certainly “fishy” as FedEx would never call to verify an address. They already have the address and if they did have a question, they would ask the sender, not the recipient. This woman was expecting a package but not from FedEx. She went to her post office to check and they confirmed that this indeed was a scam.

    Notice to Appear – Court Case Scams

    Another SMP colleague says she receives email scams daily. A recent one was titled “Notice to Appear.” It was a short letter saying she was being called to attend a hearing for her case and that a copy of the court notice was attached. It was signed from the “Clerk to the Court, Emily Mason.” Again this is fishy, as my colleague has no case pending in court. It is just another way to get her to call a number, or “verify” and give away some of her personal information.

    Bank Email Scams

    Other common email scams are appear to be from banks, credit card companies or other financial institutions and, as scammers can easily copy and paste official logos into email graphics or websites, their emails and websites can look legit. But again, there will most likely always be something that seems a bit off, or is fishy. These bank scams often say they are updating their files and want you to verify some personal information. If you get an email like this, it’s best not to go to any of their linked websites or use their phone numbers. Instead, go to the phone book or go to one of your bank statements and use the customer service number listed there. In many cases, your bank will verify that this email is a scam.

    These are just a few of the morphed scams to watch out for. Again remember, if it looks fishy, smells fishy, then it’s fishy and should be avoided and reported! If you or someone you know comes across such a scam, please report it to our Senior Medicare Patrol (SMP) at 1-855-613-7080.

    See our Medicare fraud section for more information on health care fraud.

  • 17Jun

    Below is a humorous but sadly too true commentary on the outrageous prices of drugs and how the pharmaceutical industry does everything in its power to avoid discussing prices….and to distract our attention by…looking at squirrels!

    Wow, this drug is really expens — Look! A squirrel!!

    For years, the pharmaceutical industry has had a pretty simple strategy for discussing the prices it charges for its drugs: don’t.

    Indeed, whenever the high price of pharmaceuticals is in the news, drugmakers try desperately to change the subject and distract from the issue. Now more than ever, that strategy is on full display as the industry is under increasing fire for the prices of specialty pharmaceuticals – some priced at more than $100,000 for a single course of treatment. Shifting blame may have been effective in the past, but when public health and access to life-saving drugs is being threatened by these increasingly outrageous prices, it just won’t do the trick anymore. As the drugmakers ramp up yet another campaign of distraction, here are some simple facts to consider:

    FACT: Astronomical prices for specialty drugs will blow up Medicare Part D budgets and force higher premiums for seniors

    An analysis in Health Affairs last week found that the price of the important hepatitis C drug Sovaldi could increase the cost of Medicare Part D and premiums for seniors by 8%. From this one drug alone, seniors on Part D could see an 8% premium hike.

    FACT: Astronomical prices for specialty drugs will devastate state Medicaid budgets and displace important priorities like education and infrastructure

    One recent analysis highlighted on Vox illustrated that, because Sovaldi is so expensive, California could potentially spend more administering the drug for people on Medicaid than it does for K-12 and secondary education combined. Yes, you read that correctly.

    FACT: Astronomical prices for specialty drugs put upward pressure on premiums for all consumers

    At its core, the cost of health insurance is a reflection of the cost of health care. The skyrocketing prices that drugmakers are charging has a ripple effect throughout the system, raising premiums and increasing health care costs for individuals, families, and employers.

    FACT: Health plans offer consumers a range of coverage options, including policies with lower cost-sharing

    To distract from their unjustifiable pricing, drugmakers have latched onto distorted coverage comparisons that ignore the range of cost-sharing options consumers can choose from. Hey, anything beats talking about the actual price.

    FACT: Consumers have out-of-pocket limits that mean health plans and state and federal governments rather than patients are paying the vast majority of the cost of these stratospherically priced drugs

    Pharmaceutical companies know that consumers’ out-of-pocket costs are capped under the Affordable Care Act, allowing them to ask for what amounts to a blank check from insurers and government programs. Not surprisingly, drugmakers are making the law work for them.

    BONUS FACT: Drugmakers have no straight-face explanation to justify the increasingly astronomical prices they have been charging for their medications

    That’s why they want to talk about anything – ANYTHING – other than the prices they are charging.

    The most important fact is that we all want patients to have access to the best treatments. That’s why we cannot afford to allow pharmaceutical companies to have us simply look the other way any longer when it comes to pricing. These unsustainable drug prices threaten our health care system – public and private – access for patients, as well as the very innovation that pharmaceutical companies relish. We cannot have sustainable innovation without sustainable prices to support it, and that’s why health plans and a diverse set of stakeholders have called on drugmakers to come to the table to find a private sector solution to this challenge before the government feels like it needs to.

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