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Do you have comments or concerns about your Medicare coverage? Issues regarding getting your needed prescriptions from your Part D plan, or a Medicare Advantage plan representative's marketing practices? Let us know at .

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.

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  • 01Jan

    CHA Comments on CMS’ Proposed Rules on New Compensation Limits for Agents Selling Medicare Part C & D Plans

    Medicare Advantage, Prescription drugs Comments Off

    CHA recently submitted comments drafted jointly with various advocacy organizations on the Center for Medicare and Medicaid Services’ (CMS) proposed rules. The comments reveal how proposed compensation rules actually encourage unsuitable Medicare Advantage enrollments. This is because, under the current rules, commissions are nearly double for enrolling beneficiaries new to Medicare Advantage versus commissions for people staying in their current plans or switching to a similar MA plan. The rules encourage agents to focus enrollment efforts on people new to Medicare, or those in Original fee-for-service Medicare who have a Medicare supplement plan (Medigap), Medi-Cal, or employer or retirement coverage. This poses a problem because it is precisely these beneficiaries—those who are accustomed to the wide provider access, protection against catastrophic expenses and predictable monthly expenses of a Medigap supplemental plan, who may have all Medicare cost-sharing and additional benefits paid by Medicaid, or who stand to lose supplemental coverage from a former employer —for whom a Medicare Advantage plan is often unsuitable. 

    The comments include several recommended changes to these rules and agent compensation structures.

    View full comments.

  • 22Dec

    GAO Publishes Report on Private Fee For Service (PFFS) Plans

    Medicare Advantage Comments Off

    According to a recent Government Accounting Office (GAO) report on Medicare Private Fee For Service (PFFS) plans, in April 2007, beneficiaries in PFFS plans tended to be healthier and generally younger than beneficiaries in other Medicare Advantage plans and fee-for-service Medicare. Specifically, projected health care expenditures for PFFS beneficiaries were 7% less than the projected average for beneficiaries in other MA plans and 10% less than the projected average for beneficiaries in fee-for-service Medicare. Beneficiaries in PFFS plans also generally were more likely than beneficiaries in other MA plans and fee-for-service Medicare to reside in rural areas where fewer other MA plans were available. In addition, about 81% of beneficiaries who were new enrollees in PFFS plans were in fee-for-service Medicare before enrolling in their plan, compared to 65% in other MA plans.

    This high percentage of beneficiaries (81%) who were new enrollees in PFFS plans and had previously been in Original fee-for-service Medicare precisely points out a short fall in the Center for Medicare and Medicaid Services’ (CMS) compensation limit rules for agents selling Medicare Advantage and Part D prescription drug plans. While the rules do help eliminate incentives for agents or brokers to move beneficiaries from plan to plan, a practice known in the industry as “churning,” they still allow agents to receive almost double compensation for enrolling people new to MA plans, as opposed to the much lower ‘renewal’ compensation they receive for beneficiaries they previously enrolled in an MA plan who stay in their MA plan or switch to a similar plan for the coming year. This means it is financially more profitable for agents to focus their marketing efforts more exclusively on people new to Medicare or in fee-for-service Medicare. And this is exactly what is happening as is demonstrated in the GAO report findings.
    The GAO report also discusses how many people who enroll in PFFS plans are unaware of the payment structure and that these plans currently have no preset network of providers. This means that if a beneficiary’s doctor doesn’t accept the terms of the PFFS plan’s payment, the beneficiary may be responsible for the costs of care.
    For more information see:
  • 17Dec

    10 Medicare Fact Sheets Translated into Spanish, Korean, Russian and Chinese

    Resources Comments Off

    We recently posted 10 Medicare fact sheets translated into Chinese, Korean, Russian, and Spanish (Vietnamese translations are coming soon) on our website.

    These fact sheets help Medicare beneficiaries understand Medicare, and their rights and benefits.  Each fact sheet focuses on a specific Medicare topic.  Three of the 10 translated fact sheets are:

    • Medicare Part D: An Overview, which explains how the Medicare prescription drug program works and the costs;
    • Extra Help for Part D Costs, which describes the low income subsidy (LIS) program that helps some Medicare beneficiaries pay for their Medicare Part D plan; and
    • Medicare: An Overview, which summarizes the federal health care insurance program for people 65 years and older, younger people who have disabilities, and people who have kidney failure or end-stage renal disease.

     

    Medicare is complicated enough in English, and is even more complex for people who don’t speak or read English. We are thrilled to post these 10 translated fact sheets on CHA’s website so that more people – people who speak other languages – can learn about their Medicare benefits, options and rights.  This is just one step among many to help all California beneficiaries make informed decisions about their health care.

    Both the California Department of Aging (CDA) and the Centers for Medicare and Medicaid Services (CMS) provided funding for the translations of these fact sheets. 

    For more information on providing services to people with limited English proficiency, see our article Speaking the Language: Are Your Services Available to Those Who Need Them?

  • 09Dec

    Employer Contracts with Medicare Advantage Private-Fee-For-Service Plans Increase for Retiree Coverage

    Medicare Advantage, Medicare and other health insurance Comments Off

    A recent Medicare Advantage (MA) enrollment boom is largely due to employers using the program to cover their retirees, according to a recent Kaiser Family Foundation report, prepared by Avalere Health. Employers can contract with MA plans to provide Medicare and supplemental benefits to Medicare-eligible retirees. The report shows that employers are increasingly using private fee-for-service (PFFS) plans over other types of MA plans as an option for offering retiree health benefits.

    Between 2006 and 2008, the number of Medicare beneficiaries enrolled in Medicare Advantage group plans increased to 1.7 million, from 900,000, and most of that growth came from growth in employer PFFS plan contracts.

    Prospects for continued enrollment growth in the group PFFS market, however, are uncertain because of changes in Medicare Advantage payments and the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 signed into law in July that will require PFFS plans to create provider networks by 2011. See our article on MIPPA for more information.

    Also see our website sections on:

  • 02Dec

    CMS Has New Tip Sheets on Best Available Evidence and Making Sure LIS Beneficiaries Pay Correct Copays

    Low-income help Comments Off

    The Centers for Medicare and Medicaid Services (CMS) recently posted 2 new tip sheets:

    1. on Best Available Evidence (BAE) - “Correcting Beneficiary Low-Income Status Based on Best Available Evidence” and
    2. on making sure beneficiaries who may qualify for the low-income subsidy (LIS) are paying the correct co-payment amounts - “Are You Paying the Right Amount for Your Prescriptions?“

    Both tip sheets provide an important review for beneficiaries and advocates on easy, clear steps to take if one qualifies for the low-income subsidy (LIS) and is being charged too much for their Part D prescription drug co-pays.

    The first tip sheet on BAE explains how Medicare uses data both from the state Medicaid offices and Social Security to determine who is eligible for the LIS program. Sometimes, however, Medicare’s system shows incorrect payment levels or may not show that a person is eligible for LIS when they are. In such cases, beneficiaries can use one of the outlined best available evidence methods to demonstrate to their Part D plans they are indeed eligible to receive the low-income subsidy. Once a Part D plan receives any form of BAE documentation, they must charge the beneficiary no more than $2.40 for a generic drug and $6.00 for a brand name drug (in 2009). If a beneficiary is in an institution, they cannot charge him/her any co-payment amount for either generic or brand name drugs.

    If a beneficiary cannot find one of the 9 pieces of BAE documentation outlined on the tip sheet, but still think they are eligible for the LIS, they can call their Part D plan for help. Their plan must refer their information to Medicare to verify their status, and they must do this within 1 business day.

    For more information, view the 2 tip sheets. Also, see our previous newsletter article “CMS Issues Updated Best Available Evidence Policy Memo to Part D Plans.”

    In addition, see our fact sheet on “Extra Help for Part D Costs.”

  • 18Nov

    New Guide for Reaching and Serving Clients with Limited English Proficiency (LEP)

    Resources Comments Off

    The National Senior Citizens Law Center recently published a checklist for organizations serving clients with limited English proficiency (LEP), Best Practices for Reaching Out and Serving Limited English Proficient Clients (PDF). Under federal law, all organizations receiving federal funds are required to evaluate the language needs of their clients, develop a plan to meet those needs, and notify LEP individuals of their rights to assistance. This checklist provides tips on making an organization’s office environment and culture (i.e. signage, volunteer/staff training), communications (in-person, telephone, website, and written), outreach efforts of greater benefit to LEP clients. The checklist also covers the LEP assistance requirements for Social Security, Medicare, Medicare Advantage plans and Part D prescription drug plans, and lists where to file a complaint if these requirements are not met. For more information on the federal and state laws and policies regarding organizations and agencies making their services accessible to people with limited English proficiency, see our article, “Are Your Services Available to Those Who Need Them?” Some other related articles with excellent resources include:

  • 13Nov

    New Online Community Offers Support to Veterans

    Medicare and other health insurance Comments Off

    Yesterday, on Veterans’ Day 11/11/08, Vietnam veteran, John Campbell launched a new web-based community called MyVetwork, aimed at providing support to veterans and their communities.

    Campbell, Founder and CEO of this non-profit social networking site, found it challenging to locate information about support for himself and his family when returning from Vietnam. As a way to help remedy this situation for new and retired veterans, their families and supporters, Campbell created this online community to connect people with information, services, and an easily-accessible community. In brief, this social networking site both:

    1. Provides US military and those who care about them with a way to interact with and support each other in ways that range from lighthearted to meaningful, long-lasting communication; and 
    2. Creates an interactive exchange where a broad variety of experts - including veterans of earlier conflicts - provide timely news on military matters, job and career advice, information on educational opportunities, and advice regarding health care.

    For more information on Veterans health care benefits and how they work with Medicare coverage, see our new fact sheet, “Medicare and Veterans Administration Medical Benefits Package.”

  • 11Nov

    Governor Proposes Major Cuts to Health and Human Services Including Medi-Cal, SSI/SSP and IHSS

    Low-income help, Medicare and disabilities Comments Off

    According to a recent report from California Disability Community Action Network (CDCAN), Governor Schwarzenegger is proposing major cuts that would end several optional Medi-Cal benefits and cut or reduce benefits to certain Supplemental Security Income (SSI), State Supplementary Payment (SSP) and In-Home-Supportive Services (IHSS) programs. These cuts would impact children and adults with disabilities, people with mental health needs, seniors, the blind, low-income children and families, and providers across California. Governor Schwarzenegger plans to call the Legislature back in for a special session before November 30th to address the state’s budget crisis – a budget shortfall projected to be as high as $11 billion. Governor Schwarzenegger hopes to have these proposed cuts approved by the current Legislature. This way the cuts would apply for this budget year which began July 1, 2008, and also extend through the next budget year (July 1, 2009 – June 30, 2010).  In some cases, such as with the proposed elimination of the Cash Assistance Program for Immigrants, which provides SSP level state funded grants to eligible legal immigrants who have disabilities, are blind or are over 65 years of age, would be permanent, as would the cuts proposed for IHSS and Medi-Cal.

    Below are some highlights from CDCAN’s report that would affect California’s adults with disabilities and seniors:

    Medi-Cal

    • Proposal to reduce California Medi-Cal benefits to the level of benefits most other states’ Medicaid programs provide by permanently eliminating the following optional benefits: adult dental (excluding children), chiropractic, incontinence creams and washes, acupuncture, audiology, podiatry, and psychology Medi-Cal funded services.
    • Proposal to reduce Medi-Cal benefits for newly qualified immigrants and immigrants who permanently live in California to the same level currently provided to undocumented immigrants. Medi-Cal benefits that would remain include emergency services, pregnancy related services, long-term care in nursing home facilities, and breast and cervical cancer treatments. 
    • Proposal to reinstate share of cost for Medi-Cal services for persons with disabilities, people who are blind or seniors with incomes over the SSI/SSP limits.  Eligibility for Medi-Cal without a share of cost for those persons was expanded in January 2001 from 69% to up to 127% of the federal poverty level through the Aged and Disabled Federal Poverty Level program.  
    • Proposal to cut emergency services for undocumented immigrants by implementing a monthly eligibility determination for emergency services for undocumented immigrants. Undocumented immigrants currently receive up to 6 months of health services after an initial eligibility determination.  The Governor’s proposal would limit those services to 1 month unless and until there is a subsequent health emergency.

    In-Home Supportive Services (IHSS) 

    • Proposal to cut the state’s participation (matching funds) for IHSS worker wages and benefits to the level of California’s minimum wage ($8/hour).
    • Proposal to eliminate IHSS domestic and related services for some people receiving IHSS with a higher functionality.  (Note IHSS has an index to measure a person’s ‘functionality’). Would maintain those services for persons with less functionality.  Proposed effective date if approved would be March 1, 2009. 

    SSI/SSP (Supplemental Security Income/State Supplemental Payment)

    • Proposal to permanently eliminate the Cash Assistance Program for Immigrants (CAPI), effective (if approved) March 1, 2009. 

    For more information, see CDCAN’s website for more information. 

    World Institute on Disabilities’ (WID) website, Disability Benefits 101, has detailed information on Medi-Cal, IHSS and SSI/SSP.

    See our website sections on Medi-Cal and other programs for people with low-incomes.

  • 06Nov

    New Medicare Podcasts in English and Spanish

    Medicare basics Comments Off
    Get your ipods ready for great listening! 
    CHA has just posted our first 2 Medicare Podcasts available in English and Spanish. These are brief recordings (of David in English and Jasmine in Spanish) of

    1)      an overview of Medicare, covering:

    • what Medicare is and its 4 parts (Medicare Parts A-D)
    • programs for people with low-income; and
    • where to get help with Medicare questions

    2)       an overview of Medicare Fall Enrollment, describing the annual election period (November 15- December 31) and tips on what to consider when making a change in one’s Medicare coverage.

    Please help us spread the word to your clients and their families to use this new helpful resource. Also, if you have any feedback on these, let me know. These two are the first of several to come.

    Also, if you like using RSS feeds - CHA now has one. You can sign up for our RSS feed on the left-hand side of our website and have all our updated news articles, resources, issue briefs, fact sheets, etc. that we post automatically downloaded to you. If you haven’t used RSS feeds, here are a couple helpful links to articles on RSS feeds, how to use them, and why they’re useful…

    http://www.nytimes.com/services/xml/rss/index.html

  • 04Nov

    CMS Releases New Medicare Part D Claims Data – Highlights on Beneficiary Costs Part D Benefit Use

    Prescription drugs Comments Off

    The Center for Medicare and Medicaid Services (CMS) just released information on drug claims for the 25 million Medicare beneficiaries enrolled in Medicare Part D. The Medicare Part D Data Final Rule, published in May 2008 called for the compilation of this claims data (see Final Rule fact sheet) for program monitoring, research, and quality improvement.

    Below are some highlights on beneficiaries’ experiences with Part D costs and benefits extracted from this 2006-2007 claims data and presented at CMS’ Medicare Prescription Drug Benefit (Part D) Symposium on October 30, 2008. Additional information on the Medicare Part D Data Final Rule and access to the power point presentations from the symposium will be available next week on CMS’ website.

    Beneficiary Experience

    Part D Costs and Utilization per Beneficiary

    Based on 2006 data, the average monthly cost per enrolled beneficiary (including both beneficiary out-of-pocket costs and plan costs) was $203. The average cost was higher among stand-alone prescription drug plans (PDPs) ($233) than Medicare Advantage prescription drug plans (MA-PDs) ($135). It was also slightly higher among females ($209) than males ($193), and higher among enrollees with the low-income subsidy (LIS) ($277) than non-LIS enrollees ($147).

    The average number of prescriptions per enrolled beneficiary per month was 3.2. The average number of prescriptions per enrolled beneficiary was slightly higher among PDPs (3.5) than MA-PDs (2.5), slightly higher among females (3.5) than males (2.8), and higher among the LIS (4.1) than the non-LIS enrollees (2.6).

    Beneficiaries who Reached the Donut Hole Coverage Gap or Entered the Catastrophic Coverage Phase

    According to CMS data, a smaller percentage of total enrollees were fully exposed to the Part D donut hole coverage gap (10.9%) as opposed to the 26% of beneficiaries reported in the recent Kaiser Family Foundation report. This smaller percentage was calculated after excluding all LIS beneficiaries as well as those non-LIS beneficiaries with some type of coverage in the gap.

    When taking out these exclusions, however, CMS data actually shows a greater percentage than the KFF report – 31.7% of all enrolled beneficiaries – who fall into the donut hole.

    Also, CMS found it took affected beneficiaries an average of 6 months from enrollment time to reach the donut hole. The average time in the donut hole was about 4 months. In both years, on average, LIS enrollees reached the donut hole sooner than non-LIS enrollees and PDP enrollees reached the donut hole sooner than MA-PD enrollees.

    In addition, only 8.8% of all Part D enrollees reached the catastrophic coverage phase in 2007, and the vast majority were LIS beneficiaries.

    See more information on Medicare Part D claims data on CMS’ website.

    For information on the Part D donut hole and resources for people who are in the coverage gap, see our:

     

    For more information on the Medicare Part D benefit and extra help (LIS program) for people with low-income, visit the Part D section of our website.


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