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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.

  • 23Apr

    With 2015 being Medicare’s 50th birthday, one of our partner advocacy organizations, Center for Medicare Advocacy, has created 50 insights for celebrating Medicare’s 50th. As Congress is currently debating budget proposals that would significantly change Medicare as we know it, it’s important to keep all the good Medicare provides for 52 million people in the forefront of our minds.

    A few of the good highlights pointed out already include:

    • Medicare reduces poverty
    • Medicare saves lives
    • Medicare helps people with disabilities
    • Medicare reflects the heart of American character
    • Medicare beneficiaries are remarkable
    • Medicare helps people with disabilities stay home
    • Medicare helps those with low-incomes have affordable health care coverage

    See their section on Medicare’s 50th Anniversary for more information.

  • 14Apr

    The head of the Institute for Communitarian Policy Studies at George Washington University, Professor Amitai Etzioni, recently released a video relating a sociological view on aging and how to deal with its changes. He uses the analogy of green bananas to point out that when we’re young, we’re often taught to take actions that secure a “good” future. We see things in more of a linear way, taking actions today to secure financial security, or a good home or family life, etc for the future. Once Professor Etzioni became an elder, however, he realized how this linear way of orienting one’s life, activities and goals wasn’t so applicable or relevant. The timeline that extends into the horizon isn’t so long, and more than ever, he is aware that one’s present moment is where the keys to happiness lie. In looking to sociological research, Prof. Etzioni found 3 key actions elders can take in leading happier, healthier and longer lives.

    They are:

    • Invest in friends
    • Volunteer, mentor, find ways to give back in your community, and
    • Maintain or develop your spiritual practice

    While having good, quality health insurance coverage and care certainly contributes to one’s peace of mind and quality of life, these 3 actions also enhance people’s happiness and health. Watch the short video below as Prof. Etzioni expands on these actions.

     

  • 09Apr

    One way to make a change is to get people laughing! This is what an acting troupe of seniors do…traveling and performing comedy as a way to educate their peers on senior scams. Based in southern California, Stop Senior Scams Action Program is comprised of a lively, humorous, youth-filled group even as their ages span from 65 to 96 years. They visit nursing homes, temples, churches, senior housing units and senior centers and put on their skits about IRS scams, sweet heart scams, financial and health care scams. They even have their own hit tune called “Just Hang Up!” – to the tune of “Don’t Hang Up” (a big hit 53 years ago). Options for skit material are endless as they can draw from their own personal experience.

    This group’s vision of using humor and laughter to spread awareness and empower seniors reflects the same vision our Senior Medicare Patrol (SMP) Thespians Society, which also uses funny skits to highlight fraud schemes, how to detect and report them, and ways to prevent them. See our fraud video page for our comedic skits on mail-order scams and new Medicare card scams. With so many alerts and scary news out there, having some comic relief and a good belly laugh are a welcomed and effective way to get one’s message across! :-)

    Below is a short video highlighting this traveling acting troupe and their “Just Hang Up!” hit!

     

  • 01Apr

    On Thursday, April 2, the 2015 White House Conference on Aging will host a Regional Forum in Seattle, Washington to engage with older Americans, their caregivers, advocates, community leaders and others on the key issues affecting older Americans. It will be a dynamic and important dialogue and you can listen in and participate via the internet. Below is an announcement from the White House Conference on Aging with the details.

    The 2015 White House Conference on Aging will highlight the contributions of older adults today and help inform the landscape of aging policy for the future.

    The Seattle Regional Forum is an opportunity to hear directly from you on key issues such as ensuring retirement security, promoting healthy aging, providing long-term services and supports, and protecting older Americans from financial exploitation, abuse and neglect.

    Working in collaboration with the AARP and the Leadership Council of Aging Organizations, a coalition of more than 70 of the nation’s leading organizations serving older Americans, we want to ensure that your voice is part of our work.

    The event is invitation only, however we will be live webcasting the event. So please visit www.hhs.gov/live-3 at 8:30 am MST on April 2 to view the live stream.

    We also have set up a mechanism on our website for individuals, organizations, coalitions and others to submit comments, share stories, and provide thoughts about the issues. We value the input and ideas of older adults, their families, stakeholders, and others, and we think it is an essential part of the Conference process. Please visit our website here to learn more: http://whitehouseconferenceonaging.gov/blog/forum/page/white-house-conference-on-aging-seattle-wa-regional-forum.aspx

    Webcast Agenda

    8:30 a.m. Program Begins

    9:45 a.m. Administration Keynotes

    10:15 a.m. Overview of the White House Conference on Aging and the Day’s Objectives

    10:25 a.m. Break

    10:35 a.m. Panel Discussion: Healthy Aging/Long-term Supports and Services

    11:20 a.m. Panel Discussion: Retirement Security/Elder Justice

    12:15 p.m. Live webcast ends

    All times are Pacific Daylight Time (PDT)

  • 25Mar

    California Health Advocates supports a final and long-term solution to the physician payment formula known as the Sustainable Growth Rate (SGR). This is a long-time broken system that has needed to be repealed and replaced for years, but instead Congress has put in 17 temporary fixes. If no agreement is met by the end of the week, doctors will see a 21% cut in their payments from Medicare due to this outdated SGR.

    Democrats and Republicans in both the House and Senate and our President are eager to find a permanent solution, yet funding this “fix” should not fall on the shoulders of beneficiaries. Under current proposed legislation half – $35 billion – of the $70 billion cost over 10 years is slated to come from the pockets of elders and people with disabilities. It’s proposed to come in the form of increased Part B premiums, an added deductible to future sold Medigap plans, and additional means-testing premiums for higher income beneficiaries. Yet, as pointed out from our advocacy partners, none of the $70 billion cost is slated to come from the pharmaceutical or health insurance industry. Medicare and our taxpayers are already overpaying these industries, yet those most able to afford the bill, are strangely absent from contributing to the cost of this legislation.

    For example, if one item of the President’s 2016 proposed budget that addresses inappropriate overpayment of Medicare Advantage plans due to upcoding were adopted, that alone would save $36 million in 10 years. This would eliminate the need to make the above mentioned changes that shift the costs to beneficiaries.

    Over 50% of our country’s more than 52 million Medicare beneficiaries have annual incomes under $23,500 and a quarter live on $14,400 or less.  Most of our country’s elders are on fixed incomes and tight budgets; if health care costs go up, other necessities such as food and housing suffer. While we support a permanent fix to the physicians payment formula, it must be a fix that is beneficial to both doctors and beneficiaries. We encourage Congress to find a solution that supports our country’s elders and does not hurt them.

  • 20Mar

    Great news! The Obama Administration announced on Thursday the recovery of over $3.3 billion in fraudulent health care payments for fiscal year 2014. This amounts to a return of $7.70 for every $1 invested in fraud prevention, detection and investigation efforts in the last 3 years. It also marks the 3rd highest return on investment since fraud prevention efforts began over 2 decades ago, according to a report released by the Department of Health and Human Services and the Department of Justice.

    These kinds of results show that our fraud prevention and detection efforts are paying off. As the Administration has shorten investigation to arrest times and moved away from a pay and chase model, the results have improved dramatically. For example, the government now uses predictive analysis technology to quickly identify fraudulent or suspicious billing patterns. This led to 469 investigations in fiscal 2013 which identified or prevented $211 million in improper payments — nearly double the amount in the first year of the system a year before.

    In 2014, the Administration also gave the Centers for Medicare and Medicaid Services the authority to screen providers, remove doctors and other providers with a history of abusive billing patterns. Since that change, CMS has stopped billing privileges for 470,000 and revoked privileges for nearly 28,000 others.

    Medicare estimates it loses about 10% of the money it puts out to fraud each year. As Medicare spent $583 billion in 2013, that’s over $58 billion lost to fraud. While the gains in fraud detection and prevention are great, we have more work to do, and our Senior Medicare Patrol with over 600 volunteers statewide are doing a great job!

    Help us grow these good results and prevent fraud by:

    • Guarding your Medicare card and number, just like you would your credit card.
    • Check your Medicare Summary Notices for any services or items you never received.
    • Beware of people offering “free” services in exchange for your Medicare number. They are not free; that is a red flag. They most likely are charging Medicare large amounts for a service or item you don’t require or may never receive.
    • Do not give your Medicare number or Social Security number over the phone to people who say they are from Medicare or SSA. Medicare and SSA already have your information. They will not call you by phone.

    If you suspect fraud, contact your local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222 or our Senior Medicare Patrol at 1-855-613-7080. See our Fraud section for more info on Medicare fraud.

     

     

  • 16Mar

    Both the House and Senate released their budget proposals for fiscal year 2016 in mid March. Both proposals aim to balance the budget within 10 years, repeal the Affordable Care Act, support major cuts to domestic programs including Medicare and turn certain entitlement programs such as Medicaid and food stamps into state-run block grants. The House budget, however, is more intent on overhauling current systems where as the Senate budget does not divulge how the cuts would take place. In terms of Medicare changes, the House budget proposes dramatically restructuring the Medicare program into a voucher system by 2024 where beneficiaries would buy insurance in a privatized market. This is similar to Representative Paul Ryan’s proposal several years ago. It would also combine the Medicare Part A and B deductibles, thus increasing out-of-pocket costs for most beneficiaries. While the Senate does not endorse this radical change to a voucher system, it does call for $430 billion of cuts to Medicare without specifying the details.

    Earlier this year the President also released his proposed budget (see our article Review the Good & Not-So-Good Highlights of the President’s 2016 Budget). We support several aspects of his budget, such as closing the Part D coverage gap 3 years earlier, by 2017 instead of 2020, and requiring drug manufacturers to give prescription drug rebates to beneficiaries with the Part D low-income subsidy that are at least as good as Medicaid rebate levels. Yet we also oppose several proposed items that increase beneficiary costs. This trend of increasing beneficiary costs continues to be seen in numerous proposals, including those on restructuring some of the Medigap plans. While we support viable ways to reduce Medicare spending, such as through fraud prevention efforts and ensuring Medicare pays a fair and negotiated price for drugs, we do not support shifting costs to beneficiaries. Over 50% of our country’s more than 52 million Medicare beneficiaries have annual incomes under $23,500 and a quarter live on $14,400 or less. Most of our country’s elders are on fixed incomes and tight budgets; if health care costs go up, other necessities such as food and housing suffer.

    Please join us and let your Congress people know that shifting costs to beneficiaries is not acceptable or a viable solution for millions of our elders. This year 2015 is Medicare’s 50th anniversary. Let’s celebrate Medicare by staying true to Medicare’s mission/vision and protecting this system of providing quality health care coverage to all beneficiaries.

  • 02Mar

    Identity theft ranked #1 in the top 10 consumer complaints for 2014 for the 15th consecutive year, according to the Federal Trade Commission’s report. Over 2.5 million complaints were filed and identity theft accounted for 13% of the complaints. Debt collection and imposter scams were a close 2nd and 3rd as both complaint categories are at about 11%. Imposter scams – where con artists impersonate government officials or others – are on the rise, due in large part to the increase in IRS scams and other government scams, including scams related to the Affordable Care Act. The other 7 of the top 10 complaints include complaints regarding: telephone and mobile services; banks and lenders; prizes, sweepstakes and lotteries; auto-related complaints; shop-at-home and catalog sales; television and electronic media; and internet services.

    Let the FTC know if you have complaints; they matter. If you didn’t get the services you were promised, or were cheated out of money or spot another scam, report it. This helps stop these con artists and scammers. To report to the FTC, you can file a complaint in English or Spanish at the FTC’s online Complaint Assistant or call 1-877-FTC-HELP (1-877-382-4357). To report a Medicare related scam or fraud, contact our California Senior Medicare Patrol at 1-855-613-7080.

  • 26Feb

    The term “skin in the game” was used frequently in Congressional Medicare hearings last year and continues again this year.  It means that Medicare beneficiaries should pay more of their own medical expenses.  It was used again during a recent hearing on changing the way doctors are paid by Medicare and how to pay for those changes.

    The thinking behind “skin in the game” is that Medicare beneficiaries are protected from the cost of medical care when they buy insurance to supplement their Medicare, a Medigap policy, that pays their out of pocket costs.  Many policymakers and members of Congress believe that beneficiaries use medical services they don’t really need because Medicare and their Medigap pay those costs.  Their solution then is to ban this type of coverage, increase their premium for Part B, or tax anyone who buys a Medigap policy.

    At a recent House Energy and Commerce Health Sub-committee hearing, former Senator Joe Leiberman and former Congressional Budget Office Director Alice Rivlen supported changes to Medicare that would force beneficiaries to pay more for their medical care.  One of those changes would combine Parts A and B with a single annual deductible of more than $1,000.  Another would create a $7,500 annual cap on out of pocket costs but prohibit any Medigap payment of most of that capped amount.  Others would increase Medicare’s copayments for certain high cost services, raise Medicare premiums starting at annual incomes of $40,000 or $50,000, and add copayments to the home health care benefit.

    While combining Medicare Parts A and B with a single deductible is appealing, as Kaiser Family Foundation noted last year, a small number of beneficiaries who have a hospital stay during a year might benefit from a combined deductible but a much larger number of people using only out-patient doctor and hospital services and would pay much more.  For the average middle class beneficiary a deductible could take a healthy bite of their annual income.

    Many studies have shown that copayments do discourage people from getting medical care.  The more money people have to pay when they get care, the less likely they are to get any kind of medical care, even preventive care that doesn’t have a copayment. But those same studies warn about increasing costs for emergency and hospital care when medical care has been delayed or not received at all.  If Medicare beneficiaries start considering cost before deciding to see their doctor, Medicare costs could shift rapidly away from outpatient care to more expensive types of care.

    Higher income Medicare beneficiaries already pay more for Medicare in several ways.  Their incomes were higher while working and they likely paid more tax towards Medicare. Beneficiaries with higher incomes starting at 85,000 for individuals and $170,000 for couples also already pay higher premiums for Medicare Parts B and D.  Since these amounts are not indexed for inflation more beneficiaries over time will begin paying these higher premiums even without establishing a lower threshold.  It’s interesting to note that “high income” threshold for retirees is set at a much lower amount than for younger people where the threshold is $250,000.

    Creating an annual cap on Medicare’s out of pocket expenses would be a big step forward for beneficiaries, but the amount Medicare beneficiaries would have to spend in a year before meeting that cap is an important factor.  Combining these changes with limiting or prohibiting coverage of out-of-pocket costs could result in beneficiaries paying much more for medical care, especially for those with one or more chronic conditions.  If those out-of-pocket costs apply in the same amounts to each spouse, one couple could be exposed to amounts that consume half or more of their annual income.

    A Medigap policy is not free.  Beneficiaries pay premiums for this coverage.  That cost is a known amount, usually paid on a monthly basis that allows beneficiaries to budget their health care expenses and protect themselves from an unknown, catastrophic cost.  A retiree health plan provides similar benefits and protection, and most retirees pay at least some premium cost for their retiree benefits.

    Neither of these supplemental programs encourages beneficiaries to misuse Medicare benefits since those benefits are only paid after Medicare has determined the medical necessity of a particular medical service and initiated payment.  None of the studies done on the higher costs of beneficiaries with these benefits has ever found that the services beneficiaries used were not medically necessary.  More recent studies have found that as beneficiaries age, they are more likely to have a Medigap policy than a Medicare Advantage plan.  And that may be because an older beneficiary is more likely to have multiple chronic conditions and is seeking more freedom in their choice of a doctor or hospital.

    The skin in the game myth persists in Congressional circles and fuels efforts to ban, tax, or limit Medigap policies.  While there is a similar concern about retiree plans, those cannot so easily be legislated away since those plans are connected to employers.  But Congress already has military retirees under the microscope and has begun to look for ways to limit the military’s TriCare for Life benefits that supplement Medicare.

    The Congressional Budget Office has projected approximately $130 billion in Medicare savings could be achieved by prohibiting Medigap policies.  Some in Congress have proposed to use this savings number to offset a different Medicare cost.  That cost is known as the “doc fix,” and has a projected cost of $144 billion.

    The doc fix, or Sustainable Growth Rate (SGR), is a formula for Medicare payments to doctors that Congress has “patched” each year without correcting the formula.  The House Energy and Commerce Health Sub-committee heard testimony on the doc fix and how to pay for it in the same hearing last week.  The most recent “patch” will expire by April, reducing Medicare payments to doctors by 21% unless Congress acts.  Many observers believe Congress will do another patch to avoid the reduction, and then create a different payment method for doctors for the future.

    The doc fix and redesign of the Medicare program seem now to be inexorably intertwined because Congress needs to find a way to pay for any changes they make to doctor’s payments.  One payment method would be to offset the higher cost of those payments by increasing the costs Medicare beneficiaries pay out of their own pocket.

  • 20Feb

    Earlier this month the President released his Fiscal Year 2016 budget. With respect to Medicare, it is similar to last year’s budget, with both good provisions and not-so-good provisions that shift more costs onto beneficiaries. Below are some brief highlights of both the proposals we support and those we are concerned about. For a more full analysis and overview of the President’s budget, see the Kaiser Family Foundation’s summary.

    Proposals we support

    • Increased Part D drug discounts and closing the Part D donut hole gap 3 years early by 2017: The proposed budget would increase manufacturer discounts for brand-name drugs in the Part D coverage gap to 75% (up from 50%), thus closing the gap for brand-name drugs by 2017. This is 3 years earlier than it’s currently scheduled to close.
    • Prevent “pay to delay”: Would prohibit the common practice of brand name drug makers from paying other companies to delay introducing their generic equivalents into the marketplace, thus delaying more affordable medication options. It would also shorten the length of exclusivity for biologics from 12 years to 7 years.
    • Prescription drug rebates: Would require drug manufacturers to provide rebates on behalf of beneficiaries with the Part D Extra Help (low-income subsidy) that are at least equal to Medicaid rebate levels, and to provide an additional rebate for brand-name and generic drugs whose prices grow faster than inflation, beginning in 2017.
    • Elimination of 190-day cap on inpatient psychiatric care: Would eliminate the 190-day lifetime limit on inpatient psychiatric facility services.
    • Extension of Qualified Individual program: Would extend the QI program to pay Part B premiums for qualified individuals (QIs) through 2017. The QI program is currently authorized through March 31, 2015.
    • Expanded dialysis services: Would expand Medicare’s coverage of short-term scheduled dialysis services for those with acute kidney injury.
    • Improved accuracy of payments to Medicare Advantage plans: Would improve monitoring system to prevent upcoding of making patients look more sick than they are.

    Proposals we’re concerned about

    • Increased income related premiums under Medicare Parts B and D: Under Medicare Parts B and D, certain beneficiaries pay higher premiums based on their higher levels of income. Beginning in 2019, this proposal would restructure income-related premiums under Medicare Parts B and D by increasing the applicable percent for calculating the lowest income related premiums by five percentage points, from 35% to 40% of program costs, and creating new tiers every 12.5 percentage points until capping the highest tier at 90%. The proposal maintains the current income thresholds associated with these premiums until 25% of beneficiaries under Parts B and D are subject to these premiums. This proposal claims it would help improve the financial stability of the Medicare program by reducing the federal subsidy of Medicare costs for those who need the subsidy the least.
    • Increased Medicare costs and Part B premiums: Would introduce a Part B premium surcharge for new beneficiaries who purchase Medigap policies with particularly low cost-sharing requirements, starting in 2019. Other Medigap plans that meet minimum cost-sharing requirements would be exempt. The surcharge would be equivalent to approximately 15% of the average Medigap premium (or about 30% of the Part B premium).
    • Increased Part B deductible: Would apply a $25 increase to the Part B deductible in 2019, 2021, and 2023 respectively for new beneficiaries beginning in 2019. Current beneficiaries or near retirees would not be subject to the revised deductible.
    • Increased Part D copayments for some people with Part D Extra Help: Would double the copayment amounts for brand name drugs that have generic equivalents as a way to encourage the use of lower cost generic drugs. With a successful appeal, a beneficiary could get the copayment back to current amount. This policy would exclude low-income beneficiaries receiving institutional care.
    • Introduction of Home Health copayments for new beneficiaries: Would create a copayment for new beneficiaries of $100 per home health episode, starting in 2019. This copayment would apply only for episodes with 5 or more visits not preceded by a hospital or inpatient post-acute stay.

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