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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.

  • 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 This is a long-time broken system that has needed to be repealed and replaced for years, but instead Congress has put in 17 temporary fixes. If no agreement is met by the end of the week, doctors will see a 21% cut in their payments from Medicare due to this outdated SGR.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.



  • 10Mar

    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.

  • 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.
  • 11Feb

    Below is a New York Times commentary on Steven Brill’s book, America’s Bitter Pill, a thought provoking and provocative view on some of the more hidden reasons how and why this legislation came about.

    Anatomy of a Health Care Mess

    Never sign up for a tour of the sausage factory, not if you want to keep eating sausage. In the case of health care, unfortunately, no one gets to abstain. Journalists and legislators, doctors and nurses, reformers and reformed alike, all eventually land on the conveyor belt that feeds those grinding gears.

    Is it better to go through the machinery with some understanding of how it works (or doesn’t)? Individual preferences will vary. For those who believe forewarned is forearmed, the veteran journalist Steven Brill has put together a comprehensive and suitably furious guide to the political landscape of American health care circa 2014 — a tour de force inspection of both sausage and factory.

    Mr. Brill began his muckraking early in the rollout of the Affordable Care Act, with a comprehensive indictment of American health care costs that occupied an entire issue of Time magazine in early 2013. He continued to comment in the pages of Time on the disastrous debut of the act’s health insurance marketplaces that fall and the widespread repair work that still continues.

    All this reporting reappears in the book, sometimes verbatim, reframed by several new sections. At the beginning comes a long back story detailing the years of politicking that created the new legislation. At the end, Mr. Brill offers a series of personal insights provoked in large part by his recent, unexpected detour from reporter to patient, and suggestions for how it might all be fixed.

    Full disclosure here:  It became clear early in the creation of the Affordable Care Act that my definition of the word “reform” differed substantially from that of our political leaders.  After that, I stopped paying a lot of attention to the political Kabuki — a disgraceful if all too common reaction among us beleaguered sausage-makers.

    Hence, I cannot assess the accuracy of Mr. Brill’s account of the negotiations that created Obamacare, but I found it persuasive, shocking and very sad. It is not an easy story to follow, a little like plowing through a long description of every can of paint flung onto a Jackson Pollock canvas. Still, the difficulty and occasional tedium of the narrative themselves inform the subject.

    As Mr. Brill tells it, the legislation was from the very beginning all about profit, with all the relevant industries, from insurers to drug makers to hospitals, methodically seduced aboard with promises of big returns. The politicos spoke of broader insurance coverage, but what they actually meant was more health care dollars to spread around. The nonprofit “public option” never had a chance, and vanished.

    The final legislation was a truly remarkable triumph of fiscal diplomacy. No wonder the act’s political parents were so exhausted by its creation that implementation took second place. The initial result: a deeply flawed federal enrollment website and phone banks of confused people diligently dispensing misinformation. Mr. Brill details these mishaps in full, along with the months of mopping up required.

    He revisits the sick people he came to know across the country to examine the legislation’s effects. In Kentucky, a state with a great deal of chronic illness and a seriously underinsured population, the new insurance options were deployed smoothly, and have clearly improved life for many residents. Elsewhere, confusion reigns on.

    For unintentional comic relief, Mr. Brill also details the 2013 creation of a cool New York insurer, Oscar, named after the great-grandfather of one of its founders. Devised by hipsters for their peers, Oscar aced all the start-up tasks that bedeviled the feds, with smoothly functioning technology and appealing branding. Its young proprietors were jazzed when the premiums started pouring in, then more than a little taken aback when they actually had to start paying some gigantic medical bills.

    That’s the health business for you — totally awesome till someone goes and gets sick. Mr. Brill’s own perspective took a similar lurch when in the spring of 2014 he underwent repair of an aortic aneurysm, an expensive and complicated procedure. As a patient, he writes, “I was anything but the well-informed, tough consumer with lots of options that a robust free market counts on. I was a puddle.”

    That is the fatal flaw in market-based medical care: Patients and their relatives simply cannot be savvy shoppers. Their attentions are elsewhere.

    Mr. Brill’s solution is born in large part from his gratitude that his surgery at one of New York’s premier teaching hospitals went very well. He suggests: Why not allow these giant academic medical centers, most of them smoothly run by physician-executives, to insure themselves, sweeping up smaller nearby facilities into networks of care? The plan would cut out some middlemen, reduce some bureaucratic expense, and the medical background of those in charge would ensure a patient-centered ethos. These would be “regulated oligopolies,” in Mr. Brill’s phrase, with heart and soul.

    His idea has some precedent in nonacademic insurer-provider organizations like California’s Kaiser Permanente. Some large teaching centers are already headed in this direction. Whether a more humane, less pricey marketplace will result remains to be seen, one obvious caveat being that, for all of Mr. Brill’s illusions, physician-executives are hardly immune to corruption, hubris and greed.

    As for that other definition of the word “reform,” the one that would transform American health care into a tightly controlled nonprofit commodity funded by a single payer, Mr. Brill emphatically sounds its knell, providing 500 pages of convincing evidence that it is never going to happen.

    See our Health Care Reform news articles and blogs for more info on the Affordable Care Act and how it relates to Medicare.

  • 03Feb

    In December 2014, CHA and many other advocacy organizations sent a letter to the Dept of Health and Human Services, the U.S. Dept of Labor and to the Social Security Administration requesting them to inform people nearing 65 of their rights and obligations surrounding Medicare enrollment, including their options to enroll, when they can delay enrollment and consequences of not enrolling (such as life time late enrollment penalties). With 10,000 people becoming eligible for Medicare each day, it’s imperative that they are well informed as the maze of information and choices is complex. Making sure pre-eligibility education is clear and consistent can help many people avoid costly mistakes.

    Our friends at Medicare Rights Center have put together this petition to urge the Centers for Medicare and Medicaid Services and Social Security to take action and create a comprehensive education/outreach to people nearing 65 and their Medicare eligibility. Please take a moment to sign and share. Thank you!

  • 28Jan

    Each year, beneficiaries who are enrolled in a Medicare Advantage plan, have certain times they can enroll into another plan, switch plans or disenroll from their current plan. The main time is the Annual Election Period from Oct 15 – Dec 7 of each year. People in a Medicare Advantage (MA) plan also have an opportunity to disenroll from their MA plan and return to Original Medicare during the Medicare Advantage Disenrollment Period (MADP), which is from Jan 1 – Feb 14.

    The key difference with the AEP and the MADP is that you can only leave a Medicare Advantage and return to Original Medicare plan. You cannot join another MA plan. You are also given a special election period (SEP) to join a Part D plan.

    • If you’re in a Medicare Advantage Prescription Drug plan (MA-PD, you can either 1) submit a disenrollment request to your MA-PD plan and then enroll in a Part D plan, or 2) enroll in a Part D plan first, which then automatically disenrolls you from your MA-PD.
    • If you’re in an MA only plan, you must first request disenrollment from your MA plan to trigger your SEP to join a Part D plan.

    You can only enroll into one Part D plan during your SEP, and your SEP is only available during the MADP, January 1 – February 14. Your enrollment into your new Part D plan is effective the first of the following month.

    For questions or assistance, please contact your local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222.

  • 21Jan

    Medicare’s General Enrollment Period (GEP) for Parts A and B is from January 1st – March 31. This is a particularly important time for Californian’s with low-incomes who are eligible and not yet enrolled in Medicare Part A. During this time, these individuals can apply for Medicare Parts A and/or B and the Qualified Medicare Beneficiary (QMB) program. QMB pays one’s Medicare Part A premium (if they do not qualify for premium-free Part A – which is $407 per month in 2015), Part B premium ($104.90 per month in 2015), and one’s Medicare deductibles and coinsurance. In addition, qualifying for and applying for QMB will automatically trigger a beneficiary’s entitlement to the full Part D Low-Income Subsidy (LIS), also referred to as Extra Help.

    California does not have a Medicare Part A Buy-In Agreement that allows individuals to enroll in Medicare Part A at any time during the year in order to become eligible for Medicare cost-sharing benefits under QMB. Therefore, beneficiaries who don’t currently have Medicare Part A, must enroll in Part A before March 31, 2015 in order to be entitled to QMB benefits in 2015.

    For those applying for Medicare Part A and QMB who aren’t eligible for premium-free Part A, and, cannot afford the Part A premium if they don’t qualify for QMB, a ‘conditional application’ process is available – see our website section,  How to Apply.  This means that these beneficiaries will only be enrolled in Medicare Part A if they are also confirmed eligible  for QMB and the state then pays their Part A premiums.

    People who already have both Medicare Parts A and B can apply for QMB and other Medicare Savings Programs (MSPs) at any time of the year. Visit or contact your local Department of Health Care Services (DHCS) to apply for these  Medicare Savings Programs and/or for Medi-Cal.

    See Low-Income Help for more information on MSPs and Medi-Cal.

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