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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.

  • 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.
  • 12Jan

    Below is a notice from the Centers for Medicare and Medicaid Services (CMS) regarding taxes and Obamacare health coverage tax credits for those who purchased a plan in the Marketplace in 2014.

    Consumers may need help making the connection between Marketplace premium tax credits and filing their taxes.

    Many are unaware that they:

    1. Must reconcile their tax credits or claim tax credits for the first time
    2. May have to pay a fee if they are uninsured, or
    3. May qualify for an exemption from the fee.

    It’s important for people to know that If anyone in their household enrolled in a health plan through the Health Insurance Marketplace in 2014, they’ll get a new Form 1095-A — Health Insurance Marketplace Statement.  The form will be mailed in early February for them to use to file their 2014 federal income tax return.

    Remind them to keep this form with their other important tax information, like W-2 forms and other tax records.  They’ll get a Form – 1095-A even if a member of their household only had Marketplace coverage for part of 2014.  They won’t get this form if no one in the household is enrolled in a Marketplace Qualified Health Plan.

    Visit https://www.healthcare.gov/taxes/ to learn more about how health coverage affects your 2014 federal income tax return.

  • 05Jan

    Happy New Year from California Health Advocates and from Social Security! In 2015, nearly 64 million Americans who receive Social Security or Supplemental Security Income (SSI) will receive a cost-of-living adjustment (COLA) increase of 1.7% to their monthly benefit payments.

    The average monthly Social Security benefit for a retired worker in 2015 is $1,328 (up from $1,306 in 2014). The average monthly Social Security benefit for a disabled worker in 2015 is $1,165 (up from $1,146 in 2014).

    See our Medicare Basics section for 2015 Medicare cost information. For more info on the COLA, including how it’s calculated, see the Social Security website.

  • 30Dec

    Earlier this year, the Centers for Medicare and Medicaid Services (CMS) revised its guidance on payment of Part D covered drugs for beneficiaries on Medicare hospice as beneficiaries were having trouble accessing their Part D covered medications due to too many prior authorization requirements put on these drugs. The Medicare Part A hospice benefit covers drugs used for pain control and symptom relief related to terminal illness. These drugs are excluded from Part D.

    Under the new guidance, Part D plans are strongly encouraged to only impose prior authorization on 4 drug categories (the ones most used in and covered under hospice care). These are:

    • Analgesics
    • Anti-nauseants
    • Laxatives
    • Anti-anxiety (anxiolytics)

    For more details, see CMS’ guidance, Part D Payment for Drugs for Beneficiaries Enrolled in Medicare Hospice (pdf). See our section on Part D appeals for information on how to file an appeal.

  • 18Dec

    Hospice is comprehensive care for people who are terminally ill. Hospice includes pain management, counseling, respite care, prescription drugs, inpatient care, and outpatient care, as well as services for the terminally ill person’s family. Understanding the Medicare hospice benefit can help you avoid Medicare fraud while you or your loved one receives the most appropriate care during this difficult time. The tips below are from the Medicare Minutes program.

    Step 1: Understand how and when Medicare covers the hospice benefit.

    You must meet the following criteria to receive the Medicare hospice benefit:

    • The hospice medical director and your doctor certify that you have a terminal illness, meaning that your life expectancy is six months or less;
    • Elect to have Medicare pay for palliative care treatments; and
    • Receive care from a Medicare-certified hospice agency.

    Hospice services are always covered under Original Medicare, even if you had a Medicare Advantage plan before electing hospice.

    Choosing to elect hospice is a significant and private decision between you, your family, and your primary care physician. Most hospice providers provide very important and beneficial care to people with Medicare, but a small minority tries to recruit patients who clearly lack a terminal condition.

    Beware of any hospice that says it provides curative care or that offers gifts or other payments if you elect to receive hospice.

    Step 2: Understand your own or your loved one’s conditions, diagnosis, and care regimen.

    Once you start hospice care, you must develop a plan of care with the hospice director and your physician. This plan of care is an important way to ensure that you receive appropriate hospice services.

    Under the hospice benefit, Medicare will pay in full for the following: skilled nursing services, skilled therapy services, home health aide services, durable medical equipment (DME), medical social services, pastoral care, nutrition and dietary counseling, and prescription drugs related to pain relief and symptom control for inpatients. If you are a hospice outpatient, you will pay no more than $5 for these drugs.

    Remember, the purpose of hospice is to empower the patient at the end of life and help them die with dignity. If you feel that you or a loved one is receiving unnecessary treatments or their needs are not being met, you should speak with your hospice care providers about providing appropriate care. Additionally, you can choose to end hospice care and resume receiving curative treatments for your illness at any time.

    Step 3: Review your own or your loved one’s Medicare Summary Notices (MSNs) when they are

    Review your Medicare Summary Notices (MSNs) carefully to check that the hospice has billed Medicare properly for services received. One way that hospice providers commit fraud is by inflating the level of care beyond what the patient actually needs. This can include falsely documenting patient needs or billing for additional services while providing a lower level of care.

    Take Action: If you notice a prescription you do not take or a service you did not receive listed on your MSN, take action! Speak to your hospice provider to see if there has been a billing mistake. If you don’t get a straight answer or the billing is not corrected, report the hospice provider to your local California Senior Medicare Patrol (SMP) at 855-613-7080.

  • 11Dec

    Health Insurance Explained is Kaiser Family Foundation’s newest release of their YouToons cartoons. It helps the public understand and navigate the new health coverage available through the Affordable Care Act, also referred to as Obamacare. In a short 5 minutes, viewers are both entertained and taken through various scenarios that cleverly demonstrate factors to consider when choosing a plan. They remind viewers that low premiums can be deceptive as those plans often have high deductibles. They also encourage people to know: what your plan covers and what you pay; what providers/facilities are considered in-network with your plan and what aren’t; and the price difference between brand name and generic drugs.

    While people with Medicare don’t need to purchase this insurance, many people approaching Medicare age without other insurance may need to purchase new coverage through the Marketplace. For additional resources, see:

    • 300 FAQs for consumers about the ACA
    • a short 10-question quiz, and
    • a Health Insurance Marketplace Calculator (updated with 2015 premium data).

    All of these tools are written and produced by the Kaiser Family Foundation to help consumers across the U.S. better understand health insurance. They are also all available in Spanish.

    For those of you on Medicare with questions about Medicare and the Covered California (the health insurance marketplace in our state), see our article: Medicare & Covered California ~ Get Your Questions Answered.

  • 02Dec

    Have you reviewed your coverage options and made a choice for 2015? If not, now is the time. Medicare’s Annual Election Period ends on Sunday Dec 7th at midnight and this is time when you can change plans (Medicare Advantage and/or Part D plans) or return to Original Medicare. To review your options, see the information below. Also, see our article: Are You Spending More on Drugs?

    Open Enrollment is Oct 15 – Dec 7: Review Your Medicare Options for 2015

    Open Enrollment, also known as the Annual Election Period (AEP), is the period each year during which you may change your Medicare Advantage plan and/or Part D coverage, and/or return to Original Medicare. The AEP is October 15 – December 7. Any plan changes you make during the AEP are effective January 1.

    Each year, Medicare health plans and Part D prescription drug plans can change their premiums, deductibles, cost-sharing and some benefits, or discontinue their coverage altogether. You need to be aware of how your plan may change, and prepare accordingly.

    • Review your plan’s changes for 2015. If you’re in a Medicare Advantage and/or Part D plan, your plan should have mailed you an Annual Notice of Change by September 30, explaining its changes for 2015. For example, the Annual Notice of Change would include information such as your premium and copayment, if your plan’s provider network will change, and/or a list of drugs (called a formulary) that will be covered. Even if you like your current plan, review your plan’s changes for 2015 and compare other options to determine which 2015 plans have the coverage you need.
    • Look for other options. If your health plan or drug plan is terminating its coverage, you should receive a notice by October 2 informing you of your rights and options for other coverage. See When Medicare Advantage Plans Terminate Coverage.
    • Be on the alert. Medicare health plans and prescription drug plans can start marketing their 2015 plans as of October 1, 2014. Agents and brokers selling these plan must follow strict guidelines when marketing to you — report any suspected marketing fraud or abuse to the Senior Medicare Patrol at 1-855-613-7080.

    What can I do during Open Enrollment?

    You can make changes involving your Medicare Advantage or Part D plan. Medicare Advantage plans must include hospital and medical benefits. Some Medicare Advantage plans also cover prescriptions drugs. Stand-alone Part D plans cover only prescription drugs. Thus you can get prescription drug coverage through a Medicare Advantage plan or a stand-alone Part D plan.

    During the AEP, you can enroll in a Medicare Advantage or a stand-alone Part D plan if you do not have one. If you do have one of these plans, you can change to a different stand-alone Part D plan or Medicare Advantage plan. If you’re in a Medicare Advantage plan, you can return to Original Medicare and join a stand-alone Part D plan for prescription drug coverage.

    What are my coverage options?

    • Your local Health Insurance Counseling & Advocacy Program (HICAP) has county-specific information on the Medicare advantage and Part D plans available in your area, as well as info on Medicare supplement plans known as Medigap.
    • Use the Plan Finder on Medicare.gov to find Medicare Advantage and Part D plans in your area and to see what Part D plans cover the drugs you use.
    • Read the official U.S. government Medicare handbook: Medicare & You 2015 (PDF). Hard copies were mailed to beneficiaries between September 16-30, and it is also available online. (See the “Go Paperless” option on Medicare.gov for more info.)
    I receive the Part D low-income subsidy (Extra Help) and currently don’t pay any premium or deductible. Can I stay in my same plan or do I need to switch plans to continue with no premium or deductible?

    This depends on what plan you are in. In 2015, 5 of the 8 benchmark plans for 2014 will continue: AARP Medicare Rx Saver Plus, EnvisionRxPlus Silver, Human Preferred Rx, SilverScript Basic (called SilverScript Choice in 2015) and Symphonix Rite Aide Value Rx. Benchmark plans are plans whose premiums are at or below the weighted average of premiums in California ($28.84 for 2015). If you are already in one of these 5 plans, you can stay in your plan and will have no premium or deductible. If you are in one of the other plans (HealthMarkets Value Rx, United American Select or Wellcare Classic), you will need to choose one of the 6 benchmark plans for 2015 with a premium amount at or below $28.84. If you do not choose another plan by December 7, Medicare will reassign you to a benchmark plan so that there is no gap in your prescription drug coverage.
    For 2015, California has 6 benchmark plans:
    1. AARP Medicare Rx Saver
    2. Aetna Medicare Rx Saver
    3. EnvisionRxPlus Silver
    4. Humana Preferred Rx
    5. SilverScript Choice
    6. Symphonix Rite Aide Value Rx

    If you continue to be eligible for Part D Extra Help, by joining a benchmark plan you will not have to pay a premium or deductible for 2015. You are still responsible for your copays which will be up to $2.65 or $6.60 for brand name drugs depending on your income and assets.

    What if I miss the AEP and still want to make a change? Are there other times during the year I can change my health plan and/or Part D coverage?
    The AEP is the main time most Medicare beneficiaries can change plans. However, some Medicare beneficiaries may change plans at other times:

    Medicare Advantage Disenrollment Period (MADP)

    If you’re in a Medicare Advantage plan with or without Part D coverage, you can disenroll from your plan and return to Original Medicare anytime between January 1 – February 14. You are also given a Special Election Period (SEP) to enroll in a Part D plan during this time. But you may not enroll in a Medicare Advantage plan at this time.

    Your MA plan disenrollment becomes effective the first day of the following month. For example, if you disenroll from your MA plan in January, your change becomes effective February 1. If you diseroll in February, your change becomes effective March 1.

    We also encourage you to enroll in a Part D plan as close to the time of your MA plan disenrollment as possible in order to avoid any gap in drug coverage. For example, if you disenroll from your MA plan on January 28 and enroll in a Part D plan on February 1, you would return to Original Medicare on February 1, but wouldn’t have drug coverage until March 1.

    Plan Non-Renewal Special Election Period

    If your MA or Part D plan is not renewing next year, you should have received a notice from your plan by October 2 telling you of this change and your rights and options for other health coverage.

    One of your rights is that you have a Special Election Period (SEP) to join a new plan. The SEP is from December 8 to February 28 the following year. Your new coverage will become effective the first day of the following month.

    Ongoing Special Election Period Right for Certain People with Low-Incomes
    People who receive the Part D Extra Help (which includes people in a Medicare Savings Program) can change their Medicare Advantage and/or Part D coverage on a monthly basis.

    5 Star Medicare Advantage or Part D Plan Special Election Period
    If you live in an area with a Medicare Advantage and/or Part D plan(s) that has an overall plan performance rating of 5 stars, and you’re otherwise eligible to enroll in the plan, you have a Special Election Period (SEP) to join that plan. Medicare releases plan performance ratings each fall and the ratings apply for the following calendar year. Your SEP is from December 8 through November 30. Your new coverage will become effective the first day of the following month. You can use this SEP to enroll in a 5-star plan only once during the SEP.

    Other Special Election Periods (SEPs)
    There are certain events/situations that trigger your rights to other SEPs where you can enroll in, switch, or disenroll from a Part D or Medicare Advantage plan. Some of these events include if you move out of your plan’s service area; your plan violates its contract with Medicare (including marketing misconduct); you are in a plan with a low-rating (less than 3 stars); or you move in or out of a nursing facility. See our list of events triggering an SEP for more information.

    Can I switch plans more than once during the AEP?

    Yes, you can. Your final choice will be the last one received by December 7. Your new coverage becomes effective on January 1.

  • 24Nov

     

     

     

     

     

     

     

     

     

     

    Have you heard of #GivingTuesday? It’s a global day of giving back, and it falls on the Tuesday after Thanksgiving, Black Friday and Cyber Monday. This year’s #GivingTuesday is Tuesday, December 2, 2014, and we at California Health Advocates join charities, families, businesses, community centers, and students around the world in coming together for one common purpose: to celebrate generosity and to give.

    Where does #GivingTuesday come from, you may ask? The retail industry has long benefited from seasonal shopping that symbolically kicks off with “Black Friday”– a day that has since inspired “Small Business Saturday” and “Cyber Monday.” #GivingTuesday, then, serves as a celebratory, fully connected day to kick off the giving season, when many make their holiday and end-of year charitable gifts.

    #GivingTuesday brings together diverse networks of people, large corporations, small businesses and nonprofits across an ever-expanding range of new media platforms to encourage and amplify small acts of kindness in the service of changing our world for the better.

    #GivingTuesday is not a new giving platform, but a call to action to celebrate giving and encourage purposeful giving during the Holiday Season. It’s an organizing principle to encourage the creativity and energy of people all over the world to work for good.

    Please consider donating to CHA as a way to support our continual giving and service to our millions of California Medicare beneficiaries, their families and professionals advocating on behalf of the health care rights of elders.
    Thank you! And may you enjoy a wonderful season of giving and gratitude!
  • 18Nov

    Did you know it’s illegal for Medicare beneficiaries to use coupons for their Part D drugs? Most people don’t….but it is. Coupons are a way that drug companies can entice beneficiaries to use drugs whose copayment, let alone the full cost of the drugs, would otherwise be too expensive. This means Medicare is then footing the bill for these more expensive brand name drugs that without coupons beneficiaries wouldn’t use. They would instead use lower cost generics. Drug companies are supposed to use safeguards to ensure beneficiaries don’t use coupons to get these high cost drugs, but such efforts are lacking, according to a recent Office of Inspector General report (PDF). The OIG found that up to 7% of beneficiaries use coupons to purchase their drugs, which amounts to about 2 million people buying more expensive drugs than they would otherwise and hence racking up Medicare’s Part D drug tab.

    While beneficiaries are just doing what seems like a smart and legit way to get the drugs they require at a price they can afford, this coupon use is illegal and drug companies are most likely letting it go unchecked to protect and sustain their own profit margins.

    For more information, see:

    The OIG report, Manufacturer Safeguards May Not Prevent Copayment Coupon Use for Part D Drugs (PDF)

    The Wall Street Journal article, Did Someone say Kickbacks? HHS Warns About Medicare Part D Coupons

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