CHA Blog

• 19Jan

  January is National Glaucoma Awareness Month

  Medicare basics No Comments

  Medicare has designated January as National Glaucoma Awareness Month as a way to increase people’s awareness of glaucoma and Medicare’s covered glaucoma screening benefit. More than 2.2 million Americans age 40 and older have open angle glaucoma, the most common form of glaucoma, and at least half of them don’t even know they have it.  Through early detection and treatment, blindness can be prevented.

  As mentioned, Medicare provides coverage of an annual glaucoma screening for beneficiaries in at least one of the following high-risk groups:

  • Individuals with diabetes mellitus
  • Individuals with a family history of glaucoma
  • African-Americans age 50 and older
  • Hispanic-Americans age 65 and older.

  Medicare’s coverage of glaucoma screening includes a dilated eye examination with an intraocular pressure (IOP) measurement and a direct ophthalmoscopy examination or a slit-lamp biomicroscopic examination.

  What you can do to help spread the word to beneficiaries…

  If you are a Medicare advocate or healthcare professional who provides care to seniors and others with Medicare, you can help protect the vision of your high-risk patients by educating them about their risk factors and reminding them of the importance of getting an annual glaucoma screening exam covered by Medicare.

  For More Information:

  • The CMS Glaucoma Screening Brochure
  • The CMS Guide to Medicare Preventive Services (see Chapter 7)
  • The MLN Preventive Services Educational Products Webpage
  • The National Eye Institute

  Thank you for partnering with Medicare to promote increased awareness of glaucoma and Medicare’s covered glaucoma screening benefit.

• 13Jan

  CVS Caremark Corp. Charged with Dececptive Pricing Practices on Part D Drugs

  Prescription drugs No Comments

  CVS Caremark Corporation will pay $5 million to settle Federal Trade Commission charges that it misrepresented the prices of certain Medicare Part D prescription drugs – including drugs used to treat breast cancer symptoms and epilepsy – at CVS and Walgreens pharmacies. The allegedly deceptive claims caused many seniors and disabled consumers to pay significantly more for their drugs than they expected and pushed them into the “donut hole” – known as the coverage gap where none of their drug costs are reimbursed – sooner than they anticipated or planned. The settlement will bar deceptive claims related to Medicare Part D drug prices and require CVS Caremark to pay $5 million to reimburse affected Medicare Part D consumers for the price discrepancy.

  According to the FTC complaint, CVS Caremark offers Medicare Part D prescription drug plans through subsidiaries like RxAmerica, which CVS Caremark acquired in October 2008. Many consumers choose their Medicare Part D drug plans by looking up plan benefits and drug prices on RxAmerica’s website, by going to the Centers for Medicare & Medicaid Services website and using the web-based tool Plan Finder, or by visiting other third-party websites where such information is posted.

  The FTC charged that from 2007 through at least November 2008, RxAmerica posted on its website and supplied for posting to Plan Finder and third-party websites incorrect prices for Medicare Part D prescription drugs at two pharmacy chains, CVS and Walgreens. In some instances, the actual prices for these drugs were as much as 10 times more than the posted prices. As a consequence of the deceptive price claims, many elderly and disabled consumers chose RxAmerica plans and paid significantly more than they expected for their drugs at CVS and Walgreens.

  The proposed settlement order bars CVS Caremark from misrepresenting the price or cost of Medicare Part D prescription drugs or other prices or costs associated with Medicare Part D prescription drug plans. It requires that CVS Caremark pay $5 million in consumer refunds. The FTC will be mailing checks to eligible consumers who were harmed by these misrepresentations after the order becomes final. The settlement also contains standard record-keeping provisions to allow the FTC to monitor compliance with its order.

  After a thorough and comprehensive review of other consumer protection and competition issues in this matter, the FTC issued a letter closing the investigation. The FTC will publish a description of the consent agreement package in the Federal Register soon. The agreement will be subject to public comment for 30 days, that 30-day period began January 12 and continues through February 13, 2012, after which the Commission will decide whether to make the proposed consent order final. You are welcome to submit written comments electronically or in paper form by following the instructions in the “Invitation To Comment” part of the “Supplementary Information” section. Comments can be submitted on an electronic form, or in paper form if mailed or delivered to: Federal Trade Commission, Office of the Secretary, Room H-113 (Annex D), 600 Pennsylvania Avenue, N.W., Washington, DC 20580. The FTC is requesting that any comment filed in paper form near the end of the public comment period be sent by courier or overnight service, if possible, because U.S. postal mail in the Washington area and at the Commission is subject to delay due to heightened security precautions.

  This article is edited from the 1/12/12 FTC press release. For more information, visit the FTC website.

• 05Jan

  Medicare = Big Bucks for Insurers ~ Can They Afford to Leave the Market?

  Medicare Advantage No Comments

  When Congress debated cutting payments to Medicare Advantage plan sponsors, what did the sponsors threaten?  To get out of the Medicare market.  Yet can they really afford not to be in the Medicare market, especially given that 3 of the top Fortune 500 companies in 2011 were WellCare Health Plans, Humana, and Centene, all of which are health insurers with a high proportion of Medicare Advantage enrollees? WellCare’s share price has nearly doubled while Humana and Centene are up about 50%.

  Here’s an article about profits these sponsors are earning.

  If you have time, also watch the video with Dr. Donald Berwick on “How to heal health care” at the end of the article.

  Tags: health care, Medicare Advantage, Medicare Advantage plans, profits

• 21Dec

  Phone Scam Alert! Protect Your Identity

  Medicare fraud No Comments

  We’ve received another report of a Medicare telephone scam this morning. Please alert your clients to never give out personal information, including their Medicare and bank account numbers, over the phone to someone they don’t know.

  A woman in Chico called her local HICAP/Senior Medicare Patrol office to report a call from someone claiming to be “verifying Medicare information”. The caller said he was recording the conversation and asked to verify the client’s name, address, and bank account number, including her last check number. He then said she could ask questions at the end of the call.  Yet when she tried, he hung up.

  This woman then realized she made a terrible mistake by giving out her information, and immediately went to her bank to close/change accounts, and then called her local SMP office to report.

  We and other SMP offices around the country have received other similar reports. Please warn your clients and again remind them to protect their personal information.

  See Medicare Fraud for more info on common scams and how to detect and prevent them.

  Thank you, and Merry Solstice!!

  Tags: identity, medicare fraud, phone scam, protect identity, scam

• 20Dec

  Proposed Rise in Medicare Premiums for Upper-Income Beneficiaries Would Also Affect Middle Class

  Medicare basics No Comments

  Bonnie Burns, our Training and Policy Specialist, has made many statements over the last few years related to the “camel’s nose under the tent” with regard to the creation of increased Medicare premiums for people with high incomes. And, as she predicted, those thresholds for high income seniors are likely to be set lower, in addition to the freeze on cost of living adjustments. Below is link to a story related to Congressional attempts to raise premiums for higher income beneficiaries that will ultimately also affect middle income beneficiaries. In addition, our President’s own proposals include freezing the high income threshold until 25% of beneficiaries would be subject to higher Part B and D premiums, and also include a higher Part B deductible for that same group. It’s important to note that high income with regard to workers is much, much greater than high incomes for retirees, an interesting contrast.

  For example, when Obama talks about raising taxes on the rich, he means individuals making more than $200,000 a year and families above $250,000. But his health care law fixed the level for paying “high-income” Medicare premiums at the current $85,000 and above for an individual, $170,000 for families. And the new Republican plan would drop the thresholds to $80,000 for an individual and $160,000 for families.

  See the article, Plan to raise Medicare premiums for upper-income retirees would affect middle class as well.

  Tags: beneficiaries, Medicare, premiums, rising costs

• 12Dec

  Congressional Hearing on Medicaid Fraud Acknowledges SMP

  Medicare fraud No Comments

  In a U.S. House of Representatives Hearing on Medicaid Fraud last week, the sub-committee heard from a victim of fraud who spent 7 years in a lawsuit against Maxim Healthcare. This man specifically mentions calling the Senior Medicare Patrol (SMP) fraud hot line in New Jersey. Although he eventually hired a private attorney, he and the attorney both acknowledge the good work of SMPs.

  The hearing is worth watching and is a good reminder of why SMPs across the country, including our strong California team of staff and volunteers, do what we do!

  Here’s the Hearing: House Panel Hearing From Victim of Medicaid Fraud.

  See Medicare Fraud for more info on fraud and how to prevent, detect and report it. Also see our SMP Volunteer page if you’re interested in volunteering with our California SMP team.

  Tags: congress, hearing, medicaid fraud, medicare fraud, senior medicare patrol, SMP, testimony

• 06Dec

  Open Enrollment Ends on Dec 7 But Some Beneficiaries Have More Time

  Medicare basics No Comments

  Medicare’s Open Enrollment, also referred to as the Annual Election Period (AEP), ends in on Wednesday Dec 7. The AEP allows Medicare beneficiaries to join, switch or disenroll from a Medicare Advantage (MA) or Part D plan.  Some beneficiaries have more time to make choices.

  Beneficiaries who are in an MA or Part D plan that is not renewing next year have until Feb 29, 2012.  “Almost 151,000 beneficiaries in California are in Medicare Advantage plans that are not renewing for 2012,” observed Elaine Wong Eakin, Executive Director of California Health Advocates.  “In addition, there are beneficiaries in Part D plans that are not renewing.  All these beneficiaries get a Special Election Period (SEP) from Dec 8, 2011 to Feb 29, 2012 to join another plan.”

  If your MA or Part D plan is not renewing and you use your SEP to join another plan, your new plan will be effective the first day of the next month.  (See table below for effective date depending on when change is made.)

  	Dec 8, 2011                 Special Election Period         Feb 29, 2012
  Change made between	Dec 8 and 31	Jan 1 and 31	Feb 1 and Feb 29
  Effective date of change	Jan 1	Feb 1	Mar 1

   

  Even if you made a change during the AEP, you can make another change using your SEP.

  But, if you do not make any change before December 31, 2011, what happens Jan 1, 2012?

  • If you are in an MA plan with prescription drug coverage and it is not renewing, Original Medicare automatically becomes your medical coverage and you will have no drug coverage effective January 1, 2012 unless you qualify for Extra Help. (If you have Extra Help, Medicare will automatically enroll you into a Part D plan.)
  • If you are in a Part D plan that is not renewing, you will have no prescription drug effective January 1, 2012 unless you qualify for Extra Help. (If you have Extra Help, Medicare will automatically enroll you into a Part D plan.)
  • If you are in an MA plan that is not renewing and the MA plan has no prescription drug coverage, Original Medicare automatically becomes your medical coverage effective January 1, 2012.

  After December 31, 2011, beneficiaries who have not made use of their SEP can still enroll in a stand-alone Part D plan or MA plan. The SEP ends February 29, 2012 or when they make a change, whichever is earlier.

  Beneficiaries in non-renewing MA plans also have a guaranteed issue period to buy a Medigap.  The guaranteed issue period started when you first received the notice that your MA plan was not renewing, and ends 123 days after your Medicare Advantage plan ends (May 2, 2012).

  Resources:

  • See the list below for Part D plans in California that are not renewing for 2012.  The two MA plans available statewide that are not renewing are Freedom Blue Plan I and Freedom Blue Classic (both sponsored by Anthem Blue Cross.)  Other MA plans that are not renewing are county-specific.

  Plan name	Contract-Plan ID	Premium
  Sterling Rx	S4802-067	$51.10
  CIGNA Medicare Rx Plan Two	S5617-202	$71.40
  Advantage Star Plan by RxAmerica	S5644-084	$28.10
  Aetna Medicare Rx Costco Plus Plan	S5810-236	$60.80
  Envision Rx Plus Gold	S7694-066	$91.40

  • HICAP – Contact your local Health Insurance Counseling and Advocacy Program (HICAP) to review Medicare Advantage plans available in your county, compare Part D prescription drug plans, or learn about Medigap plans in your area. Individual appointments are available with volunteer counselors.
  • CHA fact sheets – For more info, please read: When Medicare Advantage Plans Terminate Coverage, Medigap Plans and Your Rights to Purchase a Medigap Policy (PDFs).
  • Part D Prescription Drug Comparison Charts – Review the Part D stand-alone plans (PDF) and benchmark plans (PDF) available in California in 2012.
  • Medicare Plan Finder – Visit the official Medicare website at Medicare.gov to compare Medicare Advantage and Part D drug plans, find out which plans cover the drugs you’re taking with Medicare’s Formulary Finder, and enroll in a health or drug plan.

   

• 01Dec

  Medicare’s Open Enrollment Ends Dec 7th

  Medicare basics No Comments

  Medicare’s Open Enrollment, also referred to as the Annual Election Period (AEP) ends in less than one week on Wednesday December 7. This year’s AEP started earlier and ends earlier than previous years, and is an important time for beneficiaries to closely evaluate their current health coverage, whether or not they’d like to switch health plans, return to Original Medicare or join a health plan if they are already in Original Medicare.

  Options abound and knowing one’s options and how to compare them are important for making a good choice. Here are some resources to make the most of the AEP’s  final week:

  • Read our page on the AEP. It gives the details on what you can do during the AEP, has links and resources for information on health care options and your rights, and lists frequently asked questions on the topic.
  • Contact your local Health Insurance Counseling and Advocacy Program (HICAP) to review your current plan and plans (Medicare Advantage plans, Part D prescription drug plans and Medigap plans) in your area.  Individual appointments are available with volunteer counselors. Educational presentations may also be available in your county.
  • Review our Part D plan comparison charts (PDFs): Part D stand-alone prescription drug plans and Part D benchmark plans (for people receiving the Extra Help, aka the low-income subsidy (LIS)).
  • Visit Medicare.gov to compare health and drug plans, compare Medigap policies, find out which plans cover the drugs you’re taking with Medicare’s Formulary Finder, and to enroll in a health or drug plan.

  Tags: annual election period, Medicare, Medicare Advantage, Medicare open enrollment, Part D, prescription drug plans

• 18Nov

  NAIC Highlights Serious Concerns on Proposed Medigap Changes

  Health Care Reform, Supplementing Medicare No Comments

  Currently, there are multiple proposals in Congress, the Super Committee and the Administration, all of which will limit how much Medigap insurance will be able to pay in benefits as a way to address the current deficit. The thinking is that beneficiaries who don’t have enough “skin in the game,” i.e. beneficiaries who have supplemental coverage and don’t pay deductibles and copayments, end up using too many services, thus costing the Medicare program too much money. While there are no studies to support this thinking, and while the thinking doesn’t make sense, as Medicare will only cover those services it deems as reasonable and “medically necessary” anyway, the proposals are written as if this thinking is the truth.

  Some of these proposals would apply retroactively, regardless of the serious legal issues this poses, and would prevent the payment of benefits people already have in Medigap plans (i.e. benefits that cover the Part A and B deductibles, coinsurance and copayments).  The National Association of Insurance Commissioners (NAIC) recently released a Discussion Draft reflecting the views of regulators, industry and consumer groups about the dangers of eliminating existing benefits and prohibiting Medigap plans from paying a newly proposed Medicare deductible and half of the copayments.

  These proposals are not limited to Medigap. Congress is also trying to apply these prohibitions on benefits to retiree plans and to TriCare for Life.  Few Medicare beneficiaries know this is happening. We will be posting an article on these proposals and our views as an organization on them.

  Tags: budget cuts, deficit, Medicare reform, Medigap

• 16Nov

  Supreme Court to Review Constitutionality of New Health Care Law & Key Provisions

  Health Care Reform No Comments

  On Monday, the U.S. Supreme Court announced that it will review the legal challenges against the federal health reform law, the Affordable Care Act (ACA), in early spring 2012. While several different lawsuits challenging the law were presented to the justices, the court will only review the multistate lawsuit filed by 26 states and the National Federation of Independent Business.

  Although the ACA provisions that affect Medicare have not been challenged, the discord over the law casts uncertainty over the stability of new Medicare benefits and beneficiary protections provided by the new law.  The issues the Supreme Court will consider are:

  • Whether the controversial individual mandate is severable from the rest of the law or if the whole law, including the Medicare provisions, must be overturned if one provision is found unconstitutional;
  • Whether Congress may require states to expand their Medicaid programs by withholding funds from states if they do not;
  • Whether Congress was acting within its power to require Americans to buy health insurance or pay a penalty; and
  • Whether parties have legal standing to challenge the individual mandate requiring health coverage since that provision is not yet in effect.

  “Many Medicare beneficiaries have already benefited from the Medicare provisions in the ACA,” said Elaine Wong Eakin, Executive Director of California Health Advocates.  “These new Medicare benefits were hard-won, and it would be a shame to lose them should the Supreme Court find the whole law unconstitutional because of one provision.”  The Medicare improvements include discounts for beneficiaries in the Part D prescription drug “donut hole,” better access to preventive services, and an annual out-of-pocket cap for beneficiaries in Medicare Advantage plans.  Furthermore, the ACA incorporated cost-savings to sustain the Medicare program, and these cost-savings would be lost should the whole law be overturned.

  Even if the Supreme Court upholds the ACA, the Medicare program is targeted for cuts.  “As lawmakers find ways to cut the federal deficit, they should pay more attention to the cost-saving measures in the ACA,” recommended Wong Eakin.  The ACA introduced initiatives to control costs as well as improve care that results in better health outcomes for the population.  Instead of focusing on cutting Medicare benefits and increasing beneficiary out-of-pocket costs, lawmakers should build on the ACA initiatives.

  For more information on the health reform law, see our newsletter and other blog articles on this topic, including those listed below:

  • 50% Discount on Part D Brand Name Drugs Continues for 2012; 14% Discount on Generics
  • What Does Health Reform Mean for Medicare Beneficiaries? Summary of Key Provisions
  • Learn How Health Care Reform May Affect You in 2011
  • Health Reform Gives Some Immediate Benefits for Californians

  Tags: beneficiaries, health care reform, Medicare, Medicare Advantage

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