CHA Blog

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

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

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

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

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

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

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

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

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

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

Also see our website sections on:

• Medicare Advantage
• Retiree Plans

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

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

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

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

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

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

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