CHA Blog

People with end stage renal disease (ESRD) are prohibited from enrolling in Medicare Advantage plans. If, however, they are already enrolled in one and then later develop ESRD, they can stay in their plan; the MA plan cannot drop their coverage.

While these are the general rules, there are a couple of exceptions to this prohibition of joining MA plans, as outlined in CMS’ Medicare Managed Care Manual. One such exception, revised and effective as of November 19, 2010 (Chapter 2, Section 20.2.2), is that a Medicare beneficiary with ESRD who is already enrolled in an MA plan may join any of the other MA plans within the same parent MA organization during certain enrollment periods.  One such period is the Annual Election Period (AEP) which is from November 15 – December 31 in 2010 and from October 15 – December 7 starting in 2011.

In the past, CMS limited this exception to apply only to MA plans under the same organization, not the same parent organization. For example, a beneficiary with ESRD who was enrolled in a Secure Horizons MA plan could only switch to another Secure Horizons MA plan if one was available. Now, however, a beneficiary meeting 3 conditions can switch to any MA plan under the parent organization, United. This includes switching from an HMO to a PPO or PFFS plan and vice versa. In many cases, this revision gives ESRD beneficiaries more MA plans to choose from if they’d like to switch plans.

The 3 conditions determining whether a beneficiary can switch MA plans within the same parent company include:

• The new MA plan must operate in the same state as the beneficiary’s previous MA plan,
• The beneficiary meets all the other requirements for enrollment in that MA plan (i.e. has both Medicare Parts A and B), and
• The effective date of enrollment is prospective from the date of CMS’ memorandum (11.19.10).

For questions about this exception, please contact Jim Canavan at (410) 786-5223 or James.Canavan@cms.hhs.gov.

For more information on ESRD and Medicare, see our fact sheet: Medicare and People with End Stage Renal Disease (ESRD).

Bonnie Burns, our Training and Policy Specialist, testified at a California Department of Insurance (CDI) hearing on long-term care post-stabilization rates in late October. She was the first of several speakers in the 3-hour hearing.  You can view her testimony online; she speaks from minutes 7-30.

In her testimony, Bonnie reviews why rate stabilization is necessary and points out the numerous problems with current rate stabilization policies. She poses important questions that must be answered in order to effectively strengthen consumer protections in the area of  LTC insurance.

View the CDI Hearing on Long-Term Care Post Stabilization Rates.

Advocates across the state are warning clients to ignore a postcard they may get in the mail, mistakenly informing them of government benefits to be cut.

In large, bold type the postcards claim “proposed cuts to existing government programs include a significant reduction in the federal Medicare program, which may result in an increase in premiums and fees that you must pay … and a decrease in some benefits.”

This is utterly false and only creates unnecessary anxiety and damaging information for beneficiaries. Ken Palinkas, the Health Insurance Counseling and Advocacy Program (HICAP) Program Manager in the North Bay has received several phone calls about this mailing and is advising seniors to simply ignore it.

In particular, advocates object to language on the mailings that says Medicare cutbacks mean that “you will become responsible for an even greater portion of your health care expenses … expenses previously paid by Medicare.”

Again, this is a lie. There are no cutbacks happening to Medicare, and in fact, with recent health care reform, Medicare benefits are becoming even more generous. (See our articles, “50% Discount on Part D Brand Name Drugs Starts January 1st” and “Review Upcoming Changes in Medicare Due to Health Care Reform.”)

The Centers for Medicare and Medicaid Services (CMS) speculates that the cards are likely an attempt by medical insurance companies to obtain names and addresses of potential customers.

Beneficiaries are asked to sign the backs of the cards and mail them back in.

CMS encourages advocates to alert beneficiaries in their areas that these mailings are not legitimate; there’s nothing official from the government or Medicare in them.

If any beneficiaries  have responded to the cards and are contacted by an insurance sales agency, have them contact their local HICAP office at (800) 434-0222, or look up your nearest HICAP office online.

This article was edited from an article in the Times-Herald of Sonoma and Napa counties.