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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.

  • 07Apr

    In this 22-minute video below, the Office of Inspector General’s (OIG) leadership discuss their priorities in 2014, including how the OIG will fight fraud, waste and abuse, promote quality, safety and value while ensuring the future of Health and Human Services programs.

    OIG oversees the complex world of the government’s health care programs, and their 2014 work plan provides the blue print of their oversight and enforcement efforts. As it is a time of great transition, a good portion of oversight is focused on the new health care market places, particularly on:

    • Payment accuracy
    • Eligibility controls
    • Contracting oversight and
    • Privacy and security issues

    In the short video, the OIG elaborates on their goals for 2014 and beyond, including:

    • Fighting fraud waste and abuse — such as prescription drug fraud and fraud in home and community-based services.
    • Promoting quality, safety and value. A key focus is on the quality of care in nursing homes and addressing the unacceptable reality of how often beneficiaries are injured or harmed during their nursing home stays.
    • Securing the future of Health and Human Services programs, of which Health IT is big priority.

    See the video below and read the OIG’s 2014 Work Plan (pdf) for more information.

  • 02Apr

    The infographic below effectively highlights some of the failures of our own health care system. While the U.S. has some of the highest health care costs, it is not even ranked in the top 50 countries for life expectancy. This begs the important question of: “If all this money being spent is not being used to increase quality of life or life expectancy, then where is it going?”  The infographic, contributed by Best Nursing Masters, concludes with identifying some of the common traits found in the residents of countries with the highest life expectancy, and encourages people to turn away from looking for a “cure” for symptoms, and instead to focus on developing healthy lifestyles.

    Healthcare Spending
    Source: BestNursingMasters.com

  • 22Jan

    As of January 1 of this year, Medicare pays the same amount for outpatient mental health care treatment as it does for other covered medical services. Medicare pays 80% of the approved amount for care, and the beneficiary or his/her supplemental insurance pays the other 20%. This is a significant improvement from the 50% coverage Medicare provided in the past, and is great news for many elders seeking treatment for depression, anxiety and other mental health conditions.

    Since the program’s inception, Medicare had paid a smaller portion of the bill for treatment from psychiatrists, psychologists or clinical social workers than it did for medical services. It has also imposed strict lifetime limits on psychiatric hospitals stays (no more than 190 days – and this restriction still stands), though it has no such limits to medical care received in inpatient facilities.

    In 2008, however, Congress passed the Medicare Improvements for Patients and Providers Act. This law required Medicare to begin covering a larger share of the cost of outpatient mental health services in 2010 and to phase in additional increases over time. In 2008, Medicare covered only 50% of the bill, last year Medicare covered 65%, and as of January 1, 2014, Medicare now covers 80% of bill for covered treatment (after the annual deductible of $147 is met).

    This Medicare change follows new regulations issued last month by the administration for the Mental Health Parity and Addiction Equity Act, which expanded the principle of equal treatment for psychological illnesses to all forms health insurance. But that law does not apply to Medicare.

    For more info on the Mental Health Parity Act, see the article: Sebelius Releases Final Rules for 2008 Mental Health Parity Act. Also see the article: Medicare Requires Mental Health Parity.

  • 13Dec

    The federal government is giving people enrolled in the Pre-existing Conditions Insurance Plan (PCIP) an extra month, until January 31, 2014, to sign up for coverage through the health exchange, or Covered California in our state. This transitional month of coverage allows people more time to review Marketplace plan options and enroll in the coverage that best meets their needs. The government will notify PCIP enrollees by mail of this extended coverage offer, along with details about cost-sharing. Eligible enrollees can purchase this 31-day PCIP transitional coverage by sending in a January premium payment. The premium rate is the same as what they paid for December 2013.

    California has the highest number of PCIP enrollees out of all all 50 states: 16,060 or 15%. The next state is FL at 10,402. Here’s the enrollment numbers from the Centers for Medicare and Medicaid Services.

    For more information, see Kaiser Health News’ article: Thousands in Obamacare’s High-Risk Pools Get Month’s Reprieve.

  • 05Dec

    We advocate for good, equitable and quality health care for our California beneficiaries. Sometimes part of advocacy calls for exposing what isn’t working as a way to highlight the road to reform and better care for all. Another health advocacy organization, Healthcare-NOW! has launched such a campaign, exposing some of the egregious actions and policies of some of our country’s “worst” health insurance companies. They are asking people to participate in their vote for the worst health insurance company of 2013!

    The nominees are…

    • UnitedHealth for paying its CEO, Stephen Hemsley, $49 million last year.
    • Moda Health for paying $40 million for naming rights to the Portland Trailblazers arena.
    • Anthem Blue Cross for predatory premium increases even while announcing $2.7 billion in net profits.
    • And last but not least, Humana for charging women over 50% more than men for the same insurance plan.

    Cast your vote; they will be accepting votes until Tuesday, December 31st.

    Read their article on the vote for more information.

  • 18Nov

    This is an important 2-minute video outlining the high danger health care scams pose on consumers. It reviews 3 main ways scammers are reaching out:

    1. Bogus websites that gather your private info
    2. Phone calls saying they’ll help you sign up for a new health care plan, or offer you some limited offer deal
    3. In-person visits where they’ll knock on your door to “help sign you up” for a plan.

    All these fraud scams capitalize on the confusion around the Affordable Care Act. Please watch and share this short video to help people avoid such scams. Also, visit our Medicare Fraud section for more info on health care fraud.

    Medicare beneficiaries with questions about Medicare and Covered California (our state’s health care marketplace) can see our recent article: FAQs on Medicare and Covered California.

  • 17Sep

    We’re happy to report that one of the many bogus websites popping up about the new health care insurance marketplaces was recently shut down. CaliforniaCovered.com was a bogus website posing to look like the state’s official insurance marketplace site, Covered California (www.coveredca.com). Yet, it was really just there to collect people’s personal information. We reported it to the California Department of Insurance and they shut it down.

    With open enrollment to purchase health insurance in the state’s marketplace beginning on October 1st, many people are starting to research their health plan options. People who just search the web, however, may easily land on such a fake website. (Note: this open enrollment is not to be confused with Medicare’s fall Open Enrollment which is from October 15 – December 7. People with Medicare do NOT need to purchase insurance through the state marketplace; they are already considered covered.)

    Unfortunately, when a new complicated law or health program is implemented, fraudsters often take advantage of people’s confusion and develop scams. Bogus websites designed to get people’s personal information, banking account and/or credit card numbers are one of the many scams we’re seeing.

    If you come across any such suspicious websites, please let us know and report them to our California Senior Medicare Patrol (SMP) at 855-613-7080. Also read our articles:

  • 11Sep

    Open enrollment in Covered California begins soon – Oct 1 to be exact. While people with Medicare do NOT need to purchase anything through the health care exchange, as they are considered covered, many other Californians will have the opportunity to buy affordable health care. Over 2.7 million non-Medicare eligible Californians will be able to sign up for help with purchasing their health coverage. Also, in January 2014, an additional 1.4 million low-income adults will be newly eligible for Medi-Cal.

    If you have clients who are not yet eligible for Medicare and are asking about the open enrollment this fall and help in choosing their coverage, you may be interested in joining one of the events below, A New Era of Coverage: Maximizing Participation in the ACA. The events will provide updates on:

    • The state’s outreach and enrollment efforts
    • How local organizations are reaching and educating communities of color about their coverage opportunities
    • Best practices for enrolling special populations, such as immigrants and Limited English Proficient communities

    The California Pan Ethnic Health Network (CPEHN) and other local organizations engaged in outreach and enrollment efforts are putting on these events in 4 cities across the state.

    See their registration page for more info. Below are a list of the dates and locations of the events.

    Fresno – October 3, 2013
    10:00 am to 2:00 pm
    United Way of Fresno County
    4949 E. Kings Canyon Road
    Co-hosts: ACT for Women and Girls, Asian and Pacific Islanders California Action Network, California Latinas for Reproductive Justice, California Rural Legal Assistance Foundation, Centro Binacional para el Desarrollo Indígena Oaxaqueño, Centro La Familia, Fresno County Democratic Party Central Committee, Fresno Interdenominational Refugee Ministries, Fresno Metro Ministry, Vision y Compromiso

    Oakland – October 8, 2013
    10:00 am to 2:00 pm
    The California Endowment
    1111 Broadway, 7th Floor
    Co-hosts: ACCESS Women’s Health Justice, Asian and Pacific Islanders California Action Network, Asian Health Services, California Latinas for Reproductive Justice, Korean Community Center of the East Bay, Monument Crisis Center, Street Level Health Project, Vision y Compromiso, UC Berkeley Center for Public Health Practice, Young Invincibles

    Los Angeles – October 15, 2013
    10:00 am to 2:00 pm
    The California Endowment
    1000 North Alameda Street
    Co-hosts: Asian Americans Advancing Justice – Los Angeles, Asian and Pacific Islander Obesity Prevention Alliance, Asian and Pacific Islanders California Action Network, Black Women for Wellness, California Latinas for Reproductive Justice, Community Health Councils, Korean Resource Center, Orange County Asian and Pacific Islander Community Alliance, St. John’s Well Child & Family Center, Vision y Compromiso, Young Invincibles

    San Diego – October 16, 2013
    10:00 am to 2:00 pm
    Sherman Heights Community Center
    2258 Island Avenue
    Co-hosts: Asian and Pacific Islanders California Action Network, California Latinas for Reproductive Justice, Council of Community Clinics, Foundation for Change, Mid-City CAN, San Diego Black Health Associates, San Ysidro Health Center, Vision y Compromiso

  • 03Sep

    There are many scams to watch out for with the upcoming start of health care reform’s insurance marketplaces. And while people with Medicare do NOT need to buy insurance on in the health care exchange, scammers are counting on people being confused. Being well informed about the law and the upcoming changes is the best way to prevent being a victim of fraud. A few tips to remember include:

    • There is no card associated with health care reform.
    • There is no new Medicare card and you do not have to update any personal information.
    • If you have Medicare, you DO NOT need to do anything. You are considered covered. You have Medicare’s fall open enrollment period coming up (Oct 15 – Dec 7) to review your Medicare coverage and make any changes for your 2014 coverage. You do not need any coverage through the Health Insurance Marketplace (Covered California in our state).
    • The Health Insurance Marketplace (those exchanges) doesn’t open until October 1, so you can’t buy coverage under the Affordable Care Act until then.
    • Don’t respond to a cold call of any kind, especially one that asks for personal information or money. And don’t trust your Caller ID; it can be spoofed to make it look like the call is coming from a government office.
    • Don’t let anyone rush you. The rates in the exchange have been pre-approved and won’t change during the initial enrollment period, Oct. 1 to March 31. Anyone promising a “special price” or “limited time offer” or who tells you “spots are limited” is lying to you.
    • Beware of bogus websites. If you are searching for your state exchange, go to healthcare.gov or coveredca.com in California. Do not do a “search,” as many fake websites will show up. Be safe and make sure you are on the correct website, and do not enter personal information in pop up windows.

    Visit healthcare.gov and our health care reform section for more information on the Affordable Care Act, and see our Medicare Fraud section for more info on fraud and abuse and how to prevent it. If you come across any scams, please report them to our Senior Medicare Patrol at 855-613-7080.

  • 27Aug

    A majority of Californians support the Affordable Care Act (ACA), according to a poll sponsored by The California Wellness Foundation. Yet close to 1/2 of voters feel it won’t affect them very much. Fifteen percent of voters claim to be very knowledgable about the law and 60% claim to be somewhat knowledgable. These figures are 4 and 7 percentage points above the figures in 2011 respectively.

    While people’s increased knowledge about the ACA is good news, there are still more younger people who support the law versus elders. For instance, 63% of voters under 30 support the law and only 27% say they oppose it. Only 47% of voters 65 and older, however, support the law and 43% oppose it. This is surprising given all the benefits the ACA adds to Medicare, such as the expanded benefits and reduced costs for preventive care services and drug coverage. For example:

    • The ACA eliminated cost-sharing for many preventive services and added a new annual wellness visit benefit. In the first 6 months of 2013, 16.5 million people with Original Medicare received a preventive service with no cost-sharing.
    • The ACA is also shrinking the Part D prescription drug “donut hole.” If people enter the “donut hole,” they get a discount on brand-name prescription drugs and a subsidy on generic drugs. Since January 2013, over 6.6 million people have saved $7 billion on drug costs as a result of this provision in the Affordable Care Act, an average savings of $1,061 per beneficiary.

    Despite the increased benefits this law provides for youth and elders alike, many misconceptions are encouraged by misleading information in the media. For instance:

    • 57% of respondents predicts that the law will cause Medicare beneficiaries to lose health benefits; and
    • 54% said they believe currently insured individuals will be forced to change their coverage.

    Such findings only highlight that more accurate, unbiased education and outreach on the ACA is required.

    See the Field Poll publication (PDF) for more information on this study and its results. Also see our newsletter and blog articles on health care reform, and visit Healthcare.gov for more information on the ACA.

    This article was edited from a California Healthline article, 8/20/13. Also, see recent article in the Sacramento Bee, 8/20/13.

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