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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.

  • 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 to learn more about how health coverage affects your 2014 federal income tax return.

  • 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.

  • 24Apr

    The Centers for Medicare and Medicaid Services (CMS) will be phasing in fingerprint-based background checks this year for certain providers as a way to slow and prevent rampant fraud. These background checks will initially be applied to those durable medical equipment, prosthetics, orthotics and supplies providers and home health agencies trying to enroll in Medicare and will remove the “fraudsters” already enrolled. In the future, CMS will also apply the fingerprint-based background check requirements to those providers considered to be “high-risk.” These efforts stem from the Affordable Care Act’s provisions to augment Medicare’s enrollment screening.

    recent article in Fierce Health Payer Anti-fraud’s online newsletter states:

    CMS will send notification letters to affected providers with contact information for the fingerprint-based background check contractor. Providers will be required (generally just once) to pay for and undergo fingerprinting.

    The contractor will collect fingerprints and send them to the FBI for processing. Within 24 hours of receipt, the FBI will compile a background history. CMS will assess the data and either approve the provider application or exercise authority to deny the application or revoke Medicare claims filing privileges.

    For more information on this new background check requirement, see CMS’ Medicare Learning Network Matters notice: Implementation of Fingerprint-Based Background Checks (pdf).

  • 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

  • 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. was a bogus website posing to look like the state’s official insurance marketplace site, Covered California ( 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:

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