CHA Blog

• 01Jul

  Obama Holds Tele-Town Hall Meeting to Discuss Health Reform with Seniors

  Health Care Reform, Low-income help, Medicare Advantage, Medicare and other health insurance, Medicare basics, Prescription drugs No Comments

  Early last month, President Obama hosted a ‘tele’-town hall meeting for Medicare beneficiaries about the Affordable Care Act and Medicare fraud prevention efforts in light of the first $250 donut hole rebate checks that were sent out mid June. This meeting can be viewed online at whitehouse.gov.

  In this video, President Obama discusses the following topics:

  (Note: By clicking on a linked question, it will take you directly to that section of the video.)

  • Why does it take 10 years to close the doughnut hole completely?
  • Will Medicare Advantage changes hurt benefits?
  • Is there more support for primary care?
  • How does reform affect living independently vs in a nursing home?
  • Are Medicare & Social Security going to run out of money for future generations?
  • What’s going to happen to COBRA subsidies?

  For more information on health care reform and Medicare, see our article, What Does Health Reform Mean for Medicare Beneficiaries? Summary of Key Provisions.

• 07Jun

  Update on the Medicare Physician Payment Cut & COBRA Subsidy Extension

  Medicare and other health insurance, Medicare basics No Comments

  In the end of May, the House passed the “extenders” bill (HR 4213), which would extend a series of expiring unemployment and tax benefits and delay the 21% cut to physicians’ Medicare payments until 2012. Physicians’ Medicare payment rates would be increased by 2.2% for the remainder of 2010 and by 1% in 2011, before the payment formula would revert to the current formula in 2012. The bill would also eliminate the extension of COBRA subsidies for unemployed workers.

  The Senate, however, failed to pass the bill before their week-long Memorial day holiday break. Because the Medicare physician payment cut was set to be effective as of June 1,  CMS instructed Medicare contractors to delay processing medical claims for 10 business days, or until June 14.  This gives the Senate one week to review, amend the bill, and send it back to the House for a revote.

  For more information, see the following 2 articles:

  • ‘Extenders’ Bill Passes House
  • AMA to Campaign for Medicare Payment ‘Doc Fix,’ Physicians Increasingly Frustrated

• 24May

  Are You Eligible for the Part D $250 Rebate? CMS Posts Q&As

  Health Care Reform, Low-income help, Medicare basics 1 Comment

  The Affordable Care Act passed by Congress and signed by President Obama this year contains some important benefits for Medicare recipients. One benefit is the $250 rebate to help with beneficiaries’ Medicare Part D drug costs. Beneficiaries who do not receive the low-income subsidy (LIS), will automatically receive this one-time $250 rebate check from Medicare after they reach the coverage gap (also called the “donut hole”) in 2010. This rebate is the first step toward closing the Medicare prescription drug coverage gap as mandated in the new health care reform law.

  Below are a few common questions and answers on this $250 rebate that the Centers for Medicare and Medicaid Services (CMS) sent out last week. Please share it with your colleagues and beneficiary clients.

  What is the coverage gap and how will I know if I’ve reached it?

  Most Medicare drug plans have a coverage gap. This means that after you and your plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your drugs (up to a limit).

  The Explanation of Benefits notice, which your drug plan mails to you each month when you fill a prescription, will tell you how much you’ve spent on covered drugs and whether you’ve entered the coverage gap.

  Will I need to do anything to get this rebate check?

  No. There are no forms to fill out. Medicare will automatically send a check that’s made out to you. You don’t need to provide any personal information like your Medicare, Social Security, or bank account numbers to get the rebate check. Don’t give your personal information to anyone who calls you about the $250 rebate check. Call 1-800-MEDICARE (1-800-633-4227) to report anyone who does this. TTY users should call 1-877-486-2048.

  When will I get the rebate check?

  If you reach the coverage gap this year and enter the Part D “donut hole”, you will receive a one-time $250 rebate check if you are not already receiving Medicare Extra Help.  These checks will begin to get mailed to beneficiaries starting in mid-June.

  Checks will be mailed monthly throughout the year as beneficiaries enter the coverage gap. However, this is a one-time benefit and beneficiaries who qualify will only receive one check after they reach the coverage gap.

  What if I don’t get the rebate check when I should?

  Beneficiaries who hit the donut hole after the program has begun should expect to receive their check within 45 days. Your rebate may be delayed if Medicare doesn’t have information from your Medicare drug plan showing that you reached the coverage gap in time to include you in the next mailing. You should call your Medicare drug plan to make sure all of your information has been sent to Medicare.

  If you don’t get your rebate check, contact Medicare. Individuals receiving Medicare Extra Help will not receive a rebate check.

  You can also check to make sure Social Security has your correct home address. Call 1-800-772-1213 or your local Social Security office. TTY users should call 1-800-325-0778.

  What’s Next ….Coming in 2011

  If you reach the coverage gap in 2011, you may get a 50% discount on your brand name prescription drugs at the time you buy them. Stay tuned for more information from Medicare.

  Help  stop scams against beneficiaries
  

  Remember- there are no forms to fill out to receive this benefit once someone qualifies for it. Medicare will automatically send a check that’s made out to the qualified beneficiary.

  Beneficiaries also don’t need to provide any personal information like their Medicare, Social Security, or bank account numbers to get the rebate check. Please remind them to NOT give their personal information to anyone who calls them about the $250 rebate check. They should call 1-800-MEDICARE (1-800-633-4227) to report anyone who does this. TTY users should call 1-877-486-2048.

  Go to stopmedicarefraud.gov to learn more about how Medicare is working with law enforcement to stop scams against seniors.

  More questions about the $250 rebate check or the Affordable Care Act and Medicare?

  Beneficiaries with more questions can refer to the brochure Medicare and the New Health Care Law–What it Means for You (PDF) that Medicare sent them. (Also available in Spanish (PDF)). They can also visit www.medicare.gov, call 1-800-MEDICARE, or visit www.healthreform.gov.

• 16Apr

  Bill Passed to Postpone 21.2% Physician Payment Cut to May 31

  Medicare basics No Comments

  Congress passed and President Obama signed a Medicare physician payment bill that extends the 2009 physician payment rate through May 31 of this year, thus reinstating the payment rate that was in effect on March 31. The bill allows the Centers for Medicaid and Medicare Services (CMS) to repeal the 21.2% payment cut that went into effect on April 1 because of the sustainable growth rate, or SGR, a formula CMS uses to calculate physicians’ payment rate. CMS held payment of claims from April 1-15, in anticipation of passing this payment legislation.

  Since the Senate didn’t pass the Medicare payment bill before the 21.2% cut took effect, Congress has given itself time to work out the differences in a separate bill that will take the current SGR to Oct. 1, 2010. Discussions concerning this bill will begin soon. Both the House and Senate have already passed separate bills to accomplish this extension and negotiations about how to pay for it will be ongoing.

  More information will be posted as available.

• 01Apr

  What Does Health Care Reform Legislation Mean for Medicare Beneficiaries?

  Health Care Reform, Medicare basics No Comments

  Below is a brief summary of some of the main changes the recently passed health care reform will bring for Medicare beneficiaries.

  1. The Medicare Part D “donut hole” – or coverage gap where beneficiaries must cover 100% of their drug costs – will go away by 2020. Beneficiaries with Part D will gradually pay less until they are responsible for 25% of their drug costs (or costs above their deductible and below the catastrophic limit). This means as of 2020, 75% of brand-name and generic drug costs will be covered by Part D. Starting immediately, however, people who reach the donut hole will receive a $250 rebate. In 2011, people who reach the gap will receive a 50% discount on brand-name drugs.
  2. The legislation also eliminates out-of pocket costs for a wide range of Medicare-covered preventive care services. Starting in 2011, it eliminates coinsurance payments and cost-sharing for preventive services, such as for prostate cancer screenings, mammograms, diabetes screening tests, and glaucoma screening tests.
  3. Federal subsidies to private Medicare Advantage plans, which currently cover about 25% of Medicare participants and cost the government more, on average, than traditional Medicare, will be begin to be cut in 2012. Over the next several years, the federal formula for reimbursing insurers will be reduced to bring them in line with traditional Medicare. As a result, some participating insurers may raise costs or cut extra non-Medicare covered services. (Note that all services covered by Original Medicare are required to be covered in every MA plan.)
  4. The new legislation also prohibits Medicare Advantage plans from charging seniors more for certain benefits, such as some chemotherapy, renal dialysis and skilled nursing services, than what beneficiaries would pay under the traditional fee-for-service Medicare program.

  More information on additional changes will be provided in upcoming posts.

  See UC Berkeley’s Center on Health, Economic and Family Security’s recent issue brief, “Advancing National Health Reform,” for more details on how the passed health reform affects California’s Medicare beneficiaries.

• 03Feb

  Who’s Who in Medicare: Facts and Figures on CA’s Beneficiaries

  Medicare basics No Comments

  The California HealthCare Foundation recently published its 2010 overview report on the demographics, health status, insurance coverage, quality of care, utilization, and spending of Medicare in California. Consumer advocates, health care providers, and policymakers can use its factual framework to better understand California’s Medicare population and inform their efforts in designing effective programs and policies for the state’s beneficiaries.

  Some of the report’s key findings include:

  • California’s elderly population (those age 65 and older) is expected to more than double between 2000 and 2030.
  • California has the largest number of Medicare beneficiaries of any state — 4.5 million enrollees. This number will continue to increase as California’s population ages and the percentage of those by Medicare rises.
  • Medicare’s reimbursement for care delivered to California beneficiaries is higher than the national average — as of 2006, it’s about $600 more per beneficiary.
  • In 2004 and 2005, total annual medical payments per Medicare beneficiary in California averaged $11,326, of which $1,330 (11%) came out of the beneficiaries’ own pockets.
  • A large percentage of Medicare beneficiaries suffer from multiple chronic illnesses. In 2005, 79% reported having two or more chronic conditions and 37% reported four or more.

  Download the full report for more information:

  • California Health Care Almanac: Medicare Facts and Figures 2010 (PDF)

• 05Nov

  End Erroneous Health Reform Info – Watch Obama’s 4 Minute Summary

  Medicare basics No Comments

  On a call regarding health care reform and Medicare beneficiaries today, Health and Human Services Secretary Kathlene Sebelius and staff from both the White House Office of Health Reform and White House Office of Public Engagement specifically asked all beneficiaries and Medicare advocates to help end the myths that health reform hurts Medicare.  In fact, health reform strengthens Medicare in several key ways.  For instance, several Medicare provisions in the newly introduced House bill, Affordable Health Care for America Act (H.R. 3962) are that it:

  1. Immediately begins reducing out-of-pocket costs in the Part D coverage gap, or donut hole by $500 in 2010 and eliminates the gap altogether by 2019 (versus 2024 in the earlier version of the House bill).
  2. Allows the government and Part D plans to negotiate lower drug prices for Medicare beneficiaries.
  3. Improves quality of care and, through a number of payment method changes, reduces unnecessary hospital admissions and re-admissions.
  4. Emphasizes prevention and wellness by eliminating any deductible or copayment amounts for Medicare-covered preventive services.
  5. Increases coordination of care for beneficiaries with chronic conditions by changing how Medicare reimburses for certain services.
  6. Provides affordable insurance coverage options for people 55-64. Many people without good coverage during this time period may postpone getting needed treatment until they have Medicare at age 65. This results in 1) them having poorer health and more serious health conditions and 2) Medicare having higher expenditures. Making sure this pre-Medicare population has health coverage will actually help lower Medicare costs.
  7. Extends Medicare’s long-term solvency by at least 5 years.

  Secretary Sebelius and staff reiterated President Obama’s promise that Medicare is a sacred trust and they fully intend to keep and strengthen that trust. In an effort to support this promise, they asked assistance in ending the myth that health reform is bad for Medicare.  One challenge continues to be that several Medicare Advantage plans are sending out misleading information to plan enrollees that health reform will cut benefits. They don’t explain that health reform will cut the overpayment of subsidies to MA plan sponsors, NOT Medicare benefits themselves.  As a result if this misleading information, many beneficiaries erroneously believe health reform will hurt their Medicare and have opposed reform legislation.

  One easy resource White House staff suggest to share with people who have been misinformed is Obama’s 4-minute video on health reform. The video is at WhiteHouse.gov.

  I’ll also be posting a newsletter article next week with many more resources and good articles to share with people on health reform facts and how it affects Medicare beneficiaries and strengthens the Medicare program.

• 09Sep

  Medicare Covers Swine Flu (H1N1) Vaccines

  Medicare basics 2 Comments

  The H1N1 virus vaccine will be provided to Medicare beneficiaries as an additional Part B preventive immunization service. Medicare typically pays for only one vaccination per year, unless additional vaccines/doses are medically necessary. The Influenza A (H1 N1) vaccine qualifies as an additional medically necessary vaccine. If the H1 N1 vaccine requires more than one dose, additional doses will also be covered.

  Note that Medicare will pay for the vaccine’s administration fee only, not the vaccine itself as these vaccines are being given to providers free of charge. Also, the provider administration payment rate will be the same as that for the seasonal influenza virus vaccine covered under Medicare’s Part B preventive immunization services.

  If a Medicare beneficiary receives the H1N1 vaccination from a non-Medicare provider,  Medicare will reimburse the beneficiary up to the approved amount for the administration cost only. To receive reimbursement, the beneficiary must submit a CMS Form 1490S to their local Medicare contractor. In California the Part Medicare Part B contractor is Palmetto GBA. The CMS form must be sent to:

  • J1 MAC Palmetto GBA, P.O. Box 1051, Augusta, Georgia 30903

  Learn more about Medicare’s coverage of H1N1 (PDF) and payment to providers. (Center for Medicare and Medicaid Services (CMS) bulletin)

  Read general information on Medicare covered services.

• 24Aug

  What Can Medicare Teach Us About Health Care Reform?

  Medicare basics No Comments

  Medicare is the United States’ first universal health care system for people 65 and older and some people younger than 65 with a disability. Dr. John R. Burton, Professor at Johns Hopkins University, recently wrote an interesting piece on lessons Medicare can offer us in terms of national health care reform. 

  Mr. Burton reflects that “Medicare eliminated the fragmented, episodic and often dehumanizing care that many retired seniors were forced to seek through emergency departments or charitable sources because they no longer had coverage from an employer.” Medicare’s implementation “increased the demand for primary care from physicians in private practice,” and as beneficiaries then had access to comprehensive primary care, ” overall health care quality went up, and average per-patient costs went down.”

  Read Dr. Burton’s full article, “Medicare Offers Lessons on National Health Care Reform.”

  See our section on Medicare Basics for information on the Medicare program.

• 09Jul

  Learn What Drugs Are Covered Under Medicare Parts A, B, and D

  Medicare basics, Prescription drugs No Comments

  The Centers for Medicare and Medicaid Services (CMS) recently revised their tip sheet explaining what prescription drugs are covered under Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and Medicare Part D (prescription drug coverage). 

  If you or your clients have questions about which part of Medicare covers what drugs, this is a good place to start.

  In general, Part A only covers drugs that are administered as part of a beneficiary’s treatment while in a hospital or skilled nursing facility. Part B generally covers drugs that aren’t normally self-administered and instead are given as part of a doctor’s service. Coverage is usually limited to drugs that are given by infusion or injection. If the injection is self-administered or isn’t given as part of a doctor’s service, Part B generally won’t cover it.

  Part B also covers several other drugs, including: 

  • Various vaccination shots (flu shot, pneumococcal shot, Hepatitis B shot)
  • Some drugs used in infusion pumps and nebulizers
  • Osteoporosis drugs
  • Immunosuppressant drugs
  • Some oral anti-cancer drugs

  For a complete listing and explanation, see the CMS tip sheet.

  Part D provides comprehensive coverage for many generic and brand-name drugs and is offered through private Part D prescription drug plans. All Medicare drug plans must generally cover at least 2 drugs in each drug category, yet they can choose which 2 drugs to cover. In 6 drug categories, however, Medicare drug plans are required to cover all drugs. These 6 categories include: antidepressants, antipsychotics, anticonvulsants (drugs toprevent seizures), antiretrovirals (drugs to treat HIV/AIDS), immunosuppressants, and antineoplastics (anti-cancer drugs).

  Part D also covers most vaccination shots (except those covered under Part B).

  Medicare Part D does not cover drugs that are covered under Medicare Parts A and B. It also doesn’t cover the following drugs:

  • Benzodiazepines
  • Barbiturates
  • Drugs for weight loss or gain
  • Drugs for erectile dysfunction
  • Drugs for relief of cough and colds
  • Non-prescription drugs
  • Drugs used for cosmetic purposes or hair growth
  • Drugs used to promote fertility
  • Prescription vitamins and minerals, except prenatal vitamins and fluoride preparation products

  See the tip sheet, Medicare Drug Coverage under Medicare Part A, Part B and Part D, for more information. 

  See our section on Medicare Appeals for information on your appeal rights and how to file an appeal for drugs if coverage is denied. 

  For information on basic coverage under Medicare Parts A, B, and D, see our section Medicare Basics. 

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