Medicare Watch

Congress Must Take Immediate Action for People with Medicare

In a letter to Congressional leaders to be sent on November 12, the Medicare Rights Center urges Congress to take action to renew the Qualified Individual (QI) program, extend the Medicare therapy cap exceptions process, and avert cuts to Medicare physician payments in order to avoid potential disruptions in benefits and access to care in 2011.

Unless Congress passes legislation to avert the physician payment reductions, which are required by the Sustainable Growth Rate (SGR) formula, a 21 percent cut in Medicare physician payment rates will take place on December 1, 2010, and an additional four percent will take place on January 1, 2011. Since the enactment of the SGR as part of the Balanced Budget Act of 1997, Congress took action multiple times to avert the reductions in payments. Such “fixes” vary in length – the last fix, which averted the cuts for six months, was passed in June 2010.

Furthermore, without Congressional action before the end of the 111th session, both the QI program and the Medicare therapy caps exceptions process will expire in 2011. QI, a Medicare Savings Program (MSP), helps Medicare consumers whose income is between 120 and 135 percent of the Federal Poverty Level (FPL) pay their Part B premiums, and can potentially save eligible individuals thousands of dollars per year. Also set to expire at the end of this year is the Medicare therapy caps exceptions process. Medicare coverage is limited to $1860 for combined speech and physical therapy services and $1860 for occupational therapy services, but currently, the exceptions process allows those who require medically necessary services to overcome those caps.

Congress is due to return to Washington D.C. next week.

Read Medicare Rights Center’s letter to Congressional leaders.

2011 Medicare Premiums and Deductibles Released

Last week, the Centers for Medicare & Medicaid Services (CMS) announced the 2011 premiums and deductibles for Medicare Part A and Part B, as well as the additional premium amounts owed by individuals with higher income for Part B and Part D.

Medicare Part A covers inpatient hospital, skilled nursing facility and home health care. Though approximately 99 percent of Medicare consumers do not have to pay a Part A premium, people are still responsible for the deductible, which will be $1132 in 2011, an increase of $32.

Medicare Part B covers outpatient services, such as physician visits and durable medical equipment (DME). In 2011, people with Medicare may pay one of three premium amounts. The standard premium for 2011 is $115.40. However, because there is no Social Security cost-of-living adjustment (COLA) for 2011, most Medicare consumers will pay the same premium in 2011 as they paid in 2010. This is due to the “hold harmless” provision, a law that does not allow people’s Part B premium to increase more than the COLA in a given year. If someone is eligible for “hold harmless” protection in 2011 and he or she paid $96.40 in 2010, he or she will continue to pay $96.40 in 2011. The same is true for those who paid $110.50 in 2010; if they are protected by the “hold harmless” provision, they will continue to pay $110.50 in 2011.

Individuals who earn above $85,000 per year will not only be responsible for an income-related adjustment to their Part B premium as in past years, but, beginning in 2011, will be subject to an adjustment to their Part D premiums as well. Under Part B, higher income individuals will owe between $46.10 and $253.70 in additional premium costs per month. Under Part D, those individuals with higher income will owe between $12 and $69.10 in additional premium costs. The extra amount owed is pegged to income levels.

Read Medicare Rights Center’s fact sheet on Part B premiums in 2011.

Read CMS’s fact sheet on premiums and deductibles for 2011.

Medicare Reminder

The Fall Open Enrollment Period begins on Monday, November 15. The following are important questions for people with Medicare to ask during this period:

What are my Medicare coverage options?

Can I change my Medicare health plan at any time?

What insurance can I buy to fill gaps in Original Medicare?

Can I buy a Medigap policy at any time?

How do I compare Medicare private drug plans?

Do I need to review my Medicare prescription drug plan choice every year?

Medicare Rights has also released a packet of information that addresses Fall Open Enrollment in more detail. The packet was designed for journalists, but is also useful for consumers, caregivers and professionals. Read the packet.

Find answers to your Medicare questions at www.MedicareInteractive.org.

Spotlight

Medicare Rights Center President Joe Baker released a statement today on a debt reduction proposal from the chairmen of the National Commission on Fiscal Responsibility and Reform. “We have serious concerns about proposals that would directly affect the out-of-pocket costs for people with Medicare,” said Mr. Baker.

Read the full statement.