Medicare Watch

Medicare Consumers Must Benefit from Medicaid System Modernization

The Medicare Rights Center authored comments requesting that the Centers for Medicare & Medicaid Services (CMS) encourage states to include low-income Medicare consumers in new, modernized Medicaid enrollment systems that will be developed with federal matching funds made available under a recent proposed rule by the agency. The comments, submitted by Medicare Rights with several advocacy partners on January 7, applauded CMS for proposing to make federal funds available to states to upgrade current Medicaid enrollment systems, many of which use antiquated technology that leads to bureaucratic disentitlement to needed benefits.

The proposed rule primarily focused on making more federal funds available to states to address the need to redesign and streamline Medicaid systems in light of new requirements under the Affordable Care Act (ACA) that will ease enrollment, retention, and the exchange of information among states, state-based exchanges and the federal government. However, it is important that people with Medicare who are also eligible for Medicaid, Medicare Savings Programs (MSPs) and the Part D Low-Income Subsidy (LIS), also have access to improved systems. They too should benefit from streamlined processes, which will help them enroll more quickly into programs for limited-income individuals with Medicare and prevent churning, which occurs when people go on and off benefits.

Read the comments on federal funding for Medicaid eligibility determination and enrollment.

Read the proposed rule on federal funding for Medicaid eligibility determination and enrollment.

Comments on Part C and Part D Proposed Rule Call for Better Access to Information

According to comments submitted by Medicare Rights Center and other advocacy partners, the Centers for Medicare & Medicaid Services (CMS) has made many improvements in new proposed regulations on Medicare Part C, which covers private Medicare plans also known as the Medicare Advantage program, and Part D, which covers the Medicare prescription drug benefit. Such improvements include: limiting cost-sharing under Medicare Advantage for certain services such as home health care to amounts equal to or less than those under Original Medicare; creating more uniform exceptions and appeals processes, such as allowing individuals to apply online for coverage determinations and re-determinations under Part D; and strengthening beneficiary protections against marketing abuses by requiring agents to go through more thorough standardized trainings.

However, there is still room for further improvement. Providing consumers with point-of-sale notices at pharmacies when Medicare denies coverage of a drug is an important first step, the organizations say, but they also suggested to CMS that the notice contain individualized information, which would allow people to make informed decisions about whether and how to appeal. The comments also make clear the need for greater availability of translated materials for populations with limited English proficiency (LEP). Under the law, these populations must have access to information that will help them make informed choices about coverage and understand their rights as consumers.

Both the proposed regulation and the comments address a broad range of topics, including CMS and state oversight of and contracting with Special Needs Plans (SNPs), plan bid review, marketing, coverage and appeals rules, and allowable cost-sharing for medical services and drugs.

Read comments on the proposed rule on changes to Medicare Parts C and D for 2012.

Read the proposed rule on changes to Medicare Parts C and D for 2012.

Medicare Reminder

If you are enrolled in a Medicare private health plan (also known as a Medicare Advantage plan), you can switch to Original Medicare during the Medicare Advantage Disenrollment Period (MADP). The MADP runs from January 1 to February 14.

If you have a Medicare private health plan, you will be able to switch to Original Medicare with or without a stand-alone prescription drug plan. Changes made during this period will become effective the first of the following month. If you are enrolled in a PFFS plan with a stand-alone drug plan, you must keep your stand-alone prescription drug plan if you switch to Original Medicare during the MADP.

Note: If you disenroll from your Medicare private health plan, federal law does not usually give you the right to buy a Medigap plan. The laws in your state might give you more rights. Medigap plans are supplemental polices that help pay for Original Medicare deductibles and coinsurances. You should check with your SHIP (State Health Insurance Assistance Program) to find out if and when you can enroll in a Medigap plan in your state.

Read more about the MADP at www.MedicareInteractive.org.

Find your SHIP here, or call 1-800-677-1116.

Spotlight

While Medicare Watch was on hiatus, Medicare Rights issued a press release on the Medicare Advantage Disenrollment Period (MADP). The release outlines key details about the MADP and offers advice for consumers.

Read the release.