Health Reform Q&A
People with Medicare still have many outstanding questions about the Affordable Care Act (ACA), as evidenced by the response to last week’s Medicare Watch. By far the most frequently asked question about health reform by Medicare Watch readers was some variation of the following:
Q: What services are included in the new “annual wellness visit”?
A: During the annual wellness visit, you and your doctor will create and update a preventive care plan. Your doctor will also update your medical history; make a list of your current doctors and medications; create a 5- to 10-year screening schedule; identify health risk factors and discuss ways to possibly avoid them; check your height, weight, blood pressure and body mass index; and screen for cognitive issues. In addition to what is covered at no cost to consumers during the annual wellness visit, other preventive services will also be free of charge under Medicare, including mammograms, colonoscopies and diabetes screenings.
There are a few nuances about the wellness visit that Medicare consumers should understand.
First, the ACA creates the annual wellness visit under Original Medicare only, and does not require Medicare private health plans, also known as Medicare Advantage (MA) plans, to cover such visits in full. However, in the proposed rules it released recently, the Centers for Medicare & Medicaid Services (CMS) is considering requiring MA plans to provide the same preventive benefits, including an annual wellness visit, free of charge to consumers, beginning in 2012. The final rule has not yet been released. Second, while the annual wellness visit is free of charge, you may still be required to pay something out of pocket if you receive other services from your doctor during the same visit. Lastly, Medicare will cover 100 percent of the cost of the wellness visit only if you go to a doctor who accepts assignment, which means they accept Medicare rates as payment in full.
Read more about the annual wellness visit on Medicare Interactive.
Read HealthCare.gov’s fact sheet on preventive services.
Read Medicare Rights Center’s chart on preventive services.
Please keep your questions coming. If you have a personal story about Medicare or health reform, positive or negative, please share that, too. In future issues of Medicare Watch, we will continue to answer readers’ questions about the ACA and how it affects people with Medicare.
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Medicare Rights Calls for Reforms to the Drug Appeals Process
In comments on Part D appeals guidance submitted last week, the Medicare Rights Center urged the Centers for Medicare & Medicaid Services (CMS) to require Medicare Prescription Drug plans (PDPs) to provide more detailed information in denial notices to enrollees. In the Medicare Rights Center’s experience of representing clients in appeals cases, we have found that plans’ notices do not always include all of the reasons why they are denying coverage for a drug or service, and it is often only in later stages of the appeal that a plan reveals that there is more than one reason for the denial. In addition, Medicare Rights requested that CMS make it easier for Medicare consumers and their physicians to initiate appeals, escalate appeals to the next level if a plan fails to make a timely coverage decision, and access information related to their appeals, such as case files, free of charge.
The appeals guidance is part of the Medicare Prescription Drug Benefit Manual, which interprets regulations that govern the appeals process and plans’ obligations under the appeals process. The guidance appears in Chapter 18 of the Manual.
Read Medicare Rights Center’s comments on the guidance.
Read the draft guidance.
Explore CMS’s Internet-Only Manuals.