Medicare Watch

Medicare Trustees Release 2011 Report

If not for the Affordable Care Act (ACA), the Medicare Hospital Insurance (HI) Trust Fund would run a deficit eight years earlier than currently projected, according to the Social Security and Medicare Trustees report released last week. The report states that the HI Trust Fund is expected to become insolvent in 2024, five years earlier than projected in the 2010 report. This is largely the result of the economic downturn. The HI Trust Fund is funded through payroll taxes, and if fewer individuals are paying into the system, there will be less HI funds available. The trustees also stated that Medicare costs will continue to grow from about 3.6 percent of the economy in 2010 to about 5.6 percent in 2035. However, this growth rate is influenced by the growth of cost in the health care system overall in the United States. Many proposals that would cut Medicare by shifting extra costs to consumers would not address the underlying causes of Medicare cost growth or health care cost growth overall. 

The report also addresses the financial health of Medicare Part B, which covers outpatient services such as doctor visits, and Medicare Part D, which provides coverage for prescription drugs. Because these parts of the program are funded through a combination of general revenues and premiums that are adjusted each year, they are for the most part self-sustaining and are projected to remain balanced, as they have been in past years.

Medicare trustees release annual reports to Congress on the status of the Medicare programs. Four of the six trustees are appointed by virtue of their position in government: the Secretary of the Treasury, Secretary of Labor, the Secretary of Health and Human Services, and the Commissioner of Social Security. The remaining two are public representatives appointed by the president.

Statement by Medicare Rights Center President Joe Baker on the Medicare Trustees Report.

Read the CMS press release and the 2011 Medicare Trustees Report.

Streamlining Transitions to Medicaid for Medicare-Eligible Individuals

Beginning in 2014, the Affordable Care Act (ACA) expands Medicaid coverage to populations that traditionally have not been eligible, and expands coverage for those who are not eligible for Medicare if they have incomes up to 138 percent of the Federal Poverty Level (FPL). In addition, the ACA eliminates the consideration of assets from eligibility determinations and applies a universal Modified Gross Adjusted Income (MAGI) calculation to determine eligibility. The ACA also streamlines enrollment for these individuals, eliminating documentation requirements to prove income and allowing states to match information provided on applications with tax information at the IRS. The ACA envisions an electronic application portal through which individuals may be determined eligible for Medicaid in real time. Together these changes will vastly improve the application, determination and enrollment processes for Medicaid and ensure individuals receive benefits and health coverage in a timely manner.

However, these improvements may not apply to individuals once they become Medicare-eligible. For this reason, the Medicare Rights Center is working to ensure that people with Medicare receive the same benefits of streamlined enrollment in low-income programs. Specifically, Medicare Rights is working in New York and other states to encourage those in charge of establishing new protocols and designing modern enrollment systems to include the Medicare population in these improvements. Although not required to do so by the ACA, states can change application and eligibility rules for Medicaid for people with Medicare to better align them with those that will be applied to the non-Medicare population. As part of this effort, this week Medicare Rights provided testimony at a New York State Insurance Department public forum on the health insurance exchange. The testimony called for the state, in building modern enrollment systems in anticipation of 2014, to include the Medicare population in such systems. This will help prevent people with Medicare from being left behind in current determination and enrollment systems that use outdated technology and lead to bureaucratic disentitlements, and it will prevent gaps in coverage that could occur as a result of the transition from Medicaid to Medicare and Medicaid.  

Read Medicare Rights’ testimony “The Importance of Improving Eligibility and Enrollment Systems for Dually-Eligible New Yorkers.”

Medicare Reminder

Medicare may help pay for skilled nursing facility care if:

• You need skilled nursing care seven days a week or skilled therapy services at least five days a week;
• You were formally admitted as an inpatient to a hospital* for at least three consecutive days in the 30 days prior to admission in a Medicare-certified skilled nursing facility; and 
• You have Medicare Part A before you are discharged from the hospital.

*Note: If you are admitted to the emergency room under observation or only receive emergency room services, this time does not count toward meeting the three-day prior hospital requirement for SNF coverage.

However, Medicare will provide coverage for a SNF stay only for a limited period of time. If you need more than 100 days of skilled nursing facility care, you will need to pay for this additional care yourself. If you have long-term care insurance, it may cover this care or, if your income is low, Medicaid may pay for this care. Call your Medicaid office for more information.

Learn more about skilled nursing facility (SNF) care at www.MedicareInteractive.org.

Spotlight

Medicare has updated its resource for caregivers at www.medicare.gov/caregivers. Known as Ask Medicare, the resource provides tips, stories and answers to frequently asked questions about caregiving.

Visit Ask Medicare.