Medicare Watch

A Letter From Medicare Rights Center President Joe Baker

The current threat to Medicare and Medicaid is very real. The debt-ceiling debate has somehow turned into a referendum on the future of these essential health programs, and in turn on the financial outlook, health, and quality of life of older Americans, people with disabilities, and their families. In a statement I issued this week about the current state of negotiations, I called for a balanced approach that would not result in major cost-shifting to Medicare beneficiaries who are not able to bear the burden of extra costs. 

Read Joe Baker’s statement.

We can all play a part in preventing deep cuts to Medicare and Medicaid. Take action, and encourage family and friends to do the same, by contacting your elected officials to let them know that these programs are essential. Share with your senators and representatives your stories about how you and your family have come to rely on these programs, and let them know that proposed changes to these programs will impact all Americans. Send the message that any final resolution to deficit-reduction conversations must take a balanced approach that includes increased revenue. Make it clear that proposals that cut federal government spending on Medicaid and Medicare by shifting cost responsibility to states and Medicare beneficiaries will result in Medicaid benefit reductions, decreased access to health care, and increased out-of-pocket costs for older Americans and people with disabilities.

To contact your elected official, call the Congressional switchboard at 202-224-3121 and ask to be connected to your senators’ or representative’s office.

Share your story with the Medicare Rights Center.

Ensuring Consumer Protections for the Dual-Eligible Population

The past week has been a busy one for policy developments concerning people who have both Medicare and Medicaid, also known as dual eligibles. This Monday, several organizations, including the Medicare Rights Center, submitted comments to the Medicare-Medicaid Coordination Office (MMCO) on its alignment initiative. The initiative aims to better align Medicare and Medicaid coverage rules in order to increase care coordination and overcome road blocks to coverage for the dual-eligible population. The comments outline areas where differences in rules create barriers to coverage and care, but also emphasize that dual-eligibles should have access to the most generous coverage standard available. 

In addition, the U.S. Department of Health and Human Services last Friday announced several initiatives aimed at improving the quality of care for the dual-eligible population. One initiative is a demonstration that would test new financing structures for coverage delivery through two different models. Under the first model, states would enter into three-way contracts with the Centers for Medicare & Medicaid Services (CMS) and a managed care plan that would be provided with a capitated payment to administer both Medicare and Medicaid. The second model allows states to share in savings achieved as a result of initiatives designed to improve quality and coordination of care for dual eligibles while reducing costs to the Medicare and Medicaid programs. The other two initiatives announced last week include the establishment of a resource center for states, which will assist them in delivering better coordinated care to high-need, high-cost beneficiaries, and a program designed to help states reduce preventable hospitalizations for nursing home patients. The initiatives will be administered through various offices within CMS, including the CMS Innovation Center and MMCO.

A new paper released by the National Senior Citizens Law Center (NSCLC) illustrates the importance of including consumer protections in these models. The paper, titled “Ensuring Consumer Protection for Dual Eligibles in Integrated Models,” highlights the importance of ensuring that models are designed not solely to create savings, but primarily to improve care quality, coordination and experience for this population. Recommendations include preserving choice of coverage and providers, ensuring continued access to the most generous benefits from both Medicare and Medicaid, and providing extensive and proactive oversight of all integrated models. 

Read Medicare Rights Center’s joint comments on the alignment initiative.

Read more about the new HHS dual-eligible initiatives.

Read NSCLC’s paper, “Ensuring Consumer Protection for Dual Eligibles in Integrated Models.”

 

 

Medicare Reminder

Medicare covers some vaccines and immunizations. The way Medicare covers them depends on which vaccine you need.
Your Medicare health coverage (Part B) will cover vaccines to prevent:

• Influenza (the flu);
• Currently, the seasonal flu shot includes both a seasonal flu shot and an H1N1 (swine flu) vaccination.
• Pneumonia; and
• Hepatitis B (if you are at medium to high risk).

Part B will cover other immunizations only if you have been exposed to a disease or condition. For example, if you step on a rusty nail, Medicare will cover a tetanus shot; if you are bitten by a dog, Medicare will cover your rabies shots.

If you have a Medicare prescription drug plan (Part D), you may be able to get coverage for other types of vaccines, such as the vaccine for shingles (herpes zoster). Any commercially-available vaccine that is not covered by Part B should be covered by your Medicare prescription drug plan. Before you get a vaccination, you should check coverage rules with your Part D plan and see where you should get your shot so that it will be covered for you at the lowest cost.

Learn more about Medicare coverage of vaccines and immunizations at www.medicareinteractive.org.

 

Spotlight

A new YouTube channel, Health Reform Works, features stories of real people who have been helped by the Affordable Care Act. The channel is a project of the Catholic Health Association of the United States.

Watch the stories at www.youtube.com/healthreformworks.