Medicare Watch

Make Your Voice Heard and Help Preserve Medicare Beneficiaries’ Access to Their Doctors

As the year comes to a close, Congress still has important business to finish—namely, passing legislation to prevent a 27.4 percent cut to Medicare doctor payments. Reducing physician reimbursements may undermine Medicare beneficiaries’ access to health care, if doctors stop accepting people with Medicare as patients.

In addition, without Congressional action, both the Qualifying Individual (QI) program, which helps people with limited incomes pay their Part B premium, and the Medicare therapy caps exceptions process will expire in 2012. The Medicare therapy caps exceptions process allows individuals who require medically necessary services to overcome Medicare’s limited coverage of speech, physical and occupational therapy services.

As Congress contemplates ways to pay for both Medicare and non-Medicare programs set to expire at the end of the year, some Congressional leaders have suggested cutting Medicare by shifting costs to beneficiaries. We must remind policymakers of the importance of the Medicare program and the need to preserve it.

Your voice matters. Below is a sample message—either as is or personalized by you—that you can deliver as a letter, phone call or e-mail to your representatives and senators. Let them know that they must maintain Medicare beneficiaries’ access to care while keeping Medicare affordable.

• Congress must act to prevent the almost 30 percent cut to Medicare doctor payments from going into effect at the end of this year. Preventing the cut will ensure that Medicare beneficiaries’ access to their doctors is preserved.

• Congress must also extend important programs for people with Medicare, such as the Qualifying Individual (QI) program that helps Medicare beneficiaries with limited incomes pay the Part B premium each month. In addition, policymakers must extend the Medicare therapy caps exceptions process so people with Medicare are able to access the medically necessary therapies they need. Both of these programs help maintain Medicare beneficiaries’ quality of life.

• Lastly, Congress cannot pay for these vital programs or any other programs by making people with Medicare pay more for care, by means testing Medicare, or by cutting benefits. In maintaining Medicare beneficiaries’ access to care, we must guarantee that they are also able to afford it.

After you take action, tell a friend or family member to do the same. We can all work together to protect Medicare and Medicaid.

Contact your senators to tell them to preserve Medicare. (Click here to find you senators’ names and contact information.)

Contact your representative to tell them to preserve Medicare. (Click here to find your representative’s name and contact information.)

Read the Leadership Council of Aging Organization (LCAO) on Medicare programs that must be extended.

Read the Medicare Rights Center’s joint letter on the importance of the QI program.

Report Examines Part D Spending Patterns

The Congressional Budget Office (CBO) released a new brief, “Spending Patterns for Prescription Drugs Under Part D,” which analyzes the combined spending of beneficiaries, insurance companies, the government and other third-party payers on drugs under Part D. The brief compares the spending trends of those beneficiaries who qualify for the Low Income Subsidy (LIS), otherwise known as Extra Help, and those who do not (non-LIS beneficiaries). The LIS benefit provides assistance with out-of-pocket costs for Part D for individuals with limited incomes and assets.

The report found that spending patterns between LIS and non-LIS beneficiaries varied. Those without LIS tended to account for lower spending rates; spending also occurred at a higher rate in the initial phase of drug coverage. Spending for those with LIS occurred more evenly across the benefit phases (encompassing the initial coverage phase, the coverage gap and catastrophic coverage). The difference in spending patterns could be attributed to the fact that the LIS benefit protects eligible individuals from large fluctuations in out-of-pocket costs (for example, LIS beneficiaries do not experience an increase in drug costs when they enter the coverage gap).

In addition, the report suggests that LIS beneficiaries’ higher total spending on prescription drugs is the result of the greater financial assistance that they receive, as well as their poorer health status. Individuals with LIS, many of whom are also dually eligible for Medicare and Medicaid, tend to have higher rates of chronic conditions, comorbid disorders or diseases, and mental and cognitive conditions that lead to the greater need and utilization of treatment. 

Read CBO’s Issue Brief on Spending Patterns for Prescription Drugs Under Medicare Part D.

 

Medicare Reminder

If you qualify for the home health benefit, Medicare covers the following types of care:

• Skilled nursing services and home health services provided up to seven days a week for no more than eight hours per day and 28 hours per week.
• Skilled therapy services. Physical, speech and occupational therapy services that can only be performed safely by or under the supervision of a licensed therapist, and that are reasonable and necessary for treating your illness or injury.
• Medical social services. Medicare pays in full for services ordered by your doctor to help you with social and emotional concerns you have related to your illness.
• Medical supplies. Medicare pays in full for certain medical supplies provided by the Medicare-certified home health agency, such as wound dressings and catheters needed for your care.
• Durable medical equipment. Medicare pays 80 percent of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker.

Learn more about home health care coverage at www.medicareinteractive.org.

Spotlight

Last week, the Centers for Medicare & Medicaid Services launched Medicaid.gov, the first official website dedicated to the Medicaid program. Medicaid beneficiaries, advocates and professionals who visit the site will find useful information such as state-specific data, federal guidance and a timeline of health reform implementation.

Visit Medicaid.gov.