Medicare Watch

Last Chance for Eligible Beneficiaries to Enroll in Part B

Beneficiaries who are eligible for Medicare, but who have not yet enrolled in Medicare Part B, have until March 31, or the end of the General Enrollment Period (GEP), to do so. The GEP runs from January 1 to March 31 of each year. Medicare Part B covers a range of services, including doctors' visits, outpatient therapy, durable medical equipment and drugs covered under Part B. Beneficiaries who enroll during this year's GEP will have coverage effective July 1, 2012. These beneficiaries can also sign up for a Medicare private health plan, otherwise known as a Medicare Advantage plan, from April through June, with coverage beginning July 1.

Most Medicare beneficiaries enroll in Part B during their Initial Enrollment Period (IEP), the seven-month period surrounding their 65th birthday. Some people have a Special Enrollment Period (SEP) to enroll in Medicare after their IEP has passed. Individuals who are eligible for an SEP include those who had group health coverage through a current employer (or a spouse's current employer) at the time that they became eligible for Medicare. In these cases, people can typically enroll in Part B without penalty at any time while they still have group health coverage from a current employer, and for eight months after they lose their group health coverage or they or their spouse stop working, whichever comes first.

Due to the complicated rules that govern an individual's obligation to enroll in Part B, Medicare Rights often receives calls on its helpline from individuals who did not enroll in Part B at the proper time. Medicare-eligible individuals who have missed their IEP and who are not entitled to an SEP must enroll in Part B during the GEP. They may face gaps in health care coverage and lifetime Part B premium penalties. If you fall into this category, you need to enroll in Part B before March 31, because you will not have the chance to do so again until January 1, 2013, with coverage beginning July 1, 2013.

Individuals with limited incomes and assets may be eligible for Medicare-related benefits that help cover the monthly Part B premium, including any late enrollment premium penalty. Learn more about these benefits, the Medicare Savings Programs, in this week's Medicare Reminder (right sidebar).

Read the Medicare Rights Center's press release about the end of the GEP.

Read Medicare Rights' and AgeOptions' recently released toolkit, designed to help people new to Medicare understand how different kinds of insurance coordinate with Medicare:

"How Medicare Works With Employer-Based Insurance: A Guide for Employers, Professionals and Consumers.".

Report Compares Provisions of Proposals That Convert Medicare to a Premium Support Program

A new report released by the Kaiser Family Foundation compares a number of proposals that would convert Medicare into a premium support program. Generally, premium support proposals provide a “defined contribution,” or fixed payment, from the federal government to individuals to purchase health care coverage, in most cases from private insurers. However, as demonstrated by the Kaiser report, the details of the premium support policies vary between proposals. While some proposals specify that private plans must offer the “actuarial equivalence” of the Original Medicare package, they remain unclear on whether private plans would be required to offer the same guaranteed benefits that people currently receive under Medicare. If private plans have flexibility in the benefits they offer, benefit packages might be designed to discriminate against sicker beneficiaries. In addition, while some proposals would allow individuals to use their fixed payment towards purchase of Original Medicare, other proposals would eliminate Original Medicare as an option altogether.

The majority of premium support proposals include mechanisms that would cap Medicare spending, though the trigger and methods by which Medicare would be cut vary by proposal. In many cases, the trigger that would require cuts to Medicare will not keep pace with the rising costs in the health care sector overall, a major driver of rising Medicare spending. That means the amount of the fixed payment provided by the federal government may grow increasingly inadequate to cover the cost of coverage. As a consequence greater out-of-pocket costs might be shifted to beneficiaries or Congress might be required to cut provider payments, or change coverage rules or benefits.

The details of most premium support proposals are still somewhat a mystery, as most have been issued as summaries rather than in legislative language. However, the Congressional Budget Office estimates that Representative Paul Ryan's proposal, which served as the basis for the budget passed last year by the House of Representatives, would nearly double Medicare beneficiaries' out-of-pocket costs over time. Other analysts believe that the premise of premium support actually worsens Medicare's ability to contain spending: Medicare is currently better than private insurance companies at controlling costs, but if beneficiaries shift to private insurance companies, the trend could undermine Medicare's negotiating power and increase the program's administrative overhead of providing coverage.

Read the Kaiser Family Foundation's report, “Comparison of Medicare Premium Support Proposals.”.

Read the Center on Budget and Policy Priorities' report, “The Case Against Premium Support.”.

Medicare Reminder

If you have limited finances and assets, Medicare Savings Programs (MSPs) can help you pay for your Medicare costs. There are three main programs, and each has different income eligibility limits. Depending on what state you live in, the programs may also have asset limits. You should call your local Medicaid office for exact rules on how to apply for an MSP in your state, including what documentation you will need to provide.

The Qualified Medicare Beneficiary (QMB) program pays for Medicare Part A and B premiums, deductibles and coinsurances or co-payments. If you have QMB, you will not be responsible for any coinsurance or copayment for Medicare-covered services that you receive from doctors who participate in Medicare or Medicaid or are in your Medicare private health plan's (also known as a Medicare Advantage plan's) network. By law, these doctors are not allowed to charge you for services that they provide. Both the Specified Low-income Medicare Beneficiary (SLMB) and the Qualifying Individual (QI) programs pay your monthly Medicare Part B premium.

If you enroll in an MSP, you will also automatically get Extra Help, the federal program that helps cover your Medicare prescription drug costs, including at least a portion of your monthly Part D premiums and medication co-payments. If you are not enrolled in one of the programs that automatically qualify you for Extra Help, and you are eligible for the benefit based on your income and assets, you will have to fill out an application through the Social Security Administration, using either the agency's print or online application, or at your local Medicaid office.

Learn more about MSPs and Extra Help at www.medicareinteractive.org

 

Spotlight

Last week, the Medicare Rights Center submitted comments on the Centers for Medicare and Medicaid Services' (CMS') draft Medicare Marketing Guidelines. This proposed guidance governs marketing rules for private plans, including Medicare private health plans (also known as Medicare Advantage plans) and Medicare prescription drug plans. In its comments, Medicare Rights made recommendations to CMS, including that private plans be prohibited from implying to beneficiaries that enrollment in a plan provides eligible members with federal or state benefits that would be available regardless.

Read the proposed guidance

Read Medicare Rights' comments