Medicare Watch

New Resources on Medicare Preventive Benefits

Medicare Rights Center has developed new materials to help people with Medicare, caregivers and the professionals who assist them better understand improvements to Medicare coverage of preventive benefits as a result of the Affordable Care Act (ACA). Under the ACA, eligible beneficiaries can access many preventive benefits with no cost-sharing. Beginning this year, Medicare private health plans, also known as Medicare Advantage plans, cannot charge anything for preventive services that are free for people with Original Medicare, as long as beneficiaries see in-network providers. Medicare Rights has developed a new packet, “Preventive Services Explained,” that provides details of when and what preventive services are covered by Medicare at no cost to beneficiaries. In addition, Medicare Rights has released English-and Spanish-language videos that discuss those preventive services covered by Medicare in 2012.

According to a new statement released by the Centers for Medicare & Medicaid Services (CMS) this week, 8.9 million people in Original Medicare accessed at least one free preventive service from January through March of this year. Of those who received preventive benefits, 560,000 had an Annual Wellness Visit. While not a head-to-toe physical, the Annual Wellness Visit gives Medicare beneficiaries the opportunity to meet with their primary care doctors each year and create or update a five-to-ten-year preventive care schedule based on their individual needs. In other ACA-related news, CMS announced that in the first three months of 2012, more than 220,000 individuals received discounts on drugs purchased in the Medicare prescription drug coverage gap, or doughnut hole. Since the ACA began closing the doughnut hole in 2010, people with Medicare have saved a total of $184.5 million on prescription drug costs.

Read Medicare Rights’ “Preventive Services Explained.”

Watch Medicare Rights’ video on preventive services in English.  

Watch Medicare Rights’ video on preventive services in Spanish.

Read CMS’ press release, “Affordable Care Act Saved People on Medicare Over $3.4 Billion on Prescription Drugs.”

Celebrate Older Americans Month in May

This May, Older Americans Month celebrates the contributions of more than 40 million adults over the age of 65, a population larger in size or percentage than any other in the US, according to the 2010 census. In line with this year’s theme—“Never Too Old to Play”—the Administration on Aging (AoA) is encouraging older adults to remain involved in their communities and engaged with their lives, through expressing themselves creatively, interacting with their children and grandchildren, and remaining physically and mentally active.

At the Medicare Rights Center, older adults form the majority of the organization’s dedicated corps of volunteers. Whether they answer calls on Medicare Rights’ Consumer and Spanish-language Helplines, help eligible beneficiaries enroll in public benefits that lower Medicare-related costs, or lead presentations throughout their communities as part of the Seniors Out Speaking program, these volunteers empower their peers with Medicare information and enable them to access important health services. Last week, Medicare Rights celebrated the accomplishments of its volunteers at its annual Volunteer Luncheon. “Volunteering at Medicare Rights has been a very fulfilling experience for me,” said one volunteer. “The range of questions and problems seems infinite sometimes. Just when you think you get it, there is a new twist. But that’s what makes it exciting—I never stop learning new things and gaining new insights about systems and people… Moreover, being able to work through health insurance issues and help people resolve their problems or just provide some Medicare education sends me home each time feeling good about what I have done.”

Visit the Administration on Aging’s website for Older Americans Month 2012.
 
Read President Obama’s Proclamation on Older Americans Month 2012.
 
Learn more about volunteering at the Medicare Rights Center.
 
See pictures from Medicare Rights’ Volunteer Luncheon.

Medicare Reminder

If your Medicare Part D prescription drug plan is covering your drug, but your copayment is high, the drug may be on a high cost tier. Cost tiers are how drug plans price the drugs they cover, with the least expensive, usually generic, drugs on Tier 1, and more expensive, usually brand-name and specialty, drugs on higher tiers. Each plan sets its own tiers, and plans often change their cost tiers from year to year.
If you are charged a high copay at the pharmacy, talk to your pharmacist and your plan to find out why. If your copay is high because your prescription is in a higher cost tier than other similar drugs on the formulary, you can ask your Medicare drug plan to move it to a lower tier for you. This is called a request for a formulary tier exception.
Your doctor can request a formulary tier exception by filling out a Coverage Determination Request Form. All plans must accept this standard form, but some plans may have their own specific forms that they prefer you use. Plans must respond within 72 clock hours, not business hours, of getting the doctor's written statement. For emergencies, plans must respond to expedited requests within 24 clock hours. Your plan should send you a written coverage determination that says whether it will cover your drug at the lower cost tier. If you don’t hear from the plan in the proper timeframe, call and ask for the decision.

Learn more about requesting a tiering exceptionat www.medicareinteractive.org.

Spotlight

If the Supreme Court were to overturn the entire Affordable Care Act (ACA), there could be major disruptions in Medicare payments and people’s access to services. The system, which handles over 100 million claims each month, has seen changes as a result of the law, and reversing those changes could delay or create problems with provider reimbursements. In addition, if the ACA were repealed, the Medicare prescription drug coverage gap would be reopened, and people with Medicare would lose access to free benefits such as certain preventive services.