Medicare Watch

Medicare Rights Releases Video Discussing Premium Support Proposals

To help people with Medicare and their families understand the many proposals seeking to control costs in Medicare and the effects those proposals may have on the Medicare program, the Medicare Rights Center will be developing and releasing short explanatory videos. The first such video entitled “Discussing the Premium Support Proposal” explains the current premium support proposal in the budget authored by Representative Paul Ryan and passed by the House of Representatives.
 
Under a premium support system, the government would provide Medicare beneficiaries with a capped amount of money, essentially converting Medicare into a voucher system and ending the Medicare program as we know it. The proposal would cap the amount, or growth in the amount, of the voucher, which consequently would not increase at the same rate as health care costs overall. Over time, the vouchers provided to Medicare beneficiaries would be insufficient to purchase health coverage as good as that which Medicare currently provides. As a result, people with Medicare, half of whom live on annual incomes of $25,000 or less, and who, on average, already spend 15 percent of their incomes on health care costs, would be required to make up the difference with their own money.
 
While policymakers claim the goal of premium support proposals is to save the government money, they do so by shifting costs onto Medicare beneficiaries—increasing the out-of-pocket health care expenses of older adults and people with disabilities. Policies that aim to save money in the Medicare program should be based on solutions that preserve access to affordable health care and protect beneficiaries from shouldering even more health care costs.
 
Visit Medicare Rights’ Facebook page to watch “Discussing the Premium Support Proposal.”
 
Read the Center on Budget and Policy Priorities’ report, “What You Need to Know About Premium Support.”

New York Publishes Revised Duals Proposal

Last week, the New York State Department of Health posted its revised demonstration proposal to integrate coverage for dually eligible individuals, or people with both Medicare and Medicaid. The revised proposal incorporates changes based on public comments to the state’s first draft. The Medicare Rights Center submitted comments as part of a coalition which includes organizations representing older adults and people with disabilities. Among the changes that address concerns Medicare Rights voiced is New York’s plan to create stakeholder workgroups. These workgroups would discuss aspects of the proposal that remain unclear. For instance, the state would dedicate a workgroup to developing the structure of an integrated grievance and appeals process for Medicare and Medicaid benefits.
 
Additionally, as our comments suggested, New York has scaled back the number of dual eligibles that would be enrolled into private plans that provide both Medicare and Medicaid benefits, termed Fully-Integrated Dual Advantage (FIDA) plans. This program calls for the state to enter into a three-way contract with CMS and private insurance companies, which receive capped payments to administer both Medicare and Medicaid benefits. Beginning in 2014, individuals in eight downstate counties who are already enrolled into managed long-term care plans would be passively enrolled into the FIDA program. Starting in July of this year, a separate group of dual eligibles statewide would be enrolled into a managed fee-for-service program, an option that Medicare Rights and the coalition had suggested. A dedicated care manager will coordinate care for health home enrollees, but these dual eligibles are not subject to some of the restrictions that apply in a managed care setting, such as a limited network of doctors and other providers. According to the proposal, beneficiaries in either model would have the option to opt out and participate in other Medicare and Medicaid programs.
 
While the revised proposal has taken into account the comments New York received on its first draft, the proposal is still a work-in-progress. The proposal requires further feedback from stakeholders to ensure that beneficiaries receive all of the benefits to which they are entitled. The public can comment on New York’s revised proposal until May 17. There will be additional opportunity to comment when the Centers for Medicare and Medicaid Services (CMS) publishes the proposal in June.
 
Read the New York State Department of Health’s second proposal to integrate care for dually eligible individuals..
 
Read comments submitted by beneficiary advocate on New York’s initial FIDA proposal. . 

Medicare Reminder

Medicare will help pay for hospice care if you meet all of the following criteria:

•  You have Part A;
• The hospice medical director (and your doctor, if you have one) certify that you have a terminal illness, meaning you are expected to live for six months or less;
• You sign a statement electing to have Medicare pay for palliative care, rather than curative treatment;
• Your terminal condition is documented in your medical record; and
• You receive care from a Medicare-certified hospice agency.

The hospice benefit is always covered under Original Medicare. If you are enrolled in a Medicare private health plan, also known as a Medicare Advantage plan, and you elect hospice, your hospice care will be paid for by Original Medicare.
 
You can get hospice care for as long as your doctor and the hospice medical director certify that you are terminally ill. On day 180 of hospice care, you are required to have a face-to-face meeting with a hospice doctor or nurse practitioner. After that, you must continue to have these meetings before the start of each following 60-day benefit period.

Learn more about Medicare coverage of hospice care at www.medicareinteractive.org

Spotlight

Under a new proposed rule announced yesterday, primary care providers serving Medicaid beneficiaries would receive increased Medicaid reimbursements in 2013 and 2014. The rule would implement the Affordable Care Act’s (ACA) requirement that Medicaid primary care services be reimbursed at Medicare rates over those two years. Health and Human Services Secretary Kathleen Sebelius also announced that as a result of the ACA, primary care providers across the country received nearly $560 million in higher Medicare payments in 2011, helping ensure that Medicare beneficiaries have access to their doctors.

Read the press release about the proposed rule