Medicare Watch

New Report Underscores the Importance of Having Coverage for Accessing Needed Health Care

A new report released by the Kaiser Family Foundation (KFF), titled “Cost and Access Challenges: A Comparison of Experiences Between Uninsured and Privately Insured Adults Aged 55 to 64 with Seniors on Medicare,” finds that unsurprisingly, uninsured adults face significant difficulties accessing and affording needed health care. The report compares survey data on health care cost and access experiences of adults aged 55 to 64—with and without private insurance—and seniors with Medicare.

According to the report, over 41 percent of uninsured adults aged 55 to 64 postponed needed care in 2010, and almost all of these individuals attributed the reason to cost concerns. Compared to this population, a lower proportion of insured adults in the same age range and seniors with Medicare reported access and affordability issues. For instance, the uninsured adults surveyed had unmet medical needs or delayed seeking health care at three times the rate that Medicare seniors did. The report also finds that between 2003 and 2010, a higher proportion of both uninsured and insured adults surveyed have found it difficult to access care. In contrast, the share of Medicare seniors who experienced these accessibility problems did not change significantly.

According to the report, certain Medicare benefits protect older beneficiaries from experiencing difficulty accessing or affording care. For instance, a larger share of seniors without supplemental coverage reported having trouble paying their medical bills, compared to those with secondary insurance, such as employer-sponsored coverage, a Medigap, or Medicaid.

Thanks to the Affordable Care Act (ACA), beginning in 2014, uninsured adults will be able to purchase affordable insurance from state health exchanges. In the meantime, the law has mandated that states establish pre-existing condition plans for uninsured individuals; to date, adults aged 55 to 64 have been the largest enrollment group in those policies. Moreover, in 2014, those with limited incomes may become eligible for Medicaid due to expansion of this program or receive subsidies to purchase private insurance through the state exchanges. The KFF report cautions that limiting the implementation of the ACA or reducing Medicare benefits, such as by increasing the age of Medicare eligibility, could have serious cost and access implications for older Americans.

Read the KFF report.

Increase in Observation Stays May Cause Problems for Medicare Beneficiaries

The ratio of observation stays to inpatient admissions in Original Medicare increased 34 percent from 2007 to 2009, according to a study published in Health Affairs this week. Additionally, Medicare beneficiaries were held in observation for longer periods of time—some for at least 72 hours, well past Medicare’s recommended 24 to 48 hours. Observation services allow physicians to evaluate a hospital patient when it is unclear whether or not that patient should be formally admitted. According to the article, the extended use of observation versus inpatient services can limit beneficiaries’ access to skilled nursing care and subject them to higher out-of-pocket costs.

The study, which utilizes Medicare claims data for beneficiaries over the age of 65, found that between 2007 and 2009, the number of beneficiaries held under observation status increased 24 percent. In addition, the number of beneficiaries held for observation stays for longer than 72 hours more than doubled. The study also finds that observation stays were more prevalent among certain population groups, including older Medicare beneficiaries and women.

According to the study, nearly one million Medicare beneficiaries aged 65 and older received observation services each year from 2007 to 2009, and each additional episode resulted in a longer observation stay. The study’s authors suggest that this trend may be a result of recent Medicare payment policies intended to reduce avoidable hospital readmissions and contain costs. The study suggests that this shift from inpatient admissions to observation stays may create barriers to skilled nursing facility care for those who need it, as Medicare requires that beneficiaries spend three days in an inpatient setting to qualify for skilled nursing care under the Part A benefit. Patients under observation status are considered outpatients.

Read the Health Affairs article, “Sharp Rise in Medicare Enrollees Being Held in Hospitals for Observation Raises Concerns About Causes And Consequences.”

Medicare Reminder

Whether or not you can keep your COBRA coverage when you enroll in Medicare depends on when you got your COBRA coverage. COBRA is a federal law that gives you the right to continue your health insurance once it ends because of job loss, divorce, death or other reasons.

If you already had COBRA coverage when you enrolled in Medicare, your COBRA coverage will probably end. You should speak to your COBRA benefits manager for more information. If you have COBRA and you become Medicare-eligible, you should enroll in Part B immediately. Unless you are under the age of 65 and become eligible for Medicare due to End-Stage Renal Disease (ESRD), COBRA is always secondary to Medicare. In addition, because COBRA is not considered insurance through a current employer, you are not entitled to a Special Enrollment Period (SEP) when your COBRA coverage ends. As a reminder, you do have an SEP to enroll in Medicare at any time while you have health coverage through a current employer and for eight months after you lose that insurance.

If you become eligible for COBRA coverage after you have already enrolled in Medicare, you must be allowed to take the COBRA coverage. It will always be secondary to Medicare.

Learn more about how COBRA coverage coordinates with Medicare at www.medicareinteractive.org, or call our helpline at 800-333-4114.

Spotlight

The Department of Health and Human Services (HHS) has announced a new initiative to help older adults and people with disabilities access long-term services and supports at home and in the community. HHS funding for this initiative, provided for by the Affordable Care Act (ACA), will support Aging and Disability Resource Centers (ADRCs) in almost every state. These agencies will provide counseling to people about their options for accessing long-term care that best meets their health care needs.

Read CMS’ press release.