Medicare Watch

Medicare Rights Releases Report on How to Improve Access to Medication under Medicare Part D

Today, the Medicare Rights Center released a report on how to streamline the Medicare Part D appeals process for older adults and people with disabilities. The report, Medicare Facts and Faces: Refused at the Pharmacy Counter—How to Improve Medicare Part D Appeals, examines challenges faced by Medicare beneficiaries refused prescribed medications at the pharmacy counter and offers the following key recommendations:

• Add individually tailored language to the standard appeal notice that pharmacies will soon be required to deliver. In addition to the plan contact information, including phone and online access, and clear guidance on the next steps in the appeals process, the denial notice should include a clear explanation of the reason a drug is denied coverage. 
   
• Initiate the appeal at the pharmacy counter. The Centers for Medicare & Medicaid Services (CMS) should explicitly require Medicare Part D plans to treat the point-of-sale refusal as the initial coverage determination, at which time the beneficiary has the option to automatically initiate the appeals process.

Each year, the Medicare Rights Center receives thousands of calls from people with Medicare, their caregivers and service providers looking for help with Medicare appeals and coverage issues. In most cases, a beneficiary first learns that they will have difficulty obtaining their medication when they attempt to fill a prescription and are refused at the pharmacy counter. From there, the responsibility falls entirely on the beneficiary to determine how to obtain needed medication. The current process can delay a beneficiary’s access to needed medications, if they are able to access the medication at all. As noted in the report, beneficiaries must be equipped with the right information at the right time and minimize the steps required to appeal a plan’s denial.

Read the report.

Public Opinion Divided on Raising Medicare Eligibility Age

Public opinion on the proposal to raise the Medicare age of eligibility has been more divided in recent years, according to a Kaiser Family Foundation (KFF) analysis of polling results between 1995 and 2013. KFF surveys from 1995 through 2008 reveal that a clear majority of Americans opposed raising the Medicare age of eligibility. In 2009, the gap in opinion began to narrow. In fact, in KFF surveys conducted in 2011, 2012 and 2013, there was no clear majority of Americans in favor of raising the Medicare eligibility age or opposed to it. In KFF’s most recent survey, Americans are divided: 51 percent are opposed to raising the eligibility age and 48 percent are supportive.

KFF found that there is some room to shift public opinion either for or against the proposal. In its most recent survey, individuals were presented with counterarguments that challenged their initial positions. Among those who were initially opposed to raising the eligibility age, three in ten were more likely to be in favor of the proposal after hearing the counterargument that raising the eligibility age would help preserve the Medicare program and save the federal government money. Similarly, just over half of the respondents who were initially supportive of raising the Medicare eligibility age said they would be more likely to oppose the proposal after hearing that healthcare costs would increase for employers and those near retirement age as a result.

Raising the Medicare eligibility age from 65 to 67 would save the federal government money by shifting costs to older adults and employers. According to the Center on Budget and Policy Priorities, this change would increase total health care costs, as costs to consumers would be twice as large as any net federal savings.

Read the KFF analysis.

Read the CBPP blog post.

Medicare Reminder

Today is the last day for Medicare beneficiaries who are dissatisfied with their Medicare private health plans, also known as Medicare Advantage (MA) plans, to disenroll. Beneficiaries have had the opportunity to drop their private plan and enroll in Original Medicare since January 1, when the Medicare Advantage Disenrollment Period (MADP) began. After the MADP, most people with Medicare will be unable to make another change to their health coverage until the Fall Open Enrollment Period, which begins on October 15, 2013.

If you have an MA plan, you will be able to switch to Original Medicare with or without a stand-alone prescription drug plan. Changes made during this period will become effective the first of the following month. For example, if you switched from an MA plan to Original Medicare and a stand-alone prescription drug plan in February, your new coverage would begin March 1.

If you are enrolled in a PFFS plan with a stand-alone drug plan, you must keep your stand-alone prescription drug plan if you switch to Original Medicare during the MADP.

If you disenroll from your MA plan, federal law does not usually give you the right to buy a Medigap plan. The laws in your state might give you more rights. Medigap plans are supplemental polices that help pay for Original Medicare deductibles and coinsurances. You should check with your SHIP (State Health Insurance Assistance Program) to find out if and when you can enroll in a Medigap plan in your state.

Learn more about changing your Medicare private health plan at www.medicareinteractive.org.

Spotlight

The Medicare Rights Center released the first video in its web series, Paying More for Less—Medicare and the Deficit Reduction Debate. For almost 50 years, Medicare has ensured guaranteed health care benefits for older adults and people with disabilities. Today, many policymakers are looking at ways to save money in Medicare in order to reduce the national deficit. Unfortunately, the most discussed proposals achieve savings by shifting costs to people with Medicare.

The first video in our web series explains why policymakers are looking for Medicare savings. Future videos in the series will focus on the impact of individual Medicare proposals and  introduce ways to save money in the Medicare program by addressing the real spending problem--rising costs in the health care system overall.

Watch the video.