Medicare Watch

Consumer Advocates Submit Testimony on Medicare Redesign Proposals

This week, the Medicare Rights Center, California Health Advocates and the Center for Medicare Advocacy, Inc. submitted joint testimony to the U.S. House of Representatives Subcommittee on Health of the Committee on Ways and Means. Responding to the Subcommittee’s recent hearing examining traditional Medicare’s benefit design, the testimony focused on how the most discussed Medicare redesign proposals would increase out-of-pocket costs for people with Medicare and discourage beneficiaries from seeking necessary health care services.

On average, people with Medicare have lower household budgets ($30,800 vs. $49,600 respectively) and spend three times more on health care than the non-Medicare households. Yet, many notable Medicare redesign proposals shift additional costs to beneficiaries. The National Association of Insurance Commissioners, MedPAC and the Congressional Budget Office acknowledge that increased cost-sharing may lead beneficiaries to forego necessary health care, which adversely affects their health and leads to increased health care costs overall. Instead of shifting additional costs to older adults and people with disabilities, Medicare Rights, California Health Advocates and the Center for Medicare Advocacy, Inc. propose reducing wasteful spending in the Medicare program and advancing delivery system reforms in the Affordable Care Act that are intended to enhance the quality of health care while simultaneously driving down costs.

Read the joint testimony.

Medicare Rights and the Center for Medicare Advocacy Weigh in on Physician Reimbursement Reform

Joe Baker, Medicare Rights Center President, and Judith Stein, Executive Director of the Center for Medicare Advocacy, Inc., recently wrote a letter to the ranking members of the U.S. House Committee on Ways & Means and House Committee on Energy & Commerce regarding a proposed framework to repeal and replace the Sustainable Growth Rate (SGR) formula for physician reimbursements. For the past decade, the so-called “doc fix” has been annually approved to avert substantial cuts demanded by the SGR formula. This year-to-year dynamic instills uncertainty in both physicians, who are unsure of what they will get paid, as well as patients, who worry about maintaining access to their doctor of choice. 

The letter supports a plan to repeal and replace the SGR formula with a new payment structure that gradually moves from a volume-based to a value-based model of reimbursement. In addition, the letter urges Congress to adopt the following standards:

1. Protect Medicare beneficiaries from cost-shifting, which would most negatively impact the beneficiaries who can least afford to pay more.
2. Extend permanent fixes to critical Medicare benefits. Repeal the annual Medicare therapy caps. If this can’t be done, the exceptions process for those who reach the cap should be made permanent. In addition, Congress must make permanent the Qualified Individual (QI) program.
3. Involve the beneficiary community. Ensure people with Medicare, family caregivers and their advocates have a voice in the decision process.
4. Strengthen primary care. Update payment levels for primary care, care coordination and preventive services.
5. Ensure rigorous oversight and management. Look to independent entities, rather than relying solely on medical societies, to appropriately evaluate tested delivery system and payment reforms.

Read the letter.

Medicare Reminder

Medicare will not cover dental care that you need primarily for the health of your teeth. For example, Medicare will not cover routine checkups, cleanings or pay for you to get fillings. Medicare will never pay for dentures. Even if Medicare has paid for you to have a teeth pulled (extracted) as preparation for a medical procedure, you will be responsible for the cost of your dentures.

However, Medicare will cover some dental services if they are required to protect your general health, or you need dental care in order for another health service that Medicare covers to be successful.

Some Medicare private health plans cover routine dental services. If you have a Medicare private health plan, check with your plan to see what dental services may be covered.

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

Spotlight

The Huffington Post recently published a blog post by Joe Baker, Medicare Rights Center President, entitled, “Three Reasons Why Medicare Cost-Shifting Is the Wrong Solution.” The post provides three reasons for saving costs in Medicare instead of shifting costs to Medicare beneficiaries. During talks of deficit reduction, policymakers must weigh all costs when contemplating changes to the Medicare program—both for the economy and for people with Medicare.

Read “Three Reasons Why Medicare Cost-Shifting Is the Wrong Solution”