Pre-existing conditions have been prominent in the news lately and much of the discussion includes some misunderstandings about what it actually means to protect coverage of pre-existing conditions and why it matters. While Medicare and Medicaid cover pre-existing conditions and that coverage is not under threat, there are changes in laws and regulations, and even a pending court case, that do put coverage at-risk for millions of people in the United States who are covered by employer or individual insurance. Polling consistently finds that Americans want protections for pre-existing conditions, with 75% of the public saying it’s “very important” such protections remain law. But there is a lot of confusion about what this means.
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While Medicare Advantage (MA) plans are required to cover the same health services as Original Medicare, they are not required to offer the same level of provider access and can impose coverage restrictions—like prior authorization—that require enrollees to take additional steps before accessing prescribed care. If a service is covered “with prior authorization,” enrollees must get approval from the plan prior to receiving the service. If approval is not granted or sought, the plan generally will not cover it.
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Certain threats to health care seem to arise from the dead regularly, and this Halloween season features an assortment of such zombie threats to Medicare, Medicaid, and the Affordable Care Act (ACA). As 2018 winds down, we must remain vigilant about attempts to cut or eliminate these vital programs that help older adults, people with disabilities, and their families and caregivers.
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Fall Open Enrollment is the time of year from October 15 through December 7 when you can change your Medicare coverage. You can join a new Medicare Advantage Plan or stand-alone prescription drug plan (Part D) plan. You can also switch between Original Medicare with or without a Part D plan and Medicare Advantage
Here are six things to keep in mind while you are choosing your Medicare coverage:
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Mr. L, a 71-year-old New Yorker, contacted the Medicare Rights Center because he realized he needed Medicare coverage but could not afford it. He did not enroll in Medicare when he became eligible due to the costs. Medicare Rights determined that Mr. L’s low income qualified him for a Medicare Savings Program that would pay both his Part A and B premiums; eliminate his late enrollment penalty; and pay his Medicare deductibles, coinsurances, and co-pays, providing him with the affordable coverage he needs.
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Medicare Rights continues to support efforts and advance policies that make prescription drugs more affordable and do not otherwise increase costs or reduce access to care for older adults and people with disabilities.
This summer, Medicare Rights President Joe Baker was a panelist at a Capitol Hill briefing, “Tackling Prescription Drug Prices: An Examination of Proposed Medicare Part D Reforms,” an educational event hosted by the National Coalition on Health Care to shed light on proposed reforms to Medicare Part D, identify the trade-offs involved, and explore the impacts on people with Medicare.
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The Medicare Rights Center’s educational resources include an annual series of webinars which are available to everyone through Medicare Interactive (MI), but typically attended by professionals to help them better assist their clients, patients, employees, retirees, and others navigate Medicare. The 2018 webinar series dives into specific Medicare topics, including how Medicare covers people with end-stage renal disease (ESRD) and how Medicare coordinates with job-based insurance.
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Trish Sneddon is a financial services representative and certified senior advisor at a faith-based nonprofit organization. Since she started this work in 2001, Trish has been an avid user of the Medicare Rights Center’s educational resources and has also become a monthly donor.
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The staff and volunteer counselors on the Medicare Rights Center’s National Consumer Helpline answer Medicare questions from consumers, caregivers, and professionals every day. Yet there are times when a counselor will come across a complex situation where a client needs more assistance than a helpline call can provide. That’s when Medicare Rights’ lawyers step in with their expert knowledge of Medicare rules and regulations.
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As policymakers debate next steps for expanding health insurance coverage and lowering health costs, some have introduced legislation that would broaden the role of public programs, such as Medicare and Medicaid. In light of recent characterizations of such proposals, the Kaiser Family Foundation (KFF) assessment of what these bills do (and do not do) is particularly important.
In the past two years, eight proposals were introduced, ranging from bills that would create a new national health insurance program for all U.S. residents, replacing virtually all other sources of public and private insurance (Medicaid-for-All), to more incremental approaches that would create a new public plan option, as a supplement to private sources of coverage and public programs.
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