Medicare Rights NY: Issue 27

Medicare Rights Advocacy and Education

Medicare Rights reviews integrated appeals efforts in New York

On September 19, as part of an ongoing series examining Medicare and Medicaid integration, Health Affairs Forefront published an article from the Medicare Rights Center. Titled Integrated Appeals Are Essential, But Challenges Remain, it highlights the need for states to integrate Medicare and Medicaid appeals processes to help ensure that dually eligible individuals are bolstered, not burdened, by their eligibility for both programs. 

Several states have attempted to streamline Medicare and Medicaid appeals. However, those efforts have typically focused on the first level of appeal. In 2015, as part of the Fully Integrated Duals Advantage (FIDA) demonstration, New York was the first state to align all four appeal levels. Though the FIDA program ended in 2019, many policymakers, participants, providers, and plans continue to support the single integrated appeals process. Building on this momentum, in 2020 New York launched a new three-year demonstration, preserving FIDA’s integrated grievances and appeals process within the state’s 12 Fully Integrated Dual-Eligible Special Needs Plans (FIDE SNPs). The article examines lessons learned from both FIDA and New York’s current FIDE SNPs. 

For more information, read the Health Affairs Forefront article. 

Medicare Rights provides new resource on integrated care in New York

The Medicare Rights Center has released a new flier related to integrated care coverage options for dually eligible New Yorkers. Detailing the statewide integrated care coverage landscape, the flier defines the basic types of plans, coverage criteria for each, and which options include long-term care or behavioral health benefits. It also has an up-to-date list of plans approved for default enrollment in New York. 

This flier has been added to our Coverage Options for Dually Eligible New Yorkers toolkit. The toolkit itself has been updated to keep pace with changes to the Medicare-Medicaid landscape and in response to suggestions from advocates. 

Download the flier. 

Upcoming Medicare Rights webinar on what New Yorkers need to know about Medicare Savings Program and Medicaid eligibility expansion for immigrants
  
Starting January 1, 2023, Medicare Savings Program (MSP) and Medicaid eligibility will expand for New Yorkers. People who live in New York and have a limited income may be newly eligible to receive assistance with their health care costs through these two essential programs. 

Join the Medicare Rights Center and Make the Road NY to discuss how these eligibility expansions will benefit New Yorkers age 65+, including immigrant populations.

During this online information session, the presenters will cover the following:

• How Medicare eligibility works for immigrant populations​
• Overview of Medicare Savings Program (MSP), Extra Help, and Medicaid benefits ​
• The new Medicaid coverage for immigrants age 65+
• Details about New York’s expansion of the Medicare Savings Program and Medicaid

Presented by

Giovanni Florez
Director of Enrollment & Community Engagement
Medicare Rights Center

Arline Cruz Escobar
Director of Health Programs
Make the Road NY

The webinar will also review estimated eligibility guidelines for Medicaid and the MSP and other information essential for caregivers and professionals who assist people with Medicare and Medicaid. There will also be an opportunity to ask questions. 

Register today.

New York State and Federal Government Updates

Medicare costs in 2023 

The Centers for Medicare & Medicaid Services (CMS) recently announced the standard Medicare Part A, Part B, and Part D costs for 2023. These costs include the Part B premium, Original Medicare cost-sharing amounts, and the Income-Related Monthly Adjustment Amount (IRMAA) for Parts B and D.  Among other figures, CMS announced that the Part B premium will lower from $170.10 to $164.90 per month in 2023. 

To review this and other figures, visit Medicare Interactive.

Fall Open Enrollment reminders

Fall Open Enrollment occurs each year from October 15 through December 7. During this time, beneficiaries can join a new Medicare Advantage Plan or stand-alone prescription drug (Part D) plan, or switch between Original Medicare (with or without a Part D plan) and Medicare Advantage. Any changes made during Fall Open Enrollment take effect January 1.

Now and during Fall Open Enrollment, beneficiaries should review upcoming changes to their current health and drug coverage, regardless of whether or not they are satisfied with this coverage, because much can change from year to year.  Unfortunately, as reported by the Kaiser Family Foundation, more than half of beneficiaries do not review their coverage annually, which can lead to unexpected costs and other problems.

Beneficiaries with Original Medicare should read their 2023 Medicare & You handbook to know about Medicare costs and benefits for the upcoming year. Beneficiaries enrolled in a Medicare Advantage Plan or Part D plan should receive an Annual Notice of Change (ANOC) or Evidence of Coverage (EOC) from their plan. These notices detail any changes in the plan’s costs, benefits, and rules for the upcoming year. Even if a beneficiary has had no issue with their plan in the past year, keep an eye out for these letters to be aware of how the plan might change in the coming year.

Beneficiaries with Extra Help should also be aware that they will use Fall Open Enrollment if they want to make any coverage changes between October 1 and December 31. Any changes made will take effect January 1. This is because the Extra Help Special Enrollment Period (SEP)  is only for the first three calendar quarters of the year. As always, beneficiaries interested in Extra Help or other low-income programs can apply at any time, including during Fall Open Enrollment.

To help beneficiaries and professionals navigate Fall Open Enrollment, Medicare Rights recently hosted a webinar on Fall Open Enrollment and Medicare Reminders for 2023.

Sign up for the webinar recording.  

Inflation Reduction Act signed into law

The Medicare Rights Center thanks President Biden for signing—and the House and Senate for passing—the Inflation Reduction Act (IRA) of 2022. This landmark legislation includes policies we have long championed to make health care and prescription drugs more affordable.

Reforms introduced by the IRA include establishing a hard cap on prescription drug costs for people with Medicare, simplifying and expanding access to Extra Help for people with limited incomes and assets, and further modernizing the program. This will directly ease financial burdens on millions of enrollees while making choosing a Part D plan more straightforward.

To learn more about the Inflation Reduction Act or for more information about the IRA’s provisions for future years, please visit Medicare Rights’ blog.