Final Rule Codifies Observation Stay Appeal Rights
October 17, 2024
Late last week, the Centers for Medicare & Medicaid Services (CMS) finalized a rule that codifies appeal rights for people
Celebrating 35 years of making Medicare more accessible, affordable, and equitable!
Denials and Appeals
Largely driven by prior authorization, MA and Part D coverage denials leave beneficiaries with only bad options: paying out-of-pocket, going without, or getting embroiled in a daunting and deeply flawed appeals process. Each path can lead to delayed care, abandoned therapies, worse health, and higher costs. Particularly egregious are improper coverage denials, which force people to make this choice unnecessarily. Changes are long overdue. Harmful denials must be curbed, and the appeals systems must be reformed to function as a safety valve—rather than as an inadequate substitute for sound plan decisions and robust federal oversight.
Medicare Advantage Denials Increased Before the Implementation of New Prior Authorization Rules
September 26, 2024
KFF recently analyzed Medicare Advantage (MA) data on prior authorization, finding that the rates of requests, or submissions from providers
Final Rules on Medicare Advantage Prior Authorization Offer Improvements, but More Change is Needed
May 30, 2024
Prior authorization is one of the processes Medicare Advantage and other private insurance companies use to manage health care utilization
Study Shows Part D Plans Ratcheting Up Restrictions on Coverage
March 14, 2024
A new study from University of Southern California (USC) researchers shows that Medicare Part D plans have been increasingly restricting
Coverage Experiences Vary for Original Medicare and Medicare Advantage Enrollees
February 29, 2024
A recent survey from the Commonwealth Fund asked people with Original Medicare (OM) and Medicare Advantage (MA) about their experiences
Denied Insurance Claims Cause Issues for People with All Forms of Health Coverage
October 19, 2023
A new survey from KFF highlights problems people have using their health insurance, with 60% of insured adults reporting that
Medicare Rights’ Helpline Trends Report Shows Increasing Need for Help Affording Care
October 5, 2023
This week, we at Medicare Rights released our annual Medicare Trends Report, which features key challenges facing people with Medicare
2022 Medicare Trends and Recommendations
October 3, 2023
In 2022, Medicare Rights staff and volunteers addressed more than 27,000 questions through its national helpline and professional email channels. Additionally, Medicare Rights’ free and independent online reference tool, Medicare Interactive (MI), provided more than 2.6 million answers for beneficiaries, their caregivers, and professionals. This report features the top helpline trends and highlights the most commonly sought helpline and Medicare Interactive answers, providing a glimpse into the various questions and needs of Medicare beneficiaries, caregivers, and the professionals assisting them in the community in 2022.
Interoperability and Prior Authorization Proposed Rule
March 13, 2023
The Medicare Rights Center (Medicare Rights) appreciates this opportunity to comment on the Advancing Interoperability and Improving Prior Authorization Processes proposed rule.
Prior authorization is creating an ever-increasing burden on patients. We support many of the Centers for Medicare & Medicaid Services (CMS) provisions in this proposed rule that would reduce this burden by improving processes, timelines, access to information, and communication.
Medicare Part D Appeals Problems and Options to Correct Them
March 1, 2023
The Medicare Part D appeals process is an essential safety valve, allowing access to needed prescription medications—such as those that are not on the plan’s formulary, or are subject to high cost sharing, when formulary or lower cost alternatives are not appropriate. However, Part D enrollees often struggle to successfully navigate this overly complex, multi-step, process, and it can also prove burdensome for pharmacists, plans, and prescribing physicians. This can result in delayed access to needed prescriptions, abandonment of prescribed medications, reduced adherence to treatment protocols, worse health outcomes, and higher costs for the patient and the Medicare program.
Final Rule Codifies Observation Stay Appeal Rights
October 17, 2024
Late last week, the Centers for Medicare & Medicaid Services (CMS) finalized a rule that codifies appeal rights for people
Medicare Advantage Denials Increased Before the Implementation of New Prior Authorization Rules
September 26, 2024
KFF recently analyzed Medicare Advantage (MA) data on prior authorization, finding that the rates of requests, or submissions from providers
Final Rules on Medicare Advantage Prior Authorization Offer Improvements, but More Change is Needed
May 30, 2024
Prior authorization is one of the processes Medicare Advantage and other private insurance companies use to manage health care utilization
Study Shows Part D Plans Ratcheting Up Restrictions on Coverage
March 14, 2024
A new study from University of Southern California (USC) researchers shows that Medicare Part D plans have been increasingly restricting
Coverage Experiences Vary for Original Medicare and Medicare Advantage Enrollees
February 29, 2024
A recent survey from the Commonwealth Fund asked people with Original Medicare (OM) and Medicare Advantage (MA) about their experiences
Denied Insurance Claims Cause Issues for People with All Forms of Health Coverage
October 19, 2023
A new survey from KFF highlights problems people have using their health insurance, with 60% of insured adults reporting that
Medicare Rights’ Helpline Trends Report Shows Increasing Need for Help Affording Care
October 5, 2023
This week, we at Medicare Rights released our annual Medicare Trends Report, which features key challenges facing people with Medicare
2022 Medicare Trends and Recommendations
October 3, 2023
In 2022, Medicare Rights staff and volunteers addressed more than 27,000 questions through its national helpline and professional email channels. Additionally, Medicare Rights’ free and independent online reference tool, Medicare Interactive (MI), provided more than 2.6 million answers for beneficiaries, their caregivers, and professionals. This report features the top helpline trends and highlights the most commonly sought helpline and Medicare Interactive answers, providing a glimpse into the various questions and needs of Medicare beneficiaries, caregivers, and the professionals assisting them in the community in 2022.
Interoperability and Prior Authorization Proposed Rule
March 13, 2023
The Medicare Rights Center (Medicare Rights) appreciates this opportunity to comment on the Advancing Interoperability and Improving Prior Authorization Processes proposed rule.
Prior authorization is creating an ever-increasing burden on patients. We support many of the Centers for Medicare & Medicaid Services (CMS) provisions in this proposed rule that would reduce this burden by improving processes, timelines, access to information, and communication.
Medicare Part D Appeals Problems and Options to Correct Them
March 1, 2023
The Medicare Part D appeals process is an essential safety valve, allowing access to needed prescription medications—such as those that are not on the plan’s formulary, or are subject to high cost sharing, when formulary or lower cost alternatives are not appropriate. However, Part D enrollees often struggle to successfully navigate this overly complex, multi-step, process, and it can also prove burdensome for pharmacists, plans, and prescribing physicians. This can result in delayed access to needed prescriptions, abandonment of prescribed medications, reduced adherence to treatment protocols, worse health outcomes, and higher costs for the patient and the Medicare program.