Medicare Watch

Getting the Care We Need

People with multiple medical conditions often have a hard time getting the information they need from their doctors, and getting doctors to cooperate with one another to make sure the care they receive improves their health. The health reform legislation signed into law last month will help by improving Medicare coverage of preventive services and prescription drugs, and by ensuring that those not yet eligible for Medicare will not be denied coverage because of a pre-existing condition.

But it will take a sustained effort by consumers to ensure the promise of health reform is fulfilled and the care that people need improves. That is why the Medicare Rights Center has joined the Campaign for Better Care, a consumer-led coalition launched today.

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The Campaign for Better Care is working to improve the health care system so that it provides comprehensive, coordinated, patient- and family-centered care. For older adults with Medicare, that means they receive the care planning, geriatric assessment and medication management they need. It means health information technology provides doctors the information they need to assess their patients’ conditions and determine the best course of treatment. It means medical providers, especially primary care doctors, are paid to coordinate care, discuss treatment options with their patients and deliver care that improves their patients’ health. Learn more about the Campaign for Better Care.

New Regulations for Private Medicare Plans

New regulations issued this week will require all Medicare private health plans to limit, starting in 2011, the amount plan members spend on deductibles and copayments for medical care over the course of the year. In addition, the Centers for Medicare & Medicaid Services (CMS) will continue policies that encourage plans to voluntarily include a lower annual out-of-pocket limit in benefit packages. About one-third of Medicare private health plan members are now enrolled in plans that have such a limit—the maximum for 2010 is set at $3,400. CMS will issue guidance that sets maximum levels for both the mandatory and the lower voluntary out-of-pocket limit in the coming weeks.

Read Medicare Rights Center President Joe Baker’s statement on the new regulation.

Read a summary of the new regulation.

Dear Marci,

My father is currently in the hospital, and I think he is being asked to leave before he is ready. Is there anything I can do?

—Albert (Boulder City, NV)

Dear Albert,

If you feel your father is being asked to leave the hospital (discharged) before he is well enough to go, you can ask for an immediate (expedited), independent review of your case. When you are going to be discharged, the hospital must provide you with a noticed called an “Important Message from Medicare,” which will tell you how to contact the Quality Improvement Organization (QIO) to get an expedited review. You must contact the QIO by midnight on the date you are being discharged (and before you leave the hospital).

Visit www.medicareinteractive.org to learn more about hospital discharge and to view an early discharge appeal chart.

The excerpt above is adapted from Dear Marci, our weekly newsletter for consumers. Sign up for Dear Marci.

 

Spotlight

The implementation phase of health care reform will be long and complex. To help readers understand the many different parts of reform and how they will be implemented, the Washington Post compiled a list of online resources. The Medicare Rights Center’s website was included in that list. Read the article.