Medicare Watch

Medicare Doctor Payments on the Chopping Block

In coming days, Congress will vote on a bill that includes a provision to prevent a 21 percent cut in Medicare payments to doctors. If Congress does not act, the payment cut will take effect on June 1.

The provision, included in the American Jobs and Closing Tax Loopholes Act (H.R. 4213), will prevent the payment reduction and instead guarantee a 1.3 percent increase for the rest of 2010, followed by an additional one percent increase in 2011. Congress has taken action to stop these cuts in the past, but further action is necessary to prevent the current cuts from taking effect.

Read a statement by Medicare Rights President Joe Baker.

Write to your senators and representatives.

Medicare Rights Submits Comments on Coverage Gap Closure

Last week, the Medicare Rights Center and the Center for Medicare Advocacy submitted comments on proposed guidance for the brand-name drug discount program, which will be used to phase out the Part D coverage gap, or “doughnut hole.” The comments recommend that the Centers for Medicare & Medicaid Services (CMS) clearly communicate to Medicare consumers the details of the discount program and about how to access their drugs. The comments also call for CMS to provide extensive oversight of the administration of the discount program.

The phaseout of the coverage gap begins in 2011. Starting next year, people who enter the gap will receive a 50 percent discount on brand-name drugs automatically—without having to send in receipts or request a refund. The phaseout will be complete in 2020, at which time consumers in the coverage gap will pay 25 percent for their brand-name and generic drugs—the same share they pay before reaching the gap.

Read the comments.

Medicare Reminder

How you pay your doctor depends on your doctor and on whether he or she accepts assignment.

If your doctor accepts assignment, he or she can ask you to pay only the 20 percent coinsurance (45 percent for mental health services) up front (and your Part B deductible if you have not yet reached it—$155 in 2010).

If your doctor does NOT accept assignment, your doctor may ask you to pay the full amount for services in advance and charge you up to 15 percent more than Medicare’s approved amount under federal law. Some states have stricter limits on what your doctor can charge you.

Learn more about paying your doctor on Medicare Interactive, the Medicare Rights Center’s free online counseling tool.

 

Spotlight

In a statement last week, Medicare Rights President Joe Baker applauded innovations to fight Medicare fraud, waste and abuse, which were announced by the U.S. Department of Health and Human Services and the Department of Justice.

Read the statement.