Medicare Watch

Kaiser Releases Report on Geographic Differences Among Dual Eligible Populations

Twenty-six states are actively developing proposals for a federal demonstration program to integrate Medicare and Medicaid services for people enrolled in both programs (dual eligibles). According to a new report from the Kaiser Family Foundation (KFF), titled “Geographic Variation in Dual Eligible Enrollment,” there is significant variation across states—and even across counties within states—in the role that dually eligible individuals play in their state Medicaid programs.

According to the report, an analysis of dual eligible enrollment may prove helpful for policymakers. Dual eligibles are among the poorest and sickest individuals covered by Medicare or Medicaid. As states develop new proposals to improve care coordination and quality for this population, and to reduce state expenditures, information about the geographic distribution of dual eligibles could help policymakers target areas with a high percentage of these beneficiaries and ensure that duals benefit from new initiatives.

The KFF report finds that compared to states in the Midwest and the West, states in the East, which generally have older populations, also have a higher percentage of Medicaid enrollees who are dual eligibles. However, states with a lower share of Medicaid beneficiaries who are dual eligibles may in fact have a higher number of duals overall, since these states—including California and Illinois—have larger total populations. At the county level, the report finds that substantial geographic variation exists even within states. In many counties across the United States, over 30 percent of Medicaid enrollees are also Medicare beneficiaries, more than twice the average for the nation. Furthermore, in certain rural counties, more than half of Medicaid enrollees are also enrolled in Medicare.

Read the KFF report, “Geographic Variation in Dual Eligible Enrollment.”

Medicare Rights Releases New Video on Doughnut Hole

To help Medicare beneficiaries understand how the Affordable Care Act (ACA) has lowered their prescription drug costs in the Part D coverage gap, or doughnut hole, the Medicare Rights Center has created a short video, “The Doughnut Hole in 2012.” The video discusses how the ACA is gradually closing the doughnut hole. In 2012, beneficiaries receive a 50 percent discount on brand-name medications and a 14 percent discount on generics in the coverage gap, as long as those drugs are on their Part D plan’s formulary, or list of covered drugs. These discounts will increase until 2020, at which point the doughnut hole will close completely. Beneficiaries will then pay no more than 25 percent of the cost of a drug at any point during the year.

Last week, the Centers for Medicare and Medicaid Services (CMS) announced that in the first four months of 2012 alone, Medicare beneficiaries received discounts averaging $724 each on prescription drug costs in the coverage gap, for a total of $301.5 million in savings. Since the passage of the ACA in March 2010, more than 5.1 million people with Medicare have saved $3.5 billion as a result of the law’s closure of the doughnut hole.

And earlier this month, the U.S. Senate defeated the 2013 budget approved by the House of Representatives, which was passed mostly along party lines in March. The budget would have re-opened the doughnut hole, significantly increasing out-of-pocket expenses for current and future Medicare beneficiaries with high drug costs.

Visit Medicare Rights’ Facebook page to watch the video, “The Doughnut Hole in 2012.”

Read CMS’ press release about savings on prescription drugs as a result of the ACA.

Read Families USA’s report on how the House budget would impact Medicare.

Medicare Reminder

Medicare will not generally pay for routine eye care. However, Medicare may pay for eye care services under certain conditions. For instance, Medicare will cover:

-Surgical procedures to help repair the function of the eye due to a chronic eye condition, such as cataracts or glaucoma.

- Eyeglasses or contacts only if you have had cataract surgery during which an intraocular lens was placed into your eye.

- An eye exam to diagnose potential vision problems. If you are having vision problems that indicate a serious eye condition, Medicare will pay for an exam to determine the problem, even if it turns out there is nothing wrong with your sight.

Medicare will only pay for routine eye care under the following specific circumstances:

-If you have diabetes, Medicare will pay for an eye exam once every 12 months to check for eye disease.

-If you are at high risk for glaucoma, Medicare will cover an eye exam once every 12 months. The exam must be performed or supervised by an eye doctor who is licensed to provide this service in your state. You are considered to be at high risk if you have diabetes, have a family history of glaucoma, are African-American and aged 50 or older, or are Hispanic and aged 65 or older.

Learn more about Medicare coverage of eye care at www.medicareinteractive.org, or call our helpline at 800-333-4114.

Spotlight

Yesterday, the Centers for Medicare and Medicaid Services (CMS) announced its initiative to ensure proper antipsychotic drug use for nursing home residents, in an effort to improve overall dementia care. CMS’ Partnership to Improve Dementia Care aims to reduce antipsychotic drug use in nursing homes by 15 percent by the end of the year. The Partnership seeks to provide alternatives to antipsychotic medications for nursing home residents, increase availability of data on antipsychotic drug use in long-term care settings, and enhance training for nursing home staff.

Read CMS’ press release about the Partnership to Improve Dementia Care.

Read testimony to the U.S. Senate about over-utilization of antipsychotics in long-term care settings.