Medicare Watch

Medicare Rights Compiles "Five Medicare Questions for Candidates"

By tonight, both the Republican and Democratic Parties will have nominated their presidential and vice presidential candidates for the upcoming November election. Medicare has figured into convention speeches by both parties, as the program remains in the spotlight of current deficit-reduction debates. These budget discussions have serious implications for Medicare, and recent proposals, including the model put forth by Congressman Paul Ryan, now the Republican vice presidential candidate, would lower the deficit only by shifting costs to people with Medicare. Do your representatives have a plan for Medicare? How will that plan affect your health and economic security?

To help you—current and future Medicare beneficiaries—understand policymakers’ positions on the Medicare program, the Medicare Rights Center compiled “Five Medicare Questions for Candidates.” You can direct these questions at presidential, congressional and senatorial candidates to inquire how the policies they support will affect Medicare beneficiaries. Many of the questions focus on the future of the Medicare program and the benefits and coverage that will be available to people with Medicare.

Some proposals currently under consideration would save the government money by increasing out-of-pocket health care expenses for older adults and people with disabilities. For example, the aforementioned Ryan plan would convert Medicare into a premium support, or voucher, system, under which beneficiaries would receive a defined contribution from the government to buy health coverage. This voucher would likely not keep pace with rising health care costs. As a result, over time, the voucher would be insufficient to purchase coverage that provides the same health security Medicare offers today.

“Five Medicare Questions for Candidates” also focuses on how candidates plan to improve the program, for example by reducing the cost of coverage for beneficiaries. People with Medicare already spend 15 percent of their household incomes on health care, five times as much as non-Medicare households. Moreover, half of all people with Medicare have annual incomes of less than $22,000. They cannot afford to pay more for their health care. Estimates suggest that under the Ryan plan people with Medicare would spend thousands more per year in health care costs.

“We encourage everyone to ask tough questions of those who hold the future of Medicare—and therefore of our health and retirement security—in their hands,” says Joe Baker, president of Medicare Rights. “It is important to know how prospective lawmakers intend to change programs that millions of people depend on.”

Read the “Five Medicare Questions for Candidates.”

Massachusetts Moves Ahead on Duals Demonstration

The Medicare Rights Center continues its advocacy on the implementation of state demonstrations designed to test managed care models for dual eligibles, or beneficiaries enrolled in both Medicare and Medicaid. The Centers for Medicare & Medicaid Services (CMS) and the state of Massachusetts recently released a Memorandum of Understanding (MOU) outlining details related to the state’s demonstration program. The MOU is essentially a statement of principles that CMS and Massachusetts agree will guide the development, implementation and evaluation of the state’s demonstration. The MOU touches on several core aspects of the program, including:

• Basics about the managed care, capitated payment model being tested
• Information about passive enrollment and the role of an independent broker
• Assurances for care continuity
• Basics about care coordination
• Standards for network adequacy
• An initial framework for an integrated appeals process.

Starting April 2013, Massachusetts will be among the first states to begin enrolling individuals in its duals managed care demonstration. Careful review of the Massachusetts MOU by advocates is critical, given that this document will serve as a model for MOUs with other states. While the MOU lays the groundwork for many aspects of the Massachusetts demonstration, many of the details that will affect the beneficiary experience have yet to be articulated. The MOU indicates that a number of these details will be determined through three-way contracts between CMS, the state and the participating managed care plans.

Along with national and state partners, Medicare Rights will continue to monitor the development of future state MOUs and the implementation of the state demos. In addition, we will continue our advocacy efforts in New York State and federally, working with fellow advocates, state administrators and CMS to help make the duals demonstrations a success.

Read the Massachusettes MOU.

Read a summary of the Massachusettes MOU from the National Senior Citizens Law Center.

Read regular updates about the duals demos from the National Senior Citizens Law Center.

Read Medicare Rights’ recent testimony on duals.

Medicare Reminder

If you are enrolled in a Medicare private drug plan but cannot afford your medications—whether or not you have Extra Help (the federal program that lowers costs associated with the Medicare drug benefit) or get help from a state pharmaceutical assistance program—there are a few options that might help.

• Ask your doctor:
• About generics. Generic drugs are almost always less expensive than brand-name drugs.
• For samples of your medication. This is a temporary solution, however.
• Find out if your drug plan has a mail-order option. You may be able to get a 90-day supply of your prescription for the same amount of money that you would normally pay for a one-month supply.
• Request that your plan put your drug in a lower "cost tier" for you. To do so, you will have to have your doctor submit a formal request to your plan to ask for an "exception." Be aware that you cannot ask for a "tier exception" when the drug you need is in a "specialty tier" (often the most expensive drugs) or when you want to access a brand-name drug at the same copay tier as a generic drug.
• Some pharmacies and hospitals will waive copays for people with low incomes.
• Some states offer pharmaceutical assistance programs that help their members pay the out-of-pocket costs of a Medicare private drug plan.
• Some pharmaceutical companies have Patient Assistance Programs (PAPs) that offer low-cost or free drugs to people with low incomes. While many PAPs will not accept people with Part D, some do.

Learn more about options to lower your prescription drug costs at www.medicareinteractive.org, or call our helpline at 800-333-4114.

Spotlight

Recently, the Centers for Medicare & Medicaid Services (CMS) announced the redesign of its beneficiary-directed website, www.medicare.gov. In an effort to provide better service to consumers, the new site seeks to make content more accessible and easier to understand for people with Medicare, their families and caregivers.

Many of the new features allow users to find what they are looking for directly from the home page: beneficiaries can now search to find out if a particular test, item or service is covered under Original Medicare; the site provides information tailored to a person’s specific coverage situation; and beneficiaries now have access to links that help them replace a lost Medicare card, find a new stand-alone prescription drug plan or Medicare private health plan, also known as a Medicare Advantage plan, or locate resources that can assist them in paying their health care costs.

Visit www.medicare.gov to use the new features and find additional information about your Medicare coverage.

Read CMS’ press release.