Medicare Watch

Medicare Rights Releases New Report, A Bridge to Health

This week, the Medicare Rights Center released it’s latest report, A Bridge to Health, which outlines the ways states can ensure seamless transitions to Medicare for beneficiaries who will be covered by private plans through the health insurance exchange created under the Affordable Care Act (ACA) starting in 2014.

According to the report, the ACA creates a streamlined and mostly automated eligibility determination and enrollment process for Medicaid and private plans offered through the exchanges. However, that streamlined process does not apply to people who qualify for both Medicare and Medicaid (also called “dual-eligibles”). In its report, Medicare Rights offers suggestions to states to ease the transition, which include:

• aligning financial eligibility rules across all public insurance programs and the exchange plans;
• simplifying application and renewal rules and processes across all public insurance programs and the exchange plans;
• utilizing electronic data-sharing to automatically verify eligibility and facilitate enrollment into Medicare subsidy programs as an individual becomes eligible for Medicare; and
• using education, outreach, and notices to provide accurate, understandable, and timely information about enrollment obligations, eligibility guidelines, and available benefits.

Medicare Rights also wrote a blog post summarizing the new report, which was made possible by funding from The Commonwealth Fund.

Read the full report.

Read the blog post.

Read the report coverage from The Hill.

New Law Eases Access to At-Home Infusions for Medicare Patients

President Obama recently signed a new law that would make it easier for Medicare beneficiaries with immune diseases to receive intravenous immune globulin (IVIG) infusions at home. The law, known as the Medicare IVIG Access and Strengthening Medicare and Repaying Taxpayers Act of 2012 (or Medicare IVIG Access Act), would also reform the current Medicare Secondary Payer system, thus allowing for faster reimbursements to the Medicare Trust Fund and faster claims settlements for Medicare beneficiaries.

While prior laws have allowed Medicare to cover the costs of at-home IVIG infusions, the Medicare IVIG Access Act goes a step further to also cover the materials necessary for providers to give beneficiaries the infusions at home. Before the Medicare IVIG Access Act, beneficiaries who could not afford the out-of-pocket costs of at-home infusions would need to go to a hospital to seek care. The new law creates a three-year demonstration that provides the additional Medicare Part B coverage for beneficiaries. 

Read the full text of the law.

Medicare Reminder

Medicare covers blood tests every five years to test cholesterol, lipid and triglyceride levels.

Heart disease is also referred to as cardiovascular disease. Original Medicare will pay 100% of its approved amount for these tests, even before you have met the Part B deductible. You will not pay a copay or a deductible for these screenings if you see doctors or other health care providers who take assignment. Doctors who take assignment cannot charge you more than the Medicare approved amount. You do not need to show signs of heart disease or have any particular risk factors for Medicare to cover the full cost of these tests.

If you are in a Medicare Advantage plan (private health plan) you should contact your plan to find out what rules and costs apply. Because of the Affordable Care Act, Medicare Advantage (MA) plans now cover all preventive services the same as Original Medicare. This means MA plans are not allowed to charge cost-sharing fees (coinsurances, copays or deductibles) for preventive services that Original Medicare does not charge for as long as you see in-network providers. If you see providers that are not in your plan’s network, charges will typically apply.

Learn more about other preventive care services covered by Medicare at www.medicareinteractive.org.

Spotlight

Two health policy experts from the Medicare Rights Center Board of Directors, Bruce K. Vladeck Ph.D. and Theodore R. Marmor Ph.D., recently provided their thoughts on Medicare and deficit reduction. Dr. Vladeck and Dr. Marmor discussed the best ways to find cost savings in the Medicare program, the problems associated with raising the Medicare eligibility age, and the consequences of shifting costs onto Medicare beneficiaries.

Learn more by viewing Dr. Vladeck’s and Dr. Marmor’s responses on the Deficit Reduction and Medicare page on the Medicare Rights Center website. 

Bruce C. Vladeck, Ph.D. (Chairman) is Senior Advisor to Nexera Inc., a wholly owned consulting subsidiary of the Greater New York Hospital Association. From 1993 through 1997, Dr. Vladeck was administrator of the Health Care Financing Administration (HCFA, now the Centers for Medicare & Medicaid Services), and his work there was recognized in 1995 by a National Public Service Award. Subsequent to his service at HCFA, Dr. Vladeck was appointed by President Clinton to the National Bipartisan Commission on the Future of Medicare.

Theodore R. Marmor, Ph.D., is professor emeritus at Yale University in three units: the Schools of Management and Law and the department of political science. Since 2008 he has been an adjunct professor in public policy at Harvard’s Kennedy School of Government. The former director—from 1992 to 2003—of the Robert Wood Johnson Foundation’s post-doctoral program in health policy, Professor Marmor was educated at Harvard University and Wadham College, Oxford.

Watch the video clips.