Medicare Watch

Medicare Rights Responds to New York Times Columnist's Medicare Claim

This week, the New York Times published a response by Medicare Rights Center President Joe Baker to a recent op-ed that took aim at Medicare, branding this guaranteed health benefit as “the crucial element driving all federal spending over the next few decades.” According to Mr. Baker, the op-ed, written by columnist David Brooks, failed to acknowledge the real threat: rising costs in the health care system overall.

Mr. Baker points out in his response that Medicare spending is actually slowing faster than private health plans, due in part to the Affordable Care Act. Mr. Baker suggests that Medicare is a solution to rising health care costs, and not the “vise” squeezing the federal budget, as Mr. Brooks describes.

Read Mr. Baker’s letter to the editor.

Medicaid and Medicare Essential in Providing Long-Term Care for Older Adults

The Kaiser Family Foundation (KFF) released a new report, entitled “Medicaid’s Role in Meeting the Long-Term Care Needs of America’s Seniors,” which analyzes the extent to which seniors, especially those with low incomes, rely on Medicaid to pay for long-term care. While Medicare is the primary payer for acute services, it does not pay for long-term care. Nearly 5 million older adults require some form of long-term care assistance to complete their daily activities, and few can afford long-term care insurance. As a result, Medicaid accounted for 41 percent of long-term care spending in the United States in 2010.

According to the KFF report, only 32 percent of Medicaid enrollees used long-term care services, but they accounted for 74 percent of all Medicaid spending on the elderly in 2009. Older adults are one of the two highest-cost populations in Medicaid, second only to individuals with disabilities. KFF contends that both Medicare and Medicaid will continue to play a significant role in providing long-term care to older adults, especially as 76 million Baby Boomers continue to age in the absence of more affordable long-term care options.

Read the KFF report.

Medicare Reminder

To enroll in Medicare if you have End-Stage Renal Disease (ESRD), go to your local Social Security office. Your doctor and dialysis center will have to send documentation to Social Security verifying that you have ESRD and stating what kind of treatment you need. Call the National Social Security Hotline at 1-800-772-1213 for the office nearest you. If you are unable to enroll yourself due to illness, a family member or other responsible party can enroll for you. 

When your Medicare begins depends on your treatment plan:

• If you have been getting dialysis as an outpatient, Medicare eligibility starts on the first day of the fourth month you get renal dialysis. For example, if you begin receiving dialysis on May 10, your Medicare eligibility will start on August 1. 
• If you need dialysis and start a self-dialysis training program, Medicare begins the first day of the first month of the program. You must start the training program before your third month of dialysis. Your doctor must also state that he or she expects that you can complete the training program and will continue self-dialysis after the program ends. 
• If you receive a kidney transplant, Medicare begins with the month you are admitted to a Medicare-approved hospital for the transplant or for health care services that you need before getting the kidney transplant. 
• You must receive the transplant that same month or within the two following months. If the transplant is delayed, Medicare coverage begins two months before the month of your transplant.

Learn more about Medicare and End-Stage Renal Disease at www.medicareinteractive.org.

Spotlight

The Department of Health and Human Services recently announced that doctors and health care providers have formed 106 new Accountable Care Organizations (ACOs) in Medicare, coordinating care for as many as 4 million Medicare beneficiaries. Doctors and hospitals work together in ACOs to ensure access to high-quality care at lower costs by improving care coordination and providing services in an appropriate, safe and timely manner. Since the Affordable Care Act was passed, more than 250 ACOs have been established.

“Accountable Care Organizations save money for Medicare and deliver higher-quality care to people with Medicare,” said Secretary Kathleen Sebelius. “Thanks to the Affordable Care Act, more doctors and hospitals are working together to give people with Medicare the high-quality care they expect and deserve.”

Read the HHS press release.