Your Weekly Medicare Consumer Advocacy Update
Medicare Rights Urges Congress to Protect Funding for SHIPs
New Petition Urges Congress to Invest in Programs Vital to People with Medicare
Last month, Congress passed the Bipartisan Budget Act of 2015, agreeing to provide additional money that Congress can use to increase funding for government programs–including programs that keep people with Medicare healthy and safe in their homes and communities. But, it is up to Congress to decide how those funds are spent.
Earlier this year, the Senate Appropriations Committee proposed a drastic 42% cut —from $52 million to $30 million—to an important program for people with Medicare, the State Health Insurance Assistance Programs (SHIPs). Operating in every state, SHIPs answer questions about Medicare and help people make the most of their benefits. Now, Congressional leaders will decide if that cut happens.
Medicare Rights urges Congress to protect SHIPs from this unprecedented cut and increase funding for SHIPs and other programs that help older adults and people with disabilities.
Medicare Rights Center Submits Response to CMS Request for Information
This week, Medicare Rights submitted comments in response to a Request for Information (RFI) from the Centers for Medicare & Medicaid Services (CMS) regarding the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA replaced the previous system for Medicare payments to physicians and providers, called the Sustainable Growth Rate (SGR), with a new system that seeks to reward quality instead of simply paying for the quantity of services provided.
In order to interpret and implement MACRA, CMS sought input from stakeholders about how to fairly and effectively evaluate and pay for high value care. Medicare Rights wrote in support of the initiatives outlined in the law and in the RFI, but urged CMS to ensure that adequate beneficiary protections and monitoring are in place. The comments suggested that smaller provider practices are afforded the time and assistance needed to meet the technological requirements of new systems.
Volume 6, Issue 44
A transition refill, also known as a transition fill, is typically a one-time, 30-day supply of a drug that Medicare drug plans must cover when you’re in a new plan or when your existing plan changes its coverage. Transition fills let you get temporary coverage for drugs that aren’t on your plan’s formulary or that have restrictions on them. Transition fills aren’t for new prescriptions. Every year, Medicare drug plans may change which drugs they cover and the rules and restrictions associated with obtaining coverage for those drugs. December 7 is the last day to enroll in or change Medicare health or drug plans this year, unless you qualify for a Special Enrollment Period (SEP). Changes made by December 7 take effect on January 1, 2016.
You can only get transition fills for drugs you were already taking before switching plans or before your existing plan changed its coverage. All Medicare Part D drug plans must cover transition fills. The rules apply to both Medicare Advantage plans that include drug coverage and Medicare stand-alone drug plans. When you use your transition fill, your plan must send you a written notice within three business days. The notice will tell you that the supply was temporary and that you should either change to a covered drug or file a request with the Part D plan (called an exception request) to ask for coverage.
The Medicare Rights Center will host a free webinar, Benefits that Help You Afford Medicare Costs, on Tuesday, December 15 at 3:00 p.m. EST.
This one-hour web presentation will cover:
- Roles of federal, state and local governments in administering benefits
- Overview of Extra Help for Medicare drug costs
- Types of Medicare Savings Programs (MSPs) and benefits
- What to know about MSP enrollment and recertification
- Useful case examples illustrating how each program works
Space for this special session is limited, so please be sure to join the live event a few minutes before 3:00 p.m. Eastern Time. Every registrant will receive a recording of this webinar following the live presentation. So even if you are unable to make it the day of, go ahead and register to view the session later.