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Medicare Watch

Your Weekly Medicare Consumer Advocacy Update

Advocates Seek Better Notification for Those Nearing Medicare Eligibility

December 18, 2014

44 Organizations Sign Letter Advocating Better Notification System for Those Approaching Medicare Eligibility

Last week, 44 organizations, including the Medicare Rights Center, urged the Department of Health and Human Services, the Department of Labor and the Social Security Administration to implement a system for notifying individuals approaching Medicare eligibility to inform them of their rights and obligation as they near enrollment.

The organizations asked that the agencies to ensure that all individuals nearing Medicare eligibility receive timely and complete notice about Medicare enrollment. According to the letter, such a system will ensure that fewer people new to the Medicare program are saddled with higher health care costs or go without needed health care services due to gaps in coverage and late enrollment penalties resulting from missing enrollment windows.

In particular, the letter suggests the following:

  • Provide notice about nearing Medicare eligibility to all individuals turning age 65;
  • Ensure that notices include key messages about coordination of benefits and delaying enrollment;
  • Carefully engage other messengers, including health plans, employers and states;
  • Strengthen notice for those who are auto-enrolled into Medicare; and
  • Develop notices and educational materials in additional languages and alternate formats.

Click here to read the letter.

Kaiser Family Foundation Brief Examines 2015 Medicare Advantage Plan Offerings

A recent Kaiser Family Foundation (KFF) analysis examines the coverage and premium costs of Medicare Advantage (MA) private health plans offered to Medicare beneficiaries in 2015. The MA program lets Medicare beneficiaries choose to receive their Part A (hospital), Part B (medical), and often Part D (prescription drug) coverage through a single private health plan, like an HMO or a PPO. The Affordable Care Act (ACA) makes gradual changes to the amount of money the federal government pays MA plans to provide health coverage to Medicare beneficiaries. By 2017, the ACA’s changes should mostly align MA payment levels with what it costs the federal government to provide health coverage to beneficiaries with Original Medicare.

Some industry stakeholders have expressed concern that the ACA’s changes to MA plan payment rates could place beneficiary access to MA plans at risk, while causing MA coverage and cost sharing to become less generous. The KFF analysis relies on publicly available data from the Centers for Medicare and Medicaid Services (CMS) and finds that the ACA’s adjustments to MA payment rates have not reduced access or benefits available under the MA program.  In fact, MA enrollment has grown at a steady pace since 2010, when the ACA was enacted.

In 2015, Medicare beneficiaries will have access to, on average, 18 MA plans – the same average number available in 2014. Additionally, premium amounts remain relatively steady. According to KFF, the “average beneficiary who remains in the same [MA] plan in … 2015 will pay $41 per month [in premiums], an increase of $7 per month…” KFF adds that “beneficiaries could avoid higher [MA plan] premiums by changing plans or decide that their current plan still is attractive despite the higher premium.” One hundred percent of beneficiaries in urban areas, and 97 percent of beneficiaries in rural areas will have access to one or more MA plans. In addition, the maximum out-of-pocket cost sharing – the total amount of deductibles, co-pays, or co-insurance a beneficiary must pay before the plan generally picks up the full cost of covered health care – for MA medical and hospital benefits will increase only slightly in 2015, by an average of $240.

Click here to read the KFF brief.

Volume 5, Issue 47

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Medicare Reminder

Some people do not take Part B during their Initial Enrollment Period (IEP) because they or their spouse are still working and they have primary insurance from a current employer. You should talk to your employer when you become eligible for Medicare to see how your employer insurance will work with Medicare.

Your Initial Enrollment Period begins three months before your 65th birthday and ends three months after your 65th birthday. If you or your spouse are still working and you receive health insurance from that current employer, the insurance is primary if there are 20 or more employees at the company where you or your spouse work.

If you are already collecting Social Security you will be automatically enrolled in both Medicare Part A and Part B. If you are thinking about turning down Part B, you should call the Social Security Administration at 800-772-1213 and ask if you can do so without any penalties. When you call Social Security, it is important to write down whom you spoke to, when you spoke to them and what they said.

Read more about enrolling in Part B on Medicare Interactive.



The annual Medicare Open Enrollment period ended on December 7th, but if you are a resident of western New York, you have a little more time to make changes to your coverage. The Centers for Medicare and Medicaid Services (CMS) issued a Special Enrollment Period (SEP) for those affected by the recent winter storms that caused severe flooding in the western New York regions.

If you were affected by the storm and still need to make changes to your Medicare coverage, call 1-800-Medicare and ask about the SEP. If you live in western New York and still need to help a family member select a Medicare plan, your relative may also be eligible for the SEP. Under the SEP, any coverage change will begin on the first of the month after you enroll.

Learn more at Medicare.gov.


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