Your Weekly Medicare Consumer Advocacy Update
Advocates Brief House on Medicare and the Windsor Decision
Medicare Rights Participates in House Briefing on Medicare and the Windsor Decision
In June 2013, the Supreme Court issued a landmark decision in United States v Windsor, which declared parts of the Defense of Marriage Act (DOMA) unconstitutional. Since then, certain same-sex couples gained increased access to federal and state benefits. Last week, Stacy Sanders, Federal Policy Director at the Medicare Rights Center, participated in a briefing sponsored by the House Seniors Taskforce and the LGBT Equality Caucus on Social Security and Medicare benefits available to same-sex couples after the Windsor decision. The briefing panel also featured representatives from the Social Security Administration, Services for Advocacy and GLTB Elders (SAGE) and the National Committee to Preserve Social Security and Medicare.
At the briefing, Ms. Sanders reviewed the benefits available to certain same-sex couples under Medicare since the federal government—and certain state governments—now recognize same-sex marriages. For example, in states where same-sex marriage is recognized, same-sex married couples may now be able to use their spouse’s work history when determining eligibility for premium-free Part A benefits. Federally, same-sex married couples are able to delay enrollment into Medicare without penalty if they are covered by their or their spouse’s current employer insurance. Ms. Sanders cautioned, however, that having the ability to delay Medicare enrollment does not necessarily mean that a person should delay.
In closing, Ms. Sanders stressed the importance of connecting same-sex couples to counselors, like those on the Medicare Rights helpline, who can help explain new Medicare benefits and policies after the Windsor decision, and she directed the audience to policy resources available on www.ssa.gov, the Social Security Administration homepage.
CMS Finds That ACOs Successfully Improve Quality of Care for People with Medicare
This week, the Centers for Medicare & Medicaid Services (CMS) released an update on key Medicare delivery system reforms, looking at quality and financial performance results for various Accountable Care Organization (ACO) initiatives. ACOs are groups of doctors, hospitals and other health care providers who work together to provide coordinated care to people with Medicare. ACOs are meant to save money in the health care system by both streamlining care and preventing medical errors and unnecessary duplication of services.
In its findings on Medicare Shared Savings Program ACOs, CMS reports that 53 ACOs were able to hold spending about $652 million below their targets. These ACOs earned a share of program savings equaling more than $300 million in performance payments. Additionally, health care costs of 52 other ACOs came in under their target, but they did not meet the minimum savings required to qualify for shared savings. At the same time, shared savings ACOs were able to improve on 30 of the 33 quality measures used to score quality of care, including ratings from patients on clinicians’ communication, ratings of their doctors, and on screenings, such as for blood pressure and tobacco use.
In addition to the findings of Shared Savings Program ACOs, positive results for the Pioneer ACO Model were also released. The Pioneer Model, an ACO designed for experienced organizations that are prepared to take on more financial risk, reported savings of about $41 million for the Medicare Trust Fund in the second performance year. These ACOs also achieved 1.4 percent growth in spending per beneficiary for the Medicare program—about 0.45 lower than in Medicare fee-for-service. Improvements were also documented for 28 of the 33 quality measures.
Volume 5, Issue 36
Medicare Part B will cover equipment that you use in the home if it qualifies as durable medical equipment (DME). DME is equipment that is:
- Durable, meaning you can use it again;
- Designed to help a medical condition or injury;
- Suitable to use in the home (although you can also use them outside the home); and
- Likely to last for 3 years or more.
Some examples of DME covered by Medicare are walkers, crutches, wheelchairs, power scooters, seat lifts, hospital beds, home oxygen equipment, diabetes self-testing equipment, and certain nebulizers. For Original Medicare or your Medicare Advantage plan to cover your DME, you must get a doctor’s prescription and must receive the DME from an approved supplier.
On October 20, Medicare Rights will celebrate its 25th Anniversary at its annual awards dinner in New York City. The honorees this year include Senator John D. Rockefeller IV, Congressman John D. Dingell and Congressman Henry A. Waxman, as well as Pat Wang, the Chief Executive Officer at Healthfirst.
If you are in the area and would like to attend, visit www.medicarerights.org/about-us/awards-dinner to register.
If you are unable to attend, you can still help celebrate by visiting the 25th anniversary celebration page and leaving a birthday wish! http://www.medicarerights.org/25th-anniversary/