Your Weekly Medicare Consumer Advocacy Update
Medicare Rights Expresses Support for Bidding Program
Medicare Rights Submits Letter of Support for DMEPOS Competitive Bidding Program
This week, the Medicare Rights Center submitted a letter to the House Ways and Means Committee expressing support for the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) Competitive Bidding Program. According to the letter, “the DMEPOS bidding program represents an important advancement in how Medicare pays for medical equipment and services. The program serves a triple aim, contributing to lower costs for older adults and people with disabilities, the right prices for Medicare, and a better deal for American taxpayers.”
Through the bidding program, medical equipment suppliers compete for Medicare’s business on the basis of quality and price, submitting bids to serve beneficiaries in a specified region. Some claim the bidding program creates undue barriers to accessing needed medical equipment and supplies; however, an initial report by the Government Accountability Office (GAO) determined beneficiary access and satisfaction were not affected by the bidding program in 2011, though careful monitoring was needed as the program expanded. Similar findings were also reported in 2012 through a subsequent GAO analysis.
This is reflective of the trends heard on Medicare Rights’ national helpline. The most common calls to the helpline involve questions about coverage rules and concerns about denials of coverage, and none of these inquiries are unique to the DMEPOS bidding program. The same questions and concerns are heard from those with Traditional Medicare in bidding areas, those in non-bidding areas, and among Medicare Advantage enrollees. Medicare Rights believes these trends reflect a general need for enhanced oversight of suppliers and education of beneficiaries across all Medicare coverage types.
Ultimately, Medicare Rights continues to support the DMEPOS bidding program, which is credited with creating sizable savings for the Medicare program, for beneficiaries, and for taxpayers—without compromising access to needed care. Rigorous oversight of the program, most notably of suppliers, should continue and be strengthened as necessary.
Administration on Aging Releases a Profile of Older Americans in 2014
The Administration on Aging, part of the Administration on Community Living, recently released a statistical profile of older Americans. Drawing from the U.S. Census Bureau, the National Center for Health Statistics, and the Bureau of Labor Statistics, the report gives information about older Americans across a number of fields, ranging from racial and ethnic composition, to healthcare and insurance.
Some data points include:
- The population age 65 and over numbered 44.7 million in 2013, an increase of 8.8 million since 2003.
- About one in every seven Americans is an older American.
- In 2013, 21.2% of persons 65+ were members of racial or ethnic minority populations–8.6% were African-Americans (not Hispanic), 3.9% were Asian or Pacific Islander (not Hispanic), 0.5% were Native American (not Hispanic), 0.1% were Native Hawaiian/Pacific Islander, (not Hispanic), and 0.7% of persons 65+ identified themselves as being of two or more races.
- Racial and ethnic minority populations have increased from 6.3 million in 2003 to 9.5 million in 2013.
- About 28% (12.5 million) of noninstitutionalized older persons live alone. Almost half of older women (46%) age 75+ live alone.
- In 2013, about 536,000 grandparents aged 65 or more had the primary responsibility for their grandchildren who lived with them.
Volume 6, Issue 19
All Medicare Advantage plans must offer the same benefits as Original Medicare, but are allowed to have different costs and restrictions. Certain Medicare Advantage plans offer additional limited benefits, such as vision or dental coverage.
The two most common types of Medicare Advantage plans are health maintenance organizations (HMOs) and preferred provider organizations (PPOs). HMOs generally only cover care from providers who are within their networks. If you go out-of-network, you will usually be responsible for the full cost of your care. They also often require referrals to see specialists. On the other hand, you will pay the least if you see a provider within a PPO’s network, but it provides limited coverage for out-of-network providers. Additionally, PPOs do not require referrals to see specialists. Due to this additional freedom, the premiums for a PPO are generally higher than that of an HMO.
Join the Medicare Rights Center and its partners in calling on Congress to support the Improving Access to Medicare Coverage Act of 2015 (S.843/H.R. 1571) to help Medicare beneficiaries who are hospitalized in observation status. This legislation would require that time spent in observation be counted towards meeting the three-day prior inpatient stay that is necessary to qualify for Medicare coverage of skilled nursing facility care.
Visit Open Congress to find your local representatives. Contact your Senators and Representatives today to share the following messages:
- Medicare beneficiaries are being denied access to Medicare’s skilled nursing facility benefit because acute care hospitals are increasingly classifying their patients as “outpatients” receiving observation services, rather than admitting them as inpatients.
- Patients are called outpatients despite the fact that they may stay for many days and nights in hospital beds and receive medical and nursing care that is often indistinguishable from the care they would receive if formally admitted as inpatients.
- In times of sickness, Medicare beneficiaries and their families should not have to worry about their hospital billing classification status and whether or not Medicare will reimburse their care.
- There is bipartisan support in Congress to fix this problem. The Improving Access to Medicare Coverage Act of 2015 (S. 843/H.R. 1571) would require that time spent in observation be counted towards meeting the three-day prior inpatient stay that is necessary to qualify for coverage of skilled nursing facility services under Medicare.
- Please cosponsor S. 843 or H.R. 1571.
- The legislation was introduced by Senators Sherrod Brown (D-OH), Susan Collins (R-ME), Bill Nelson (D-FL) and Shelley Moore Capito (R-WV) and Representatives Joe Courtney (D-CT) and Joe Heck (R-NV).