Your Weekly Medicare Consumer Advocacy Update
After 49 Years, Medicare Stands on Stable Ground
Trustees Report Brings Good News for the Medicare Program
According to the 2014 Medicare Trustees Report released this week, the Medicare Hospital Insurance (Part A) Trust Fund is now solvent through 2030—four years longer than predicted last year and thirteen years longer since passage of the Affordable Care Act (ACA). The Part A Trust Fund will now be able to pay on Medicare Part A inpatient claims in full for the next 16 years, and the Supplemental Medical Insurance (Part B and Part D) trust fund remains on firm financial footing, ensuring full payment for outpatient care and prescription drug needs.
In recent years, Medicare spending per beneficiary has grown at historically low rates, with zero growth in 2013 as reported by the trustees. The trustees acknowledge that many factors are contributing to the slowdown in Medicare cost growth. Among these, the trustees give ample credit to provisions in the ACA, including realigned payments to private Medicare plans, initiatives to curb fraud and abuse, policies designed to discourage hospital readmissions, and innovations now being tested to enhance health care quality and improve care coordination.
Additionally, according to the trustees, the standard Medicare Part B premium will not increase in 2015, remaining the same for the third consecutive year at $104.90 per month.
CMS Improves on Guidance for Part D and Hospice Prescription Drug Coverage
When a Medicare beneficiary elects the hospice benefit, all drugs prescribed for conditions related to their terminal condition should be covered at no cost to the beneficiary under the hospice benefit. Whereas, prescription drugs for health issues unrelated to the terminal illness should continue to be covered under the beneficiary’s Part D prescription drug plan. Yet, coverage is not always appropriately coordinated among the involved payers, resulting in instances where the incorrect entity covers the beneficiary’s drugs. In an effort to address this issue, the Centers for Medicare & Medicaid Services (CMS) released guidance in March 2014 strongly encouraging Part D plans to place prior authorization on all drugs for hospice beneficiaries. After listening to feedback from various stakeholders, including beneficiary advocates, hospice providers, Part D plans and members of Congress, CMS recently updated this guidance to strongly encourage prior authorization only for drugs commonly prescribed for hospice beneficiaries.
CMS, the Office of the Inspector General (OIG), and the National Hospice and Palliative Care Organization (NHPCO) identified four categories of drugs are often used to treat symptoms that hospice beneficiaries typically experience – analgesics, antinauseants (antiemetics), laxatives, and antianxiety drugs (anxiolytics). Since these drugs are generally covered by the hospice provider, CMS strongly recommends that drugs in these four categories should be subject to prior authorization before a Part D plan will cover them for hospice beneficiaries. All other categories of drugs should continue to be covered under Part D without additional restrictions.
Also as part the revised policy, CMS strongly encourages hospice providers to provide a compassionate fill for needed prescriptions where any delays are occurring as the hospice provider and Part D plan communicate to ensure the appropriate entity pays for a medication. Finally, CMS is committed to ensuring that educational content on this policy is appropriately communicate to beneficiaries and their families through the Medicare & You handbook, Medicare.gov, and other notices.
CMS listened to stakeholders’ concerns and amended their guidance in a way that helps beneficiaries, Part D plans, and hospice providers. Most importantly, this new guidance means that hospice beneficiaries will be less likely to experience delays accessing needed medications, or be forced to navigate a burdensome appeals process. Alongside the Center for Medicare Advocacy, AARP and other advocates, Medicare Rights actively weighed in on the development of this interim policy related to the coverage of prescription drugs for hospice beneficiaries.
Medicare Rights will continue to work with CMS and its partners as a final policy is developed, and will strongly encourage CMS to develop a system through which the appropriate entity covers needed drugs, absence the use of prior authorization, which may unduly delay access for this vulnerable population.
Volume 5, Issue 30
Medicare fraud is when someone deceives Medicare into paying when it should not or paying more than it should. This is against the law and should be reported. There are a few ways to help protect yourself from fraud:
- Only give your Medicare number or your Social Security number to your doctors and health care providers.
- Learn more about what Medicare covers. If a provider tells you how to get Medicare to cover a service that is not normally covered, be suspicious.
- Don’t accept services you don’t need. Some dishonest providers may try to pressure or scare you into getting unnecessary tests or other services. Don’t let them.
- Keep a record of all health services you receive. Then, compare it to the summary of claims you receive from Medicare or your Medicare Advantage plan to make sure they line up.
If you suspect fraud, call 800-Medicare or the national Senior Medicare Patrol hotline at 877-808-2468.
This week marked the 49th anniversary of the establishment of Medicare. In 1964, the year before these programs were signed into law, almost half of older Americans did not have health insurance, and only a quarter were estimated to have adequate hospital insurance coverage. Today, Medicare provides guaranteed health care benefits to over 50 million older adults and people with disabilities.
For Medicare’s birthday, Joe Baker, president of Medicare Rights, sat down with CUNY TV for an extensive Q&A on today’s most important Medicare questions.