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Medicare Watch

Your Weekly Medicare Consumer Advocacy Update

Seeking Permanent Solutions for Critical Benefits

January 9, 2014

Medicare Rights Urges Congress to Seek Permanent Solutions for Critical Extenders Benefits 

Today, the US House Committee on Energy and Commerce, Subcommittee on Health held a hearing to discuss extenders policies usually continued alongside short-term fixes to the Sustainable Growth Rate (SGR) formula. For the last decade, Congress has acted on an annual basis to temporarily avert drastic cuts to Medicare reimbursements to physicians and other providers mandated by the SGR formula. As Congress seeks to permanently repeal and replace the SGR, many advocates are pushing for a permanent solution for these extenders benefits. To this end, Joe Baker, President of the Medicare Rights Center, submitted a written statement to the committee.

In his statement, Mr. Baker urges Congress to enact the following:

  • Make the Qualified Individual (QI) program permanent. This critical benefit covers the full cost of the Part B premium and is afforded to older adults and people with disabilities with very low incomes and limited assets. Failure to make the QI program permanent as part of an SGR reform package threatens the health and well being of the most vulnerable people with Medicare.
  • Find a permanent solution for the Medicare therapy exceptions process. Medicare therapy caps serve as a significant barrier to accessing needed care for people with long-term, chronic conditions, most notably for those who require long-term therapy services. Ideally, Congress should repeal the Medicare therapy caps as part of an SGR reform package to ensure access to needed care for older adults and people with disabilities. In the absence of full repeal, Congress should make the therapy cap exceptions process permanent.

As negotiations on a permanent SGR solution move forward, Medicare Rights urges Congress to protect people with Medicare from higher health care costs. In his statement, Mr. Baker said, “A legislative proposal to repeal and replace the SGR must not be paid for by shifting added health care costs to older adults and people with disabilities.”

Read the statement.

Growth in National Health Spending Remains Low

The Centers for Medicare & Medicaid Services (CMS) recently announced that overall growth in national health spending was 3.7 percent in 2012, marking the fourth consecutive year that annual health spending growth has been low. Additionally, health spending as a percentage of gross domestic product declined slightly to 17.2 percent in 2012. Medicare’s growth in spending also remains low at 4.8 percent in 2012. This is one of the lowest annual growth percentages in the past 30 years. Due to a large increase in Medicare enrollment, this overall increase corresponds to only a 0.7 percent increase in Medicare spending per enrollee in 2012—far below the 3.2 percent increase in private insurance spending per enrollee found in CMS’ report.

These numbers are promising for a number of reasons. First of all, Medicare’s slow growth is encouraging because, according to a recent article in the Washington Post, Medicare pricing impacts private insurance pricing. If Medicare’s costs increase at a slower rate, then it is possible that private insurance growth rates will follow suit. Second, CMS stated that the growth in health care costs was slower than the growth of the economy for the second year in a row. This represents an encouraging trend for the long-term sustainability of the Medicare program. Finally, while some of the decrease in growth rates can be attributed to the recession and other one-time factors, CMS has found that some of the slowdown can also be attributed to the Affordable Care Act (ACA). This means that the health care savings should not completely disappear when our economy recovers.

Read the CMS press release.

Read the CMS report.

Read the Washington Post Article.

Volume 5, Issue 1

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Medicare Reminder

Due to the Mental Health Parity Act, for the first time in 2014, Medicare will cover outpatient mental health care in the same way it covers other outpatient health services. If you have Original Medicare and see a mental health provider that accepts the Medicare amount, Original Medicare will cover 80 percent of the cost, and you or your supplemental insurance will cover the remaining 20 percent. If you have a Medicare Advantage plan, contact your plan to find out its mental health cost and coverage rules.

The services Medicare covers include:

  • Individual and group therapy
  • Family counseling to help with your treatment
  • Tests to make sure you are getting the right care
  • Activity therapies, such as art, dance or music therapy
  • Occupational therapy
  • Training and education (such as training on how to inject a needed medication or education about your condition)
  • Substance abuse treatment
  • Laboratory tests
  • Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you
  • Yearly screenings to detect depression as part of Medicare’s preventive services benefit (click here to learn more about Medicare’s coverage of preventive services)

Click here to learn more about mental health coverage on Medicare Interactive.



A recent opinion article written on behalf of the Observations Stays Coalition, which includes the Medicare Rights Center, draws attention to an issue surrounding hospital observation stays. Observation stays occur when a hospital asks a patient to stay for observation under an outpatient status before they are either admitted as an inpatient or sent home. Medicare makes distinctions between observation and inpatient status when determining payment or eligibility for services like skilled nursing care. For instance, Medicare requires a three-day inpatient stay at a hospital before it will pay for skilled nursing care—a three-day observation stay would not fulfill this requirement, which could result in increased costs for patients.

The blog post calls for continued momentum in Congress and urges the enactment of the Improving Access to Medicare Coverage Act. Introduced in early 2013, this law would count time spent in observation towards the three-day stay requirement. The post concludes by saying, “Patient advocates and provider groups alike are calling on policymakers to fix this problem once and for all, and enact into law the Improving Access to Medicare Coverage Act. Now is the time. Our aging population simply cannot afford to wait any longer for this issue to be addressed.”

Read the blog post.


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