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Medicare Watch

Your Weekly Medicare Consumer Advocacy Update

A Responsible Fix to the Sustainable Growth Rate

November 14, 2013

Beneficiary Advocates Weigh in on SGR Discussion in Congress

Congress continues to discuss ways to fix the Sustainable Growth Rate (SGR), the formula used to control Medicare payments to physicians. Under the current system, physician and other provider payments under Medicare are subject to cuts based on the SGR formula each year. Congress must act on an annual basis to prevent these drastic cuts to Medicare providers. In addition to subjecting doctors to needless stress, the threat of payment reductions creates uncertainty for Medicare beneficiaries about their ability to continue to see their doctors.

This week, Medicare Rights and partners from AARP, AFL-CIO, AFSCME, the Center for Medicare Advocacy, National Council on Aging, National Committee to Promote Social Security and Medicare, and others submitted comments to the Senate Finance Committee and the House Committee on Ways and Means on a bipartisan, bicameral draft proposal to repeal and replace the SGR formula. The comments outline key principles to consider while drafting legislation to fix the SGR, including:

  • Protect people with Medicare from added health care costs by ensuring that proposals to repeal or replace the SGR are not paid for by shifting costs to beneficiaries;
  • Extend a permanent fix to critical Medicare benefits, including the therapy caps exceptions and the Qualified Individual (QI) program;
  • Facilitate access to chronic care management for vulnerable beneficiaries by eliminating cost sharing for newly proposed payment codes;
  • Build on existing programs and capacities, including accountable care organizations, patient-centered medical homes and bundled payments systems; and
  • Adopt rigorous standards for new quality measure development, such as by emphasizing the development of outcome-based measures, patient experience measures and measures for frail patients with multiple, chronic conditions.

Read the letter.

Social Security Benefits Will Increase by 1.5 Percent in 2014

The Social Security Administration recently announced that it will increase monthly Social Security and Supplemental Security Income (SSI) benefits by 1.5 percent in 2014. This increase reflects an annual cost-of-living adjustment (COLA) that Social Security applies to its benefits. The adjusted payments will begin in January of 2014.

According to the Social Security Administration, the annual COLA increase is meant to help ensure that “Social Security and Supplemental Security Income benefits keep pace with inflation.” In other words, the COLA is designed to ensure that Social Security benefits do not decrease due to an increase in the cost-of-living.

This COLA increase means that the new maximum monthly amounts for SSI are $721 for an individual and $1,082 for a couple in 2014. This adjustment also means that the maximum amount of earnings subject to the Social Security tax will increase to $117,000.

The Social Security Administration estimates that the COLA adjustment will increase benefits for nearly 63 million Americans. Although this year’s adjustment is small, this increase is critically important to Medicare beneficiaries living on limited incomes and resources, particularly so for those wholly dependent on Social Security or SSI benefits as a sole source of income.

Read Social Security’s press release.

Volume 4, Issue 44

Medicare Interactive logo

Medicare Reminder

Medicare uses a Star Rating System to measure how well Medicare Advantage and Part D prescription drug plans perform. Ratings range from one to five stars, with five being the highest and one being the lowest score. Medicare assigns plans one overall star rating to summarize its performance as a whole. Plans also get separate star ratings in each individual category reviewed.

Star ratings can be found in the Medicare Plan Finder tool (www.medicare.gov/find-a-plan) or by calling 800-MEDICARE. A plan’s star rating is only one factor to look at when you compare plans in your area. Even though a plan has a high star rating, it may not be right for you. You should also consider cost and if it covers all the drugs and services you need.

If you are enrolled in a plan that gets one or two stars for three years in a row, Medicare will mail you a letter telling to tell you this. You will not be removed from the plan but, if you receive this letter, check the plan’s costs and coverage to make sure it is still a good plan for you. If you do not make a change during Fall Open Enrollment, you will be allowed to switch from this plan to a plan that has received three stars or more at any point during the year.

Learn more about star ratings on Medicare Interactive.



This week, NY State of Health (NYSOH), announced that since October 1, 48,162 people have enrolled in Marketplace plans and 197,011 have completed the application process but still need to choose plans.

New Yorkers without health insurance have until March 31 to enroll in a plan through NYSOH, and those who enroll by December 15, 2013 will begin their coverage on January 1. This enrollment period should not be confused with Medicare Fall Open Enrollment, the time of year from October 15 to December 7 when people with Medicare can change their Medicare coverage.

For more information about the NYSOH Marketplace, visit www.nystateofhealth.ny.gov, call 1-855-355-5777, or receive in-person assistance by using the NYSOH website to find a counselor, or navigator, in your area.

For more information about Medicare Fall Open Enrollment visit www.medicare.gov or call 1-800-MEDICARE.

Read the NYSOH press release.


Stay up-to-date on Medicare policy and advocacy developments, and learn about changes in Medicare benefits and rules with this weekly newsletter.

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Health Care Professionals:

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Get answers to your Medicare questions from Medicare Interactive at www.medicareinteractive.org.

© 2013 by Medicare Rights Center. All rights reserved.

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