Your Weekly Medicare Consumer Advocacy Update
Medicare Rights Center Testifies Before House
Medicare Rights Center Testifies Before House about Medicare Advantage Plans
Yesterday, Joe Baker, President of the Medicare Rights Center, testified before the Subcommittee on Health of the U.S. House Committee on Energy and Commerce about the positive impact of the Affordable Care Act (ACA) on Medicare Advantage (MA) and how to further improve the MA program for people with Medicare.
As the ACA continues to rollout, recent changes to the MA program advanced by the ACA have strengthened the program for current and future enrollees. In addition to improving Medicare’s overall financial outlook, the ACA enhanced MA plans through added benefits, fairer cost sharing, and improved plan quality. For instance, the ACA expands coverage for preventive services; prohibits MA plans from charging higher cost sharing for renal dialysis, chemotherapy and skilled nursing stays; and requires that plans spend 85% of beneficiary premiums and federal payments on patient care. While many predicted that ACA changes to the Medicare Advantage payment system would lead to widespread disruption of the plan landscape, we have not seen that among the clients we serve or generally. The premium costs, benefit levels, and availability of plans remain relatively stable.
Each year, Medicare Rights counsels thousands of people with Medicare Advantage about topics ranging from enrolling in a plan to appealing a denied claim. MA plans are a good option for some, but not for all. Many of the callers to Medicare Rights’ helpline are satisfied with their plan, and their inquiries are easily resolved. Others find navigating an MA plan challenging.
To further strengthen the MA program and help people with Medicare, Medicare Rights urged Congress in yesterday’s testimony for various MA changes, including:
- Simplifying MA plan selection and coverage rules;
- Improving beneficiary notice regarding annual plan changes;
- Further streamlining and standardizing MA plans;
- Improving the appeals system;
- Adequately funding independent counseling resources; and
- Expanding Medigap supplemental coverage options
Bill to Protect Seniors from Health Care Fraud Introduced
In recent years, there has been an increasing amount of health care fraud targeting seniors. Scammers contact seniors pretending to be from Medicare or their health insurance plan. They claim that they need the senior’s personal information, often including their Social Security number and personal bank account information. Unfortunately, scammers have also been trying to capitalize on the confusion surrounding the Affordable Care Act (ACA), claiming that they need seniors’ personal information due to ACA changes.
A new bill that seeks to address this problem, called the Protecting Seniors from Health Care Fraud Act of 2013, was recently introduced by Representative Ruiz (D – CA). The bill was introduced with the support of a number of non-profit organizations, including the Medicare Rights Center. It would authorize the production of regular reports that would help seniors identify scams and report them to the proper authorities.
If passed, the Health Care Fraud Act of 2013 would require the Department of Health and Human Services to work with the Department of Justice and other federal agencies to create an annual report on the most frequent health care fraud schemes, actions that are being taken to combat these schemes, and policy recommendations to help protect seniors. It would also require a quarterly list of the top ten health care fraud schemes seniors to be mailed to seniors.
Volume 4, Issue 46
You can receive your Medicare coverage in two ways—through Original Medicare or through a Medicare Advantage plan. If you have Original Medicare, you usually must purchase a separate, stand-alone drug plan. On the other hand, Medicare Advantage plans usually cover both health and prescription drug benefits. While you must receive the same benefits no matter which way you receive your Medicare, there are some differences.
- If you have Original Medicare you can go to any provider who accepts Medicare. If you have a Medicare Advantage plan, you usually have to stay within the plan’s network, and often have to get referrals to see specialists.
- Medicare Advantage plans are required to offer at least what health benefits Original Medicare does. However, Medicare Advantage plans may offer additional benefits that Original Medicare does not cover, such as dental care or eye care.
- Your costs may differ depending on which way you receive your Medicare benefits, especially if you have chronic health conditions.
Remember, Fall Open Enrollment ends on December 7th. Most people are only able to switch their Medicare coverage during Fall Open Enrollment. If you want to make changes to your Medicare coverage, make sure to do so before December 7th.
Last week, the Coalition to Protect the Rights of New York’s Dually Eligible, a coalition representing many of the consumer stakeholder groups that assist dually eligible individuals with accessing health care services, submitted a letter to the Centers for Medicare & Medicaid Services and the New York State Department of Health. The letter addresses various priorities for the Fully Integrated Dual Advantage (FIDA) program contract and requests greater detail and consumer protections. The areas addressed include: an integrated appeals process for Medicare and Medicaid; continuity of care; care coordination; transition between care settings; as well as firmer rules for plan networks, quality measures, and marketing.