Your Weekly Medicare Consumer Advocacy Update
Good News and Bad News in President’s Budget
Medicare Rights Responds to President’s Proposed Budget for 2015
This week, President Obama released his proposed budget for 2015, which contained good news and bad news for people with Medicare. The proposed budget outlines responsible solutions to slow Medicare spending, but it also endorses policies that would shift higher health care costs to Medicare beneficiaries now and in the future.
Medicare Rights Center’s president Joe Baker addressed the proposed budget in a statement saying, “We applaud proposals in the budget that would reduce wasteful spending on prescription drugs. Restoring Medicare’s ability to benefit from the same discounts that Medicaid receives on prescription medicines is a sensible savings solution that does no harm to people with Medicare. The same is true for the President’s proposals to accelerate closure of the Part D prescription drug coverage gap, or doughnut hole, to prohibit drug companies from brokering anti-competitive deals intended to delay access to generic medicines, and to reduce the exclusivity period for expensive biologic drugs.”
Baker also addressed the President’s commitment to simplifying the appeals process for those who are dually eligible for Medicare and Medicaid and receive coverage through managed care plans. “While seemingly small, this proposal would alleviate known barriers to accessing needed health care services for low-income beneficiaries unable to navigate the needless complexity of a fragmented appeals system,” said Baker.
However, the President’s budget is not entirely good news for beneficiaries. Responding to proposals that negatively impact people with Medicare, Baker said, “We remain deeply concerned by proposals that would shift the burden of higher health care costs to older adults and people with disabilities living on low or modest, fixed incomes. Suggested policies to further means test Medicare premiums, add a home health copayment, increase the Medicare Part B deductible, tax comprehensive Medigap plans, and hike brand name drug copayments for low-income Part D beneficiaries are alarming. These so-called structural reforms seek savings for the federal government at the expense of those least able to afford it.”
Advocates Weigh in on Doc-Fix Plan and Suggest Responsible Offsets
The Medicare Rights Center, along with more than 20 other nonprofit organizations, recently sent a letter to Congress addressing proposals to repeal and replace the sustainable growth rate (SGR) formula. Because of the SGR, Medicare physicians face a drastic payment cut in reimbursement rates. For the past decade, Congress has acted on an annual basis to temporarily avert these cuts to Medicare reimbursements to physicians and other providers. Overall, Medicare Rights and its partners support the repeal of the SGR, but believe it should not happen at the expense of Medicare beneficiaries.
The letter sets forth two areas of concern. The first involves the Qualified Individual (QI) program, a critical benefit that 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. In December, the Senate Finance Committee voted to extend the QI program through 2018; however, Medicare Rights and its partners support using an SGR repeal bill to make the QI program permanent so assistance for this population will no longer be in question.
The second area of concern involves how an SGR repeal would be paid for. Advocates urge that costs not be shifted to people with Medicare, most of whom live on modest incomes. Instead, Medicare Rights and its partners recommend that Congress use unspent Overseas Contingency Operations (OCO) funds and the restoration of drug rebates for low-income beneficiaries to offset the cost of repealing the SGR.
Volume 5, Issue 9
If you are dissatisfied with your Medicare Advantage or Part D prescription drug plan for any reason, you can choose to file a grievance. A grievance is an official complaint that you file with your plan. It is not an appeal, which is a request for your plan to cover a service or item it has denied. In some cases, you may want to file both an appeal and a grievance.
To file a grievance, send a letter to your plan’s Grievance and Appeals Department. Contact your plan for the address. You can also file a grievance by calling your plan, but it is best to send it in writing. Be sure to send your grievance within 60 days of the event that led it. You may want to send copies to your regional Medicare office and Congressional legislators. Go to Medicare’s website or call 800-MEDICARE to find out the address of your regional Medicare office. Keep a copy of any correspondence for your records.
Your plan must investigate your grievance and get back to you within 30 days. If your request is urgent, your plan must get back to you within 24 hours. If you have not heard back from your plan within this time, you can call your plan or 800-MEDICARE to check on the status of your grievance.
Medicare Rights continues to improve Medicare Interactive (MI), its online Medicare information tool. Recent changes to the Medicare Rights and Appeals section on MI have made the appeals information easier to navigate.
Visitors to MI can now see the whole appeal process for a specific item or service in one script. The many sections of appeals information have also been condensed into just five sections, and there are now links within the appeals pages to informational charts that outline the appeals process. Finally, the appeals process has been broken down into easy-to-understand steps, helping readers understand where they are in the process and what they have left to do.