Your Weekly Medicare Consumer Advocacy Update
More of the Same in House Republican Budget Proposal
House Budget Proposal Still Seeks to Dismantle Medicare
Congressman Paul Ryan, House Budget Committee Chairman, introduced a budget proposal this week that repeats on an old and tired theme—ending the Medicare program as we know it. The Ryan budget would convert Medicare into a premium support program, significantly increasing costs for people with Medicare. Under the proposed model, people with Medicare would receive a set payment to purchase coverage from a private insurance company or from Original Medicare. Under the Ryan model, Original Medicare would likely be severely weakened. Experts predict that older, sick beneficiaries would remain in Original Medicare, while younger, healthier beneficiaries would enroll in private plans. Consequently, those with Original Medicare, including beneficiaries in the program today, would be subjected to higher premium costs as Original Medicare serves a population that is older, sicker and more costly.
Many people with Medicare cannot afford added health care costs. Half of all Medicare beneficiaries have annual incomes below $23,500, and Medicare households spend, on average, 15 percent of their incomes on health care. The Ryan plan also proposes to raise the Medicare age of eligibility and force middle class beneficiaries—individuals with incomes equivalent to just $45,600 today—to pay higher premiums.
Once again, the Ryan budget does little to address the issue of rising costs in the health care sector overall. Moreover, health care savings are possible without shifting costs to people with Medicare. The Affordable Care Act (ACA) exemplifies this: the law bolsters Medicare’s finances while also investing in new benefits, such as closing the Medicare prescription drug coverage gap, or doughnut hole, and providing Medicare beneficiaries with low cost preventive services.
In a recent statement, Medicare Rights Center’s president Joe Baker said, “Congress must reject this plan and instead look to responsible options, like obtaining lower prices for pharmaceutical drugs and advancing the delivery system reforms made possible by health care reform, to secure Medicare’s future for years to come. In many ways, the Medicare program is stronger than ever. Adoption of the Ryan budget would only serve to dismantle that success.”
Congress Passes Another Short Term Doc-Fix
There has been much discussion in the past few months surrounding repealing and replacing the Sustainable Growth Rate (SGR) formula, the formula used to control Medicare payment to physicians. Since 2003, Congress has acted to temporarily delay scheduled cuts in physician reimbursement rates. The most recent delay was set to expire earlier this week, on March 31st. Thankfully, Congress worked to further delay the cut of physician rates for another year, and the President signed the bill into law. Unfortunately, Congress failed to pass a permanent fix to the SGR.
According to a Politco article, there are mixed feelings among members of Congress about the passage of the 17th delay in SGR reductions. Even though many Congressional representatives support the fact that the bill postponed a 24 percent cut in doctor reimbursement rates, many desired a long-term solution. Senator Tom Coburn of Oklahoma was quoted as saying, “We’re putting off again the hard choices.”
In addition to delaying the cut to physicians, the law also extends the Qualified Individual program, one of four low-income assistance benefits for people with Medicare, delays the implementation of new medical billing codes, creates a mental health funding program for community health centers, and delays the implementation of new Medicare inpatient vs. outpatient rules.
Volume 5, Issue 13
Durable medical equipment (DME) is equipment that helps you complete your daily activities. It includes a variety of items, such as walkers, wheelchairs, and oxygen tanks. Medicare usually covers DME if the equipment is:
- Durable, meaning you can use it again;
- Designed to help a medical condition or injury;
- Suitable to use in the home, although you can also use it outside the home; and
- Likely to last for three years or more.
Medicare will only cover the cost of your DME if your doctor prescribes it and certifies that you need it to get around your home, not just to get around outside of your home.
The cost of your DME and the rules you must follow vary depending on your area and what DME you need. If you have Original Medicare, it will usually cover 80 percent of the cost of your DME and you or your supplemental insurance will be responsible for the remaining 20 percent. This applies to providers who accept assignment, or the Medicare amount as payment in full. If you go to a provider who doesn’t accept assignment, you may have to pay more. Call 800-Medicare or go to www.medicare.gov/supplier to find out your cost and the rules you must follow.
If you have a Medicare Advantage plan, each plan sets its own rates. Contact your plan to find out your cost and the rules you must follow.
This week the New York State Legislature came to an agreement on the 2014-2015 New York State budget, which includes a number of worthwhile provisions that will continue to improve access to quality and affordable health care for Medicare beneficiaries and their families throughout the state of New York.
The final budget agreement maintains funding for the Managed Care Consumer Assistance Program (MCCAP), a statewide network of agencies serving more than three million Medicare beneficiaries and provides assistance in accessing services that reduce Medicare costs for older adults and people with disabilities. Further, the budget agreement includes an increase in funding for New York’s State Pharmaceutical Assistance Program (SPAP)—the Elderly Pharmaceutical Insurance Program (EPIC)—thereby expanding access to lower cost Medicare Part D prescription drugs for 25,000 additional seniors. Legislators have also continued support for the State’s designated consumer assistance program, Community Health Advocates (CHA). CHA helps consumers use their health coverage, access health care services without coverage, and understand how to resolve disputes with health insurers.