Your Weekly Medicare Consumer Advocacy Update
Advocates Ask CMS to Suspend New Part D and Hospice Guidance
Advocates Send Letter to CMS Requesting Suspension of New Guidance to Part D Plans and Hospice Providers
The Medicare Rights Center and 26 other advocacy organizations recently sent a letter to the Center for Medicare & Medicaid Services (CMS) to request a suspension of new guidance to Part D plans and hospice providers. The guidance directs Part D prescription drug plans to require prior authorization for all prescription drugs for hospice beneficiaries. The advocates urge CMS to bring together stakeholders to find a solution that ensures the appropriate entity pays for the drugs, while making sure the hospice beneficiary is not put in the middle of any disputes and unable to get their medications.
Medicare beneficiaries can elect hospice care if they meet certain requirements and have a life expectancy of 6 months or less. Once they are on hospice, the hospice provider is supposed to cover drugs prescribed for the terminal condition or related complications. Part D plans are supposed to cover drugs for conditions unrelated to the terminal illness. In the past, the proper entity has not always covered the drugs; therefore, CMS has issued guidance encouraging Part D plans to require prior authorization for all drugs once a person elects hospice care.
The advocates state that this guidance is premature and should be suspended for multiple reasons. First, the guidance places the burden on terminally ill beneficiaries to make sure the correct entity is billed, instead of on the Part D plans and hospice providers. Second, beneficiaries are not typically provided with clear information about how to proceed if their drug is denied at the pharmacy. Third, it requires these beneficiaries to navigate the confusing – and often inefficient – Part D appeals process. Finally, these barriers can cause terminally ill beneficiaries to go without needed medications, or pay for them out-of-pocket unnecessarily. The advocates strongly encourage CMS to delay this guidance until stakeholders have created a suitable alternative that does not place the burden on terminally ill Medicare beneficiaries.
Medicare Payment Advisory Commission Release its Report to Congress
This week, the Medicare Payment Advisory Commission (MedPAC) released its annual, mandated report to congress, “Medicare and the Health Care Delivery System.” The report highlights various issues impacting Medicare in the context of overall changes to the delivery of health care and the health care services market.
The report touches on the following:
- Synchronizing payment policy across traditional fee-for-service, Medicare Advantage, and accountable care organizations.
- Supporting primary care under fee-for-service Medicare by changing bonus payments from add-ons to primary care claims to payments per beneficiary paid either monthly or annually.
- The possibility of paying the same rate for certain post-acute care services received in a skilled nursing facility or inpatient rehab facility that patients frequently recover from. This would replace a system where the rate for these services vary based on the facility.
- Increased protections for low-income beneficiaries by changing income eligibility for the Medicare Savings Program—helping this population afford any increase in out-of-pocket costs resulting from a redesigned benefit package.
- How adherence to medication impacts medical spending and health outcomes.
Medicare Rights will continue to review and evaluate these proposals ensuring the best interests of people of Medicare.
Volume 5, Issue 24
You can have both Medicare and Medicaid. You may qualify for Medicaid coverage of a broad range of health services, including doctors’ visits, hospital care, and medical equipment if you meet the financial requirements. Each state has its own Medicaid program with different eligibility limits and slightly different benefits.
If you have both Medicare and Medicaid, Medicare will pay first for all Medicare-covered services and Medicaid will pay second by covering your remaining costs, such as the Medicare coinsurances, copayments and deductibles. Medicaid will also pay for certain medical services that Medicare does not cover, such as transportation to medical appointments, some dental services and additional home care. You will most likely be required to have a Part D prescription drug plan, but Medicaid will help cover your costs.
Celebrating 25 years of getting Medicare right!
This June, the Medicare Rights Center is celebrating 25 years of helping seniors and people with disabilities access the health care they need. Through our direct counseling, advocacy, and policy work, we increase access to care for our helpline clients, and for all people with Medicare.
Come and visit our special 25th anniversary celebration page, where we look back at our beginnings as a small call center, hear from just a few of the many clients we’ve assisted, and check in with some former staff who have continued working to improve the health care system for people in need.