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Top Trends Heard on Medicare Rights’ National Helpline

January 14, 2016

Medicare Rights Center Report Highlights 2014 National Helpline Trends and Policy Solutions

Today, the Medicare Rights Center released its annual helpline trends report, which outlines the top concerns facing people with Medicare heard through thousands of calls to Medicare Rights’ national helpline.

The report, Medicare Trends and Recommendations: An Analysis of 2014 Call Data from the Medicare Rights Center’s National Helplineincludes an in-depth discussion of two important issues heard on Medicare Rights’ helpline. Each issue is accompanied by policy solutions, which the Centers for Medicare & Medicaid Services (CMS), state agencies, insurers, elected officials, and others can pursue to improve the Medicare program for the more than 52 million people it serves.

Out of more than 17,000 questions posed by older adults and people with disabilities, their family members, and the professionals serving them in 2014, two trends stood out among the questions from helpline callers:

  • Navigating Medicare Part B Enrollment: Many individuals who call Medicare Rights are confused by Medicare enrollment rules, and specifically by decision-making related to taking or declining Part B, which covers doctors’ and other services. Some have other coverage through an employer or the new state or federal Marketplace and need information about how that insurance may change because they are eligible for Medicare. While callers may be aware of the risk of late enrollment penalties, they may not realize that their former insurance may refuse to pay for care entirely once they are Medicare-eligible.
  • Navigating Part D Prescription Drug Appeals: Frequently, in addition to not knowing why their prescription drug was denied, callers are confused by the Part D appeals process, which they need to use to access their medications. They are often unsure as to whether their appeal has been filed, what level of appeal they are at, and what their doctors may have done on their behalf.

Drawing directly from Medicare Rights’ 25 years of experience serving people with Medicare and their families, the report includes a comprehensive set of policy recommendations intended to improve access to affordable health coverage for beneficiaries.

Among the recommendations regarding Part B enrollment and prescription drug appeals are:

  • Provide better education and notice for newly eligible beneficiaries
  • Streamline and align enrollment periods
  • Include the reason for a drug denial in the pharmacy counter notice
  • Allow an immediate request for an appeal

Read the report.

Medicare Rights, Consumer Advocates, and Health Insurers Urge CMS to Provide Advance Notice to People with Marketplace Coverage Nearing Medicare Eligibility

More than 40 leading consumer advocacy organizations and health insurers joined the Medicare Right’s Center’s letter to the Centers for Medicare & Medicaid Services (CMS), urging the agency to develop a system to notify people with coverage through Marketplace plans about the ramifications of nearing Medicare eligibility.

The letter, where Medicare Rights is joined by AARP, America’s Health Insurance Plans (AHIP), BlueCross BlueShield Association, and other leading voices, urges CMS to develop a system to adequately screen, notify, and educate individuals about how and when to seamlessly transition from their Marketplace coverage to Medicare. The letter emphasizes the need for advance notice on Medicare enrollment rules and the potential consequences of delayed enrollment.

The letter was sent in response to CMS’ request for comment on unmet notification needs for Marketplace enrollees

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nearing Medicare eligibility in the proposed Notice of Benefit and Payment Parameters for 2017.

Read the full letter.

Volume 7, Issue 1

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Medicare Reminder

HMOs (Health Maintenance Organizations) and Original Medicare differ in five key ways:

  1. Providers you can use. HMOs will usually only cover your care from doctors and hospitals in their network, except in the case of emergency or urgent care. Original Medicare will cover your care from most doctors and hospitals in the country. HMOs usually require that you receive a referral from your primary care physician before you can get care from a specialist, while in Original Medicare you do not need to get a referral.
  2. Benefits. HMOs must offer all the benefits available under Original Medicare (Part A and Part B). Some HMOs may offer additional benefits that Original Medicare does not cover, such as dental care or eye care. Many Medicare HMOs also offer Medicare prescription drug coverage (Part D). If you are in a Medicare HMO, and you want Medicare drug coverage, you must get your drug coverage from that same plan.
  3. Premium. In Original Medicare, you pay only the Part B premium. HMOs may charge a monthly premium in addition to the Medicare Part B premium. The premium may be higher if the HMO offers prescription drug coverage (Part D) benefits. When you are in an HMO you must continue to pay the Part B premium.
  4. Out-of-pocket costs. With Original Medicare you generally pay 20 percent coinsurance for doctors’ and other medical services. Supplemental insurance such as a Medigap* or a retiree plan could help pay for that coinsurance. In an HMO, you usually pay a fixed amount for services (copayment). HMO copays cannot be higher than Original Medicare for some services, like chemotherapy, dialysis and durable medical equipment, but could be higher for other services, such as home health and hospital.  Also, unlike Original Medicare, HMOs must have a cap on out-of-pocket costs to protect you against very high costs if you receive expensive care.
  5. Affordability. If you are generally healthy and only see doctors and other providers in the HMO’s network, your out-of-pocket costs may be lower than in Original Medicare. If you use doctors and hospitals that are not in the HMOs network, or you see many providers, your costs could be higher. Since HMOs include a limit on out-of-pocket costs, you are protected from very high costs if you need a lot of medical care or expensive treatments.

Read more about How Medicare HMOs compare with Original Medicare on Medicare Interactive.



Big changes are coming to Medicare Interactive.

On January 19th, the Medicare Rights Center will launch a brand-new Medicare Interactive. We think you’ll like what we’ve been working on.

Watch your inbox for the announcement, or connect with us on social media to get the latest updates from Medicare Rights.


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