Medicare Watch

Your Weekly Medicare Consumer Advocacy Update

Problems with Transitioning to Medicare Highlighted

February 6, 2014

Reuters Article Details Problems with Transitioning to Medicare

Reuters recently published an article highlighting the problems that arise when individuals who are retiring and those who are working past the age of Medicare eligibility (65 years old) transition into Medicare. If the transition process is navigated improperly and a person enrolls in Medicare late, they can be subject to gaps in coverage and premium penalties. The article reviews transition issues that are often found to be confusing, such as when to initially enroll and how retiree coverage works with Medicare.

According to the article, transitioning into Medicare can be a difficult and confusing process to navigate. This is supported by the Medicare Rights Center’s report on call center trends, which shows that transition problems were the second most common reason people called its national helpline for assistance. The article also emphasizes that even employers can get confused by this process. When deciding when to enroll in Medicare, it is important for a person to talk to both their employer’s human resources department and Social Security or a third party expert. This will help avoid any coverage gaps and penalties.

Transition problems were also discussed at a recent National Academy of Social Insurance (NASI) roundtable, where Medicare Rights’ President Joe Baker spoke. Mr. Baker said that, while these transition problems are significant, there are potential solutions that would address these issues. First, it is important to greatly improve beneficiary education and outreach. Second, notice requirements should be strengthened in a way that actively trains and involves employers. Third, Medicare enrollment periods and penalties should be restructured to alleviate the difficulties that many people are experiencing when transitioning to Medicare. Finally, programs should be simplified and aligned to make the rules less confusing and difficult to navigate.

Read the Reuters article.

Learn more about the NASI roundtable.

CMS Finds Considerable Savings and Quality Improvements in Key Medicare Delivery System Reforms

The Centers for Medicare & Medicaid Services (CMS) recently released an update on key Medicare delivery system reforms, looking at analysis and results for various Accountable Care Organization (ACO) initiatives.  ACOs are groups of doctors, hospitals and other health care providers who work together to provide high quality, coordinated care to people with Medicare. ACOs are meant to save money in the health care system by streamlining care and preventing medical errors and unnecessary duplications of services.

In its interim findings on the Medicare Shared Savings ACO, CMS reports that 54 of the 114 ACOs that began operations in 2012 had lower expenses than projected in their first 12 months. Of these 54 ACOs, 29 produced a net savings of $128 million for the Medicare Trust Fund. While ACOs are meant to produce savings over several years and not annually, these initial figures show positive signs that results are in-line with projections for the first year of operations. A final report on ACO performance for the first year will be released later in 2014.

In addition to the preliminary findings of the Medicare Shared Savings ACO, positive results for the Pioneer ACO Model and the Physician Group Practice Demonstration were also released. The Pioneer Model, an ACO designed for experienced organizations that are prepared to take on more financial risk, reported savings of $147 million in their first year and significant lower growth in spending relative to Medicare fee for services for nine of its 23 ACOs—all while surpassing quality benchmarks. The Physician Group Practice Demonstration, which offers incentive payments for group practices that deliver high-quality, coordinated care for its patients, reported overall savings during the five year demonstration with seven out of ten groups receiving a total of $108 million in incentive payments for improving care quality and cost efficiency.

Read the CMS press release to learn more about these ACO initiatives.

Volume 5, Issue 5

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Medicare Reminder

You typically have the seven months surrounding your 65th birthday to enroll in Medicare. However, if you are still working, Medicare may be either your primary or secondary insurance. Primary insurance pays first for health care claims. Secondary insurance pays after the primary insurance for some or all of what the primary insurance did not cover. Often, secondary insurance will refuse to pay anything if the primary insurance has not paid first. If Medicare is secondary, you may be able to delay enrollment.

The rules are slightly different if you are eligible for Medicare due to age or disability. If you are eligible for Medicare due to age and work for a company that has 20 or more employees, your employer insurance is primary and Medicare is secondary. In this case, you may be able to delay your enrollment in Medicare. If you work for a company that has less than 20 employees, Medicare pays primary, so you will need to enroll when you are eligible.

If you are eligible for Medicare due to disability and work for a company that has 100 or more employees, your employer insurance is primary and Medicare is secondary. In this case, you may be able to delay your enrollment in Medicare. If you work for a company that has less than 100 employees, Medicare pays primary, so you will need to enroll when you are eligible.

When making the decision to delay enrollment in Medicare, it is important to talk to the human resources department at your employer and Social Security. Keep records of who you talk to, when you talk to them, and what they say. If you do not enroll when you are supposed to, you may be subject to penalties or gaps in coverage.

Learn more about how Medicare works with current employer insurance on Medicare Interactive.



In December, the National Senior Citizens Law Center (NSCLC) learned that applications for the Supplemental Security Income (SSI) program submitted by people in a same sex marriage were being held up indefinitely after the Supreme Court’s decision last summer to restrict the federal government from interpreting “marriage” and “spouse” to apply only to heterosexual unions. SSI, a federal program administered by the Social Security Administration (SSA), provides crucial assistance to low-income, disabled Americans who often times live in dire economic circumstances.

In coordination with the Gay & Lesbian Advocates & Defenders (GLAD) and the American Civil Liberties Union (ACLU), the issue was brought to SSA which in turn issued instructions on how to process SSI applications for certain individuals who live in states that recognize same sex marriage. NSCLC believes that these instructions have significantly reduced the amount of applications being held up, but stresses the impact of holding applications for such a significant benefit, which could ultimately prevent access to food, shelter and more.

Read more from NSCLC.


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