Medicare Watch

Your Weekly Medicare Consumer Advocacy Update

New Plan Threatens to Derail Permanent Doc-Fix

March 13, 2014

House and Senate Republicans Tie Doc-Fix to the Delay of ACA Individual Mandate

This week, Republican leadership in the U.S. House of Representatives and the U.S. Senate introduced plans to pay for the repeal and replacement of the Sustainable Growth Rate (SGR), the formula used to control Medicare payment to physicians. The new plan proposes to pay for the SGR fix by delaying the Affordable Care Act’s individual mandate, which requires individuals to purchase health insurance or pay a tax penalty. Unfortunately, this comes on the heels of a bipartisan, bicameral proposal that was introduced in the House and Senate last month to fix the flawed SGR and avert drastic cuts to Medicare providers.

According to the Congressional Budget Office, delaying the individual mandate for five years would increase the number of people without health insurance by 13 million people by 2018 and increases the total number of uninsured to 43 million. Finding a permanent solution for the SGR is important for people with Medicare and their doctors, but it should not come at the expense of the health and well being of the long-term uninsured.

In a letter to both Republican and Democrat leaders in the House, Medicare Rights and fellow advocates, including AARP, the Center for Medicare Advocacy, the Alliance for Retired Americans and others, called on Congress to keep partisan politics out of legislation to fix the SGR and proceed with a permanent and equitable solution. Advocates urged members of Congress to refocus on reaching a bipartisan agreement to fix the SGR and ensure that it is paid for fairly and responsibly.

Read the letter.

Medicare Rights and Partners Send Letter of Support to CMS

The Medicare Rights Center along with its partners recently sent the Centers for Medicare & Medicaid Services (CMS) a letter of support of the Medicare Advantage (MA) plan reimbursement rates for 2015. The Affordable Care Act (ACA) mandated that Medicare Advantage reimbursement rates be gradually brought in line with Original Medicare costs—CMS’ 2015 rate proposal works to fulfill this obligation.

According to a 2009 MedPAC report to Congress, MA plans were paid approximately $14 billion more that year than if the same care was provided under Original Medicare. The ACA requires MA reimbursement rates to be gradually adjusted to the same level as Original Medicare costs. Additionally, the ACA requires MA rates to be reviewed annually to reflect Medicare cost trends. In recent years, Medicare costs and national health care costs have increased at historically low rates. This trend should also be reflected in MA reimbursement rates; therefore, Medicare Rights and its partners support CMS’ implementation of these ACA mandates.

With the recent increase in the percentage of Medicare beneficiaries enrolling in MA plans, bringing MA costs in line with Original Medicare is more important than ever. Adhering to ACA requirements on reimbursement rates for MA plans will help improve the financial outlook for Medicare and ensure that current and future Medicare beneficiaries are able to receive the health coverage they need.

Read the letter.

Read the Medicare Watch article about CMS’ proposed MA rates.

Volume 5, Issue 10

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Medicare Reminder

If you are having trouble covering your Part D drug costs, there are assistance programs that can help. The federal program that helps with drug costs is called Extra Help. Click here to see a chart that lists the income and asset limits to qualify for Extra Help. Depending on your eligibility level, Extra Help may assist you with your Part D premium, deductible, and copayments.

Additionally, many states offer a state pharmaceutical assistance program (SPAP) to help their residents pay for prescription drugs. Each program works differently. SPAPs may help pay for your Part D plan premium, deductible, copayments, and/or coverage gap. Click here to see a chart that lists the states that have SPAPs. Use the information listed on the chart to contact your state’s SPAP and see if you qualify.

Learn more about Extra Help on Medicare Interactive.

Learn more about SPAPs on Medicare Interactive.



This week, Senate and House co-sponsors of the Medicare Part D Beneficiary Appeals Fairness Act sent a letter to Marilyn Tavenner, Administrator of the Center for Medicare & Medicaid Services (CMS), raising concerns about the Medicare Part D appeals process. The letter demands greater transparency from CMS on the Part D appeals system, and outlines critical steps to ease beneficiary confusion and barriers to accessing needed prescriptions at the pharmacy counter, many of which were in our recent report, Medicare Trends and Recommendations: An Analysis of 2012 Call Data from the Medicare Rights Center’s National Helpline.

In a statement about the letter, Joe Baker, President of the Medicare Rights Center, said, “The Part D appeals system is in desperate need of repair. Each year, the Medicare Rights Center answers more than 15,000 calls on our national helpline. Over one third of these calls come from seniors and people with disabilities denied a medication or health care service, and too often these callers are beneficiaries who leave the pharmacy empty-handed and with nowhere to turn. The current Part D appeals process is bogged down by needless steps that translate into delayed access to medications for beneficiaries, threatening their health and well being and putting them at greater risk for ambulance rides, emergency room visits and hospital stays.”

Read the letter.

Read Medicare Rights’ statement.


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