Medicare Watch

Your Weekly Medicare Consumer Advocacy Update

House Passes a Budget That Would End Medicare as We Know It

April 17, 2014

House Passes the Ryan Budget

Last week, the U.S. House of Representatives passed a budget that repeats on an old and tired theme—ending the Medicare program as we know it. Once again, the budget put forward by House Budget Committee Chairman Paul Ryan proposes privatizing Medicare by replacing Medicare’s guaranteed health benefits with a voucher (or premium support) that seniors and people with disabilities would use to purchase health coverage through private health care plans.

The Ryan budget’s privatization scheme would grind away at traditional Medicare, pushing younger and healthier retirees into private health plans and leaving older, sick beneficiaries in the traditional Medicare program. Providing coverage for this vulnerable population will make traditional Medicare more expensive and less able to compete. In short, the Ryan budget allows Medicare as we know it to wither on the vine. At the same time, the Ryan plan would force seniors and people with disabilities to pay more for less by raising the Medicare eligibility age and increasing premiums for the middle class.

There are responsible ways to protect the future of Medicare that do not involve benefits cuts or privatization. Some responsible options for strengthening Medicare include obtaining lower prices for prescription drugs and advancing reforms to improve health care quality made possible by the Affordable Care Act. Instead of utilizing key advancements made through health care reform such as low cost preventive care, the House of Representatives voted to repeal all recent health care advancements and to dismantle an already strong Medicare program.

To let Congress know that there are responsible ways to protect Medicare, which do not include benefit cuts or privatization, Medicare Rights released a petition against the Ryan budget. Use the link below to take action and reject the Ryan plan to end Medicare as we know it.

Sign the petition.

New Issue Brief Explains Key Payment Protections for Medicare Beneficiaries

A recent Kaiser Family Foundation (KFF) issue brief discusses how the current Original Medicare payment system works when Medicare beneficiaries visit the doctor. There are three types of Original Medicare providers: participating providers, who accept Medicare and accept the Medicare-approved amount as payment in full; non-participating providers, who accept Medicare but may charge more than the Medicare-approved amount; and opt-out providers, who do not accept Medicare at all. The KFF brief puts this system into historical context and explains important beneficiary protections.

According to KFF, the participating provider program was enacted to both identify providers who charge Medicare-approved rates and to encourage them to accept those rates as payment in full. At least partially due to this program, approximately 96 percent of eligible providers are participating providers. The KFF analysis also finds that the limitation on the additional amount that non-participating providers can charge a beneficiary (also known as balance billing) saved Medicare beneficiaries billions of dollars over the past 25 years. Additionally, the requirement for opt-out providers to establish a contract with Medicare beneficiaries helped ensure that Medicare beneficiaries understand the financial consequences of going to an opt-out provider. This policy also contributed to the fact that only about one percent of practicing doctors opt out of Medicare.

The current Original Medicare provider payment structure was created to protect Medicare beneficiaries, while encouraging providers to accept Medicare. With Congress’ recent decision to once again avoid a long-term solution to the physician payment structure, it is important to understand what protections exist for beneficiaries, and what incentives exist for doctors to accept patients with Medicare. In order for the Medicare program to remain strong, proposals to change the payment structure should ensure that beneficiary protections and incentives for providers to accept Medicare remain in place.

Read the KFF issue brief.

Learn more about the different types of Original Medicare providers.

Volume 5, Issue 15

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Medicare Reminder

Medicare will help pay for your home care if all four of the following are true:

  1. You are considered homebound, meaning it is extremely difficult for you to leave your home.
  2. You need skilled care, which is care that is provided by either a nurse or a skilled therapy provider, such as a physical therapist, speech therapist, or occupational therapist. Your skilled care need must be intermittent, which means you need care no more than once per day.
  3. Your doctor certifies that you need home health care.
  4. You receive your care from a Medicare-certified home health agency (HHA).

Keep in mind that if you only need occupational therapy, you will not qualify for the Medicare home health benefit. However, if you qualify for Medicare coverage of home health care on another basis, you can also get occupational therapy. If you qualify for skilled care, you can also receive limited personal care (usually provided by a home health aide), but you do not qualify for Medicare-covered home health care if you only need personal care.

Learn more about qualifying for home health care.

Learn more about what the home health care benefit includes.



This week, Kathleen Sebelius announced that she is stepping down as Secretary of the Department of Health and Human Services (HHS). Secretary Sebelius served as HHS Secretary for the past five years. Under Secretary Sebelius’ watch, Medicare became the testing ground for innovative delivery system reforms intended to improve health care quality and care coordination. The Medicare Rights Center thanks Secretary Sebelius for her service to people with Medicare and their families.


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