[QUAD-L] Fwd: Medicare Watch #21, October 11, 2005

[DAANOO]

FYI Dana

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Welcome to MEDICARE WATCH, a biweekly electronic newsletter of the Medicare Rights Center

Vol. 8, No. 21: October 11, 2005

 

Contents:

 

1.   FAST FACT

2.   MEDICARE’S MISTAKE WILL COST THE POOR

3.   PREMIUM ASSISTANCE PROGRAM REAUTHORIZATION HANGS IN THE BALANCE

4.   SENATORS ASK FOR A DELAY IN WHEELCHAIR REGULATIONS

5.   CASE FLASH: QUALIFYING FOR EXTRA HELP FOR PART D

 

 

1.   FAST FACT

 

While 37 percent of older Americans understand the Medicare drug benefit, 61 percent say they do not, according to a recent survey. Of the people polled, one in four intends to sign up for the new Medicare prescription drug program (USA TODAY/CNN/Gallup Poll, September 2005).

 

2.   MEDICARE’S MISTAKE WILL COST THE POOR

 

            The 2006 print edition of Medicare & You—Medicare’s guidebook to the government’s health care program for the 42 million older adults and people with disabilities with Medicare—contains a mistake that will fall heaviest on the poor.

            Some 14 million people with low-incomes who qualify for Extra Help to pay for the Medicare Part D benefit qualify for a premium exemption for plans at or below a certain regional average—often called the “benchmark.” Those with Extra Help who choose a plan above the benchmark will be responsible for the difference in cost between the plan premium and the benchmark amount.

            The 2006 print edition erroneously indicates that all plans—regardless of premium price—are open to those with the low-income subsidy at no extra charge.

            A Medicare spokesman said that the mistake will be corrected on the Medicare web site and that insurance companies have been instructed to inform people with Medicare who receive Extra Help whether the subsidy will cover their plan premiums. The Centers for Medicare and Medicaid Services (CMS) will not be mailing a reprint or correction.

            Consumer advocates have bemoaned the error saying that Medicare is making the already difficult task of choosing a Part D plan even more difficult.

 

3.   PREMIUM ASSISTANCE PROGRAM REAUTHORIZATION HANGS IN THE BALANCE

 

            A federal program that pays Medicare Part B premiums for low-income people with Medicare expired on September 30 leaving more than 185,000 people with an additional $1,062 annually in health care costs.

            The Senate passed an extension of the Qualifying Individual (QI) Medicare Savings Program on September 29. On October 6, the House passed similar legislation but tied QI reauthorization to legislation that would prevent government medical insurance plans for poor and older Americans from paying for erectile dysfunction drugs. The Senate then amended the House version of the extension by substituting its original version and sending it back to the House.

            Beginning in January 2006, the Medicare Part B premium will increase 13.2 percent to $88.50 a month, up from this year’s monthly premium of $78.20. Medicare Part B covers services such as doctors’ visits, laboratory tests and outpatient care.

            Consumer groups expect that people currently enrolled in the QI program will receive disenrollment notices in the upcoming weeks. Not only will people in the QI program lose government assistance to pay for the Medicare Part B premium, but if they want Extra Help—Medicare’s low-income subsidy program to pay for Part D—they will have to apply instead of being automatically enrolled.

 

4.   SENATORS ASK FOR A DELAY IN WHEELCHAIR REGULATIONS

 

            Senate Republicans Rick Santorum and Arlen Specter of Pennsylvania and Senate Finance Chairman Charles Grassley of Iowa are asking the Centers for Medicare and Medicaid Services (CMS) to delay new coverage guidelines for power mobility devices and new payment codes.

            The interim final rule set to go into effect on October 25 eliminates the certificate of medical necessity—a document used by doctors to understand Medicare coverage criteria and answer relevant questions about the patient’s medical condition. The new regulations instead require doctors to provide detailed chart and progress notes to the supplier in order to prove eligibility under Medicare. 

            Additionally, the interim rule implements the 2003 Medicare law’s “face-to-face” requirement—requiring doctors to provide a prescription and supporting medical records to the supplier within 30 days of the face-to-face exam.

            Senators Santorum and Specter call these changes “an exceptionally comprehensive change to the practices of physicians, clinicians, beneficiaries, providers, and even manufacturers.” They ask CMS Administrator Mark McClellan to delay the interim rule until April 1, 2006, and the payment codes until July 1, 2006.

            Senator Grassley calls the new coverage rules “overly restrictive, confusing and impossible to successfully implement in their proposed time frame—fueling fraud, waste and abuse in the Medicare program.”

            Senator Grassley is urging a delay so CMS can fully educate providers and suppliers in order to ensure a smooth transition. “Indeed, as eager as I am to see this rule implemented, I am equally committed to ensuring that we do this right the first time,” he writes.

            Senator Grassley is asking CMS to respond to his questions regarding the new regulations by October 11.

 

5.   CASE FLASH: QUALIFYING FOR EXTRA HELP FOR PART D

 

Ms. S has Original Medicare Parts A and B and no prescription drug coverage. She wanted to sign up for Medicare Part D (prescription drug coverage), but she was worried about paying another monthly premium on top of the Part B premium. Ms. S called her State Health Insurance Assistance Program (SHIP) hotline for help. After a brief survey of her income and assets, a counselor told her that her income made her eligible for partial assistance through Extra Help, a federal program that would help her pay for some of the costs of her Medicare prescription drug coverage.

 

The counselor asked Ms. S more questions about her family situation and learned that her two teenage grandchildren live with her and rely on her financial support. The counselor told Ms. S that she could claim her grandchildren as dependents, which would raise her income limits. With the higher income limits, Ms. S qualified for the full subsidy that would pay all of her Part D premiums and deductible and was also eligible for a Medicare Savings Program that will pay her Medicare Part B premiums. In 2006, Ms. S will only have to pay $3 or $5 for prescription drugs covered by her Medicare Part D prescription drug plan and will save $1,062 in Medicare Part B premiums.

 

To read more cases by subject, go to “Interesting Cases” on our web site at www.medicarerights.org/interestingcasesframeset.html.

 

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Medicare Watch is MRC’s fortnightly newsletter, established to strengthen communication with national and community-based organizations and professional agencies about current Medicare policy and consumer issues. Each edition contains the latest Medicare policy developments, case stories from our hotline and action steps that professionals can take to ensure that older adults and people with disabilities get good, affordable health care.

 

 

Medicare Rights Center (MRC) is the largest independent source of health care information and assistance in the United States for people with Medicare. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.

 

 

 

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