Asclepios
Your Weekly Medicare Consumer Advocacy Update
Worth Fighting For
July 10, 2008; Volume 8, Issue 28
The Medicare bill that passed the Senate yesterday in a dramatic 69 to 30
vote does a lot more than roll back a drastic Medicare pay cut to doctors.
Here
is our top ten list of reforms included in the Medicare Improvements for
Patients and Providers Act. It includes a number of reforms that the Medicare
Rights Center has advocated for years (see Medical Record).
New preventive services of proven benefit will be covered by Medicare.
Patient coinsurance for mental health services will be lowered from 50
percent to 20 percent, the same rate that now applies to other doctor visits.
A life insurance policy or "in-kind" help from friends and family (e.g. with
groceries, heating bills) will no longer disqualify people from help with
their drug costs.
Bureaucratic obstacles that prevent low-income people from receiving help
with their drug and medical costs will be eliminated.
The Centers for Medicare & Medicaid Services will be required to rein in the
exorbitant broker commissions that have fueled aggressive and fraudulent
marketing of Medicare private health plans.
Medicare private health plans will be required to provide care coordination
and other services that meet the special needs of the enrollees they are
designed to serve.
All Medicare private health plans will be required to implement programs to
improve the quality of care they provide.
Fewer Medicare private health plans will be exempt from requirements that
they have networks that guarantee access to specialists and other local
providers.
The Part D drug benefit will cover benzodiazepines, a class of drugs used to
treat seizure disorders and anxiety disorders, which are now excluded from
coverage.
Part D coverage for anticancer drugs will be expanded to encompass more
treatments that have been shown in respected medical journals to be effective.
To save money—the bill results in a small net reduction in the budget deficit
— some of these reforms will be phased in over a number of years.
These are crucial reforms. In the fight for passage, this legislation was
brought to the Senate floor three times for a vote. The dramatic return to the
Senate floor of Senator Edward Kennedy, who has been diagnosed with brain
cancer, helped tip the scale. The bill passed the Senate, as it had the House,
with enough votes to override a threatened presidential veto.
The President should sign the bill immediately. A veto would simply delay
implementation until after an override vote. That will complicate
implementation of the provisions that are effective immediately. People with
Medicare are
fed up with politics that prevent them from receiving the care they need.
Medical Record
The "blanket exclusion of benzodiazepines could have serious consequences to
the health and mental health of millions of older adults and people with
disabilities who have Medicare. . . The exclusion of benzodiazepines under
Part
D will inappropriately constrain doctors' ability to develop the best
individualized treatment plans for patients with acute debilitating mental
conditions." (Critical Coverage: The Exclusion of Benzodiazepines under Part D
(http://www.medicarerights.org/benzoreport.pdf), Medicare Rights Center, June
2005)
"Because accurately determining [in-kind support] will require exhaustive
efforts, we believe that the inclusion of [in-kind support] will result in
fewer applications for [Part D Extra Help] from eligible applicants . . .
Life insurance policies and pre-paid burial accounts should be excluded from
determinations of "resources" for [Extra Help} eligibility." (Improving the
Part D Low Income Subsidy: Comments and Recommendations to Social Security
(http://www.medicarerights.org/SSA-LISregscomments.pdf), Medicare Rights Center
May, 2005)
"All low-income subsidy applicants, no matter where they apply, should be
screened for Medicare Savings Program eligibility and given the opportunity to
apply for full Medicaid benefits. To that end, the model low-income subsidy
application should be designed to screen applicants for the Medicare Savings
Programs as well, while also notifying applicants that they could apply for
full Medicaid coverage." (The Medicare Low Income Drug Subsidy, Strategies to
Maximize Participation
(http://www.medicarerights.org/lowincomeissuebriefframeset.html), Medicare
Rights Center, January 2005)
* * * *
Medicare Part D Appeals Help for Advocates Is Here!
MRC's new Medicare Part D Appeals: An advocate's manual to navigating the
Medicare private drug plan appeals process offers an easy-to-understand,
comprehensive overview of the entire appeals process, including real-life case
examples, a glossary of important appeals terms, a sample protocol for
advocates,
and links to important resources.
Register for a FREE copy (http://www.medicarerights.org/appealsmanual.html)
of this great resource.
* * * *
Medicare Private Health Plan Monitoring Project
The Medicare Rights Center (MRC) would like to hear about your experience,
or that of someone you know, enrolled in a private health plan. With
information about what the issues are with Medicare Advantage plans, we will be
able
to demand that those problems be fixed.
Submit your story at www.medicarerights.org/maplanstories.html
(http://www.medicarerights.org/maplanstories.html).
* * * *
The Louder Our Voice, the Stronger Our Message
Asclepios—named for the Greek and Roman god of medicine who, acclaimed for
his healing abilities, was at one point the most worshipped god in Greece—is a
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* * * *
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helps older adults and people with disabilities get good, affordable health
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