Welcome to MEDICARE WATCH, a biweekly electronic newsletter of the Medicare Rights Center Vol. 11 , No. 21 : October 14, 2008 Contents: 1. FAST FACT 2. LOW-INCOME PEOPLE WITH MEDICARE FACE REASSIGNMENT AS DRUG PREMIUMS RISE 3. NURSING HOMES WIDELY CITED FOR DEFICIENT CARE 4. MEDICARE STOPS PAYING HOSPITALS FOR MEDICAL ERRORS 5. CASE FLASH: SWITCHING PRESCRIPTION COVERAGE FROM A MEDIGAP PLAN TO PART D ____________________________________ 1. FAST FACT According to Douglas Holtz-Eakin, Senator John McCain's senior policy adviser, the health care reform plan offered by Sen. McCain will have major cuts for Medicare and Medicaid. The nonpartisan Tax Policy Center, a Washington think tank, estimates that the McCain plan would cost the government $1.3 trillion over 10 years. The McCain campaign has not disputed these figures or offered their own. _(“McCain Plans Federal Health Cuts”, Washington Post, October 2008) _ (http://www.kintera.org/TR.asp?a=glKSK6PQJfIYLrK&s=fqLHJWMCIbLHI0NPG&m=kkJWLaOPLfJ3F&af=y) 2. LOW-INCOME PEOPLE WITH MEDICARE FACE REASSIGNMENT AS DRUG PREMIUMS RISE At least 1.3 million low-income people with Medicare will be reassigned to a new prescription drug plan in 2009, as the number of drug plans that qualify for a full premium subsidy dropped from 495 in 2008 to 308 in 2009, according to Avalere, a health consultancy firm. Low-income people who qualify for full Extra Help can receive premium-free drug coverage, but only in a plan that charges a premium below the regional average. When a drug plan’s premium rises above that average, which is reset every year, the Centers for Medicare & Medicaid Services reassigns most Extra Help recipients in that plan to a new drug plan with a premium below the average. Because reassignment is random, and plans vary greatly in the drugs they cover and the coverage restrictions they impose, low-income people will face new coverage restrictions under their new plan. In all but one state, Wisconsin, the number of drug plan offerings for low-income Medicare enrollees decreased. In six states – Arizona, Florida, Hawaii, Maine, Nevada and New Hampshire – there will be five or fewer drug plans available to automatically enroll low-income people with Medicare in 2009. Nevada will have only one drug plan for those people automatically reassigned by CMS, eliminating any choice of stand-alone drug plans for low-income enrollees unless individuals can pay for part of the premium cost from their limited incomes. Arizona has the second fewest options for low-income enrollees, with only two zero-premium drug plans for Extra Help recipients. Humana completely withdrew from the low-income market, offering no plans with premiums below the benchmark. However, United Healthcare increased the number of PDPs it will offer to low-income people with Medicare after it lost nearly 600,000 low-income enrollees last year. The number of people reassigned by CMS has increased annually since Part D went into effect in 2006. In 2007 CMS reassigned 250,000 people; the number steeply jumped in 2008, when CMS reassigned 1.2 million people. 3. NURSING HOMES WIDELY CITED FOR DEFICIENT CARE >From 2005 to 2007 more than 91 percent of nursing homes surveyed were cited for deficiencies, the Health and Human Services Department Office of Inspector General (OIG) reports. Nearly 17 percent of nursing homes had deficiencies that caused residents actual harm or immediate jeopardy of harm, with a greater percentage of for-profit nursing homes cited for these serious violations than not-for-profit nursing homes. The most common deficiency categories cited in each of the past three years were quality-of-care, resident assessment and quality of life. Almost 74 percent of nursing homes surveyed were cited for deficiencies involving accident hazards, and failure to prove the highest physical, mental and psychosocial care for the residents’ well-being. Around 34 percent of nursing homes were cited for improper storage, preparation or serving of food. In addition, 17 percent of nursing homes surveyed in 2007 were cited for actual harm or immediate jeopardy deficiencies. Examples of these problems included infected bedsores, medication mix-ups, poor nutrition and abuse and neglect of residents. 4. MEDICARE STOPS PAYING HOSPITALS FOR MEDICAL ERRORS The Centers for Medicare & Medicaid Services (CMS) will no longer reimburse hospitals for ten categories of preventable medical errors that result in serious risk of injury to patients. CMS prohibits hospitals to charge people with Medicare for the additional costs associated with treating these conditions. Hospitals will now assume the costs of procedures associated with “never events,” so called because they should never occur. While Medicare will save $21 million as a result of the new policy, the primary purpose of the rule is to improve quality of care for people with Medicare by creating greater incentives for doctors and hospitals to avoid preventable errors. The expectation is that if these errors affect hospitals’ overall budgets, doctors and hospitals will take more aggressive measures to prevent these errors. The ten categories of “never events” Medicare no longer covers include remedial treatments related to foreign objects retained by patients after surgery; transfusion of incompatible blood; falls and traumas during a hospital stay; manifestations of poor glycemic controls; catheter-associated urinary tract infections; surgical site infection following a coronary artery bypass graft or orthopedic surgery; and deep vein thrombosis/pulmonary embolism. 5. CASE FLASH: SWITCHING PRESCRIPTION COVERAGE FROM A MEDIGAP PLAN TO PART D Mr. S has had Original Medicare Parts A and B since 2005. He has also had a Medicare supplemental plan with drug coverage, Medigap Plan H. Medigap Plan H (along with Plans I and J) with drug coverage has not been sold since January 1, 2006, when the Medicare drug benefit (Part D) began. However, people like Mr. S, who bought one of these Medigap plans with prescription drug coverage before that time, can keep the Medigap’s drug coverage. In the past year, Mr. S’s overall health has declined. As a result, his prescription drug costs have gone up, but Mr. S’s Medigap plan only pays up to a certain amount each year for his drugs, leaving him paying a high price out-of-pocket for the medications he needs. Mr. S began looking for other options to get more comprehensive coverage for his prescription needs. He decided that he would prefer to enroll in a Medicare Part D plan for his prescription drug coverage. In August Mr. S called the Medicare Rights Center for help choosing a Medicare Part D plan. The Medicare Rights Center hotline counselor told Mr. S that he would have to wait until the Annual Coordinated Election Period (ACEP) to switch plans; the ACEP runs from November 15th to December 31st. For people who sign up for a Part D plan during the ACEP, Part D coverage becomes effective on January 1st. The hotline counselor went on to warn Mr. S that he would likely have to pay a Part D premium penalty when he enrolled in a drug plan because Medigap Plan H drug coverage is not considered “creditable coverage”—coverage that is as good as or better than the Medicare drug benefit. In most cases, people with Medicare who do not enroll in Part D when they are first eligible and do not have creditable coverage have to pay a premium penalty for enrolling late. People who qualify for Extra Help—a federal program that helps pay for Part D costs—can avoid this penalty regardless of when they enroll. Since Mr. S had income too high to qualify for Extra Help, he would have to pay a premium penalty in addition to his monthly premium for as long as he remained enrolled in Medicare Part D. Since Mr. S could have enrolled in a Medicare drug plan in the spring of 2006 when the first Part D enrollment period ended, he would have to pay a premium penalty that would be calculated based on the number of months that he delayed enrollment in Part D. Mr. S decided that even with the premium penalty, it would be a better idea for him to choose a prescription drug plan that provided him better coverage than to stick with his Medigap plan with prescription drug coverage. The longer Mr. S waited to enroll in Part D, the greater his premium penalty would be. Together, Mr. S and the hotline counselor used the Prescription Drug Plan Finder on Medicare.gov and searched for different Part D plans that covered Mr. S’s medications without restrictions at the lowest cost. The hotline counselor also mentioned that Mr. S has the option of enrolling in a Medicare private health plan with prescription drug coverage, but Mr. S told the hotline counselor that he wanted to stay in Original Medicare because he would be able to continue to see the same doctors. If Mr. S wanted to keep the health benefits of his Medigap Plan H, Mr. S could enroll in a Part D plan and then call his Medigap plan to request that they drop him from the prescription drug component of the plan and adjust his monthly Medigap premium so that he is no longer paying a prescription drug premium to his Medigap plan. ____________________________________ This message was generated by the Medicare Rights Center list-serve. 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From fantasy trips to fun items, you’ll find one of a kind items galore to bid on as gifts – for others or for yourself! Go to _www.medicarerights.org/events/auction.html_ (http://www.kintera.org/TR.asp?a=etLOL0OIIeIQIgK&s=fqLHJWMCIbLHI0NPG&m=kkJWLaOPLfJ3F&af=y) to begin bidding on these unique items, such as a house in Ireland for a week, tickets to a Metropolitan Opera Dress Rehearsal, and autographed sports memorabilia. ____________________________________ Medicare Watch is the Medicare Rights Center’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 news of recent policy developments affecting Medicare and health care generally and a case story from our hotline that illustrates steps professionals can take to get older adults and people with disabilities the health care they need. 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