Life After 50 Expo

Doc Fix Passes Senate !

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This week, the Senate passed the Medicare Access and CHIP Reauthorization Act of 2015 to repeal the Sustainable Growth Rate (SGR) formula that determines Medicare physician payments and extend the Children’s Health Insurance Program (CHIP) for two years. Congress has acted 17 times to temporarily prevent drastic payment cuts resulting from use of the SGR formula. The “doc fix” bill replaces the SGR with alternative, value-driven payment strategies. This is good news for people with Medicare, who need to know their doctors will be there when they need them.

The bill also permanently funds the Qualified Individual (QI) program that helps low-income Medicare beneficiaries afford Part B premiums. While the Senate considered an amendment to the bill to permanently repeal the Medicare therapy caps, this measure was not successful. Instead, the therapy caps exceptions process will be extended for two years. When this exceptions process expires, Congress must again act to ensure that people with Medicare are able to retain access to needed therapy services.

Also extended for two years is federal funding for community-based organizations, including State Health Insurance Assistance Programs (SHIPs), Area Agencies on Aging (AAAs) and others, to find and enroll vulnerable Medicare beneficiaries in low-income assistance programs. Like the therapy cap exceptions process, it will be paramount for Congress to ensure this funding continues beyond the two-year extension included in the final bill.

The legislation will now go to the President, and he is expected to sign it into law.

Doc Fix Passes House !

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House of Representatives Votes to Fix Medicare Payments for Doctors

Today the House passed a bill, the Medicare Access and CHIP Reauthorization Act of 2015 (H.R.2), to repeal the formula for physician payment under Medicare and extend the Children’s Health Insurance Program (CHIP) for two years. Congress has acted 17 times to temporarily prevent the formula, called the Sustainable Growth Rate (SGR), from going into effect. H.R.2 would replace the SGR with alternative, value-driven payment strategies. The bill also permanently funds the Qualified Individual (QI) program that helps low-income Medicare beneficiaries afford Part B premiums.

Medicare Rights supports this bipartisan effort to repeal and replace the SGR. Yet, Medicare Rights and other beneficiary advocates are concerned that the current replacement proposal asks beneficiaries to shoulder too much of the cost of this legislation—$30 billion in higher costs would be shifted to some beneficiaries. Reflecting that concern, Medicare Rights wrote a letter to House Speaker John Boehner and Democratic Leader Nancy Pelosi, expressing the need for additional improvements for low-income beneficiaries as the Senate takes up the legislation.

Click here to read Medicare Rights’ letter to House leadership on H.R. 2.

Click here to read Medicare Rights’ statement about H.R. 2.

Click here to read the text of the House bill H.R. 2.

Medicare Rights Asks CMS to Improve the Part D Appeals Process

Every year, Medicare Rights helps thousands of individuals navigate the complicated Medicare Part D appeals process, which allows beneficiaries to challenge a prescription drug plan’s coverage decision. Because the process is the equivalent of a nonsensical maze, it leaves beneficiaries confused, frustrated, and unable to adhere to prescribed treatment plans.

The most recent audit conducted by the Center for Medicare and Medicaid Services (CMS) of Part D and Medicare Advantage (MA) plan sponsors showed that:

  • 89% issued denial letters to beneficiaries that either failed to include an adequate rationale or contained incorrect information
  • 78% failed to demonstrate sufficient outreach to obtain additional information necessary to make an appropriate clinical decision
  • 56% made inappropriate denials when processing coverage determinations
  • 61% were shown to apply unapproved quantity limits
  • 50% were shown to apply unapproved utilization management practices

The Medicare Rights Center is asking CMS to immediately implement reforms to help people with Medicare better navigate Part D denials and appeals.

Click here to join Medicare Rights and take action today.

Volume 6, Issue 11

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Medicare Reminder

The coverage gap, also known as the doughnut hole, is a period of time during your Part D prescription drug coverage when the amount you pay for your drugs suddenly increases. The coverage gap starts when your total drug costs—including what you and your plan have paid for drugs—reaches $2,960 in 2015.

As a result of the Affordable Care Act, you get discounts to help you pay for your drugs during the coverage gap. In 2015, there is a 55 percent discount on brand-name drugs and a 35 percent discount on generic drugs while you are in the coverage gap. These discounts will gradually increase each year until 2020, when you will typically pay no more than 25 percent of the cost of your drug.

In 2015, once you have paid $4,700 out-of-pocket, you reach catastrophic coverage. During catastrophic coverage, your costs will be significantly less.

Learn more about the coverage gap on Medicare Interactive.

Learn more about catastrophic coverage on Medicare Interactive.

 

Spotlight

Five years ago this week, the Affordable Care Act (ACA) was passed into law, bringing real benefits to the tens of millions of Americans who have Medicare. Older adults and people with disabilities are now receiving low-to-no cost preventive services as well as more affordable prescription drugs in the coverage gap.

In a statement, Medicare Rights Center President Joe Baker said, “The ACA tackles the systemic causes of rising costs in the Medicare program, and so far the results continue to be promising. Most importantly, the ACA demonstrates that the federal government can contain costs without shifting even higher health care costs to beneficiaries, all while improving Medicare benefits. Continued implementation of the ACA is essential to preserving and strengthening Medicare for today’s and future beneficiaries.”

Click here to read the statement.

 

“Doc Fix” for Medicare up for renewal !

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The Kaiser Family Foundation (KFF) recently released a report examining the likely cost to people with Medicare of permanently replacing the Sustainable Growth Rate (SGR) formula, otherwise known as the “doc fix.” Enacted in 1997, the SGR places a cap on Medicare payments to health care providers. Since then, Congress has been forced to enact 17 temporary legislative patches to avoid drastic cuts in physician payments. Once again, due to the SGR, Medicare providers are facing a significant pay cut—21 percent unless Congress acts before the April 1st deadline.

Temporary actions by Congress have only delayed SGR. Last year, members of Congress reached consensus on a bipartisan, long-term alternative for setting Medicare provider payments through a value-based system. Yet, lawmakers have yet to come to an agreement on how to pay for this change.

According to the KFF report, beneficiaries wouldautomatically contribute to the cost of repealing and replacing the SGR, through higher Part B premiums and cost sharing. KFF estimates that Medicare beneficiaries would pay $58 billion in higher Part B premiums over ten years if last year’s bipartisan package to permanently fix the SGR were adopted. Despite this automatic increase, some lawmakers continue to support proposals to additionally increase Medicare beneficiaries’ premiums, deductibles and cost sharing as a way to pay for a permanent SGR fix.

Yet, most people with Medicare simply cannot afford to pay more for health care. Half of all people with Medicare—more than 25 million seniors and people with disabilities—live on annual incomes of $23,500 or less, and already contribute a sizable share of their income towards out-of-pocket health care costs. In fact, the average Medicare household spends nearly three times what the average non-Medicare household spends on health care expenses.