Posts filed under ‘Cost-sharing’

Medicare Beneficiary Costs Will Rise if Affordable Care Act is Repealed (And Private Medicare plans will be paid more)

With all the talk about repealing the Affordable Care Act (ACA/Obamacare), many people miss the impact repeal would have on Medicare, older and disabled adults, and their families. ACA added preventive benefits to Medicare, decreased Part D cost-sharing for prescription drugs, and increased the long-term solvency of Medicare by about 11 years.

According to the Kaiser Family Foundation:

” Full repeal would increase spending primarily by restoring higher payments to health care providers and Medicare Advantage plans. The increase in Medicare spending would likely lead to higher Medicare premiums, deductibles, and cost sharing for beneficiaries, and accelerate the insolvency of the Medicare Part A trust fund. Policymakers will confront decisions about the Medicare provisions in the ACA in their efforts to repeal and replace the law.”

http://kff.org/health-reform/issue-brief/what-are-the-implications-of-repealing-the-affordable-care-act-for-medicare-spending-and-beneficiaries/

Policy-makers and people who rely on Medicare should think twice before supporting legislation that will give windfalls to private insurance companies, while reducing coverage and increasing costs for older and disabled people.

December 13, 2016 at 5:20 pm Leave a comment

Proposed Budget Seeks to Reduce Dramatic Rise in Part B Costs: Advocates Remain Concerned About Underlying Causes

October 27, 2015 – Congress is considering the Bipartisan Budget Act of 2015. This proposed budget agreement would reduce an expected spike in the Medicare Part B deductible and premiums for 2016. The premium increase, expected to be over 50% for beneficiaries who do not already have premiums taken from their Social Security, will instead be about 15%. Similarly, the Part B deductible would increase approximately $20.00 rather than the previously projected $75.00.  The cost of limiting the increases will be paid for by a loan from general revenues. Medicare beneficiaries will pay back the loan over time from set increases to future premiums.

“While we have concerns about the way in which the Part B cost-sharing resolution is paid for, we are glad people who rely on Medicare can breathe a bit easier – knowing their premiums and deductible will not skyrocket next year,” said Judith Stein, founder and executive director of the Center for Medicare Advocacy.

Although relieved that Congress seems poised to address next year’s Medicare Part B cost-sharing, the Center for Medicare Advocacy remains concerned about the expenses underlying these increases. “We continue to urge law-makers to join Congressman Courtney in asking Secretary Burwell to investigate and fix the underlying reasons for the huge increase in Part B costs. Much of the increase seems to come from parallel increases in billing inpatient hospital care to Part B through the use of so-called ‘outpatient’ Observation Status.”

 

October 27, 2015 at 8:54 pm Leave a comment

Solution to Medicare Part B Cost Increases? Look at “Observation Status”

If Congress and the Administration truly seek ways to limit Medicare premiums and deductibles (Robert Pear, 10/6/2015, and 10/15/2015), they ought to look at the Medicare agency’s hospital Observation Status policy.

A major cause of the Part B increase is likely the parallel increase in so-called “outpatient” observation status. The result of this misguided policy is that unprecedented amounts of hospital care are being billed to Medicare Part B, rather than Part A. This was never intended by the law. In fact Part A is called “Hospital Insurance” in the Medicare Act. Yet, thousands of patients stay days in hospitals only to learn they were not admitted as inpatients. Instead, they are classified as outpatients on observation status. One of the myriad consequences of this policy is that Part B expenses are sky rocketing – increasing Part B premiums and deductibles and cost shifting to Medicare beneficiaries.

October 15, 2015 at 3:25 pm Leave a comment

Hold The Applause

We agree it’s important to find a permanent solution to the physician payment formula (“Sustainable Growth Rate” or SGR), but the Bill passed by the House of Representatives today is not the answer. It isn’t balanced. It asks too much from beneficiaries without providing enough in return. It asks nothing from pharmaceutical or insurance companies. It continues the ever-increasing privatization of Medicare by increasing costs for beneficiaries for traditional Medicare and Medigap plans. It adds unnecessary costs for the Medicare program and taxpayers.

Of the portion of the SGR costs that will be off set, roughly half (approximately $35 billion of the total $70 billion over 10 years) would come from Medicare beneficiaries through changes that will increase their out-of-pocket costs for health care, including:
• Adding deductibles to Medigap plans purchased by new Medicare beneficiaries starting in 2020;
• Further means-testing premiums for higher-income beneficiaries; and
• Overall increases in Part B premiums.

While the SGR package would make the low-income, Qualified Individual (QI), program permanent, which we strongly support, and would minimally increase and temporarily extend important funding for beneficiary education and outreach, it does not address other key issues that serve as barriers to care. For example, instead of repealing the annual outpatient therapy caps, the process to seek an exception to the cap is extended for another two years. Instead of addressing hospital Observation Status, the Bill further extends enforcement of the so-called “two-midnight” rule.

In short, Medicare beneficiaries would pay too much, with too little in return. Major drug and insurance industries pay nothing, and stand to gain a great deal. As the SGR debate moves to the Senate, we hope further balance and improvements for beneficiaries will be made.

March 26, 2015 at 9:22 pm Leave a comment

50 Years Ago Pres. Johnson Proposed the Medicare Program

2015 is a year of anniversaries important for all families: 50 years of Medicare. 50 years of Medicaid. 80 years of Social Security.

To honor the Medicare and Medicaid anniversaries, Senator Wyden introduced a Sense of the Senate Resolution today that should pass unanimously. It celebrates Medicare (and Medicaid) by resolving to protect a real Medicare program for future generations. Importantly, the Resolution states:

“… Resolved, That it is the sense of the Senate that—
(1) all efforts to improve Medicare and Medicaid must support and build upon President Johnson’s vision ‘‘to assure the availability of and accessibility to the best healthcare to all Americans, regardless of age or geography or economic status’’;
(2) Medicare’s guaranteed benefit is a lifeline to millions of Americans and must remain intact for this and future generations;
(3) Medicare should not be transformed into a voucher program, leaving seniors and people with disabilities vulnerable to higher out-of-pocket costs;”

Sen. Wyden’s three Medicare commitments deserve support from every lawmaker who really cares about Medicare and fair access to health coverage for all older and disabled people. That was Medicare’s promise in 1965. It’s up to us, and today’s lawmakers, to ensure it remains Medicare’s promise in 2015. We hope all members of Congress will start by committing to Sen. Wyden’s Medicare resolutions.

January 7, 2015 at 8:32 pm Leave a comment

Proposed Home Health Co-Pay is a Big Mistake

We have to say, Forbes has it right!  The co-pay for Medicare home health care proposed in the President’s budget is a big mistake.  It will not save money, will harm people with chronic conditions, and will increase avoidable hospitalizations.  It isn’t even a good tool for fighting fraud – if that is the goal.

Far from getting too much care, our experience is that thousands of people with multiple sclerosis, Parkinson’s disease, ALS, paralysis, and other long-term conditions, struggle to get the home care they DO need.  A little bit of nursing and/or therapy, along with hands-on health aide services, often means the difference between staying home and requiring a hospital stay or nursing home placement.  For most Medicare beneficiaries with chronic conditions, home health care is more humane, more effective and less expensive.

If fraud is the concern, fight it. Don’t add co-pays or other barriers for those who really do need home care and qualify for Medicare coverage.

April 22, 2013 at 2:56 pm Leave a comment

ACA is Good for Medicare!

Misconceptions and misinformation about the Affordable Care Act are still too many to innumerate. However, as advocates for Medicare beneficiaries and a strong Medicare program, we can tell you that the Affordable Care Act (ACA) is good for beneficiaries and good for the stability of a full and fair Medicare program. ACA has already added significantly to Medicare-covered preventive services – with no beneficiary cost-sharing, continues to reduce the cost of prescription drugs for people under Medicare Part D, is phasing out wasteful overpayments to private Medicare Advantage plans and added over a decade to Medicare’s long-term solvency.

Happy Anniversary, ACA. As my grandmother would say, “You should live and be well!”

March 25, 2013 at 5:23 pm Leave a comment

Benefit Cuts or Drug Discounts?

According to a 2012 Congressional Budget Office report, aligning Medicare drug payments with what Medicaid pays just for low-income beneficiaries would save $137.4 Billion over ten years. (CBO Estimates for President’s Budget for 2013, 3/16/2012).

While the President suggested this reform in his State of the Union address, discounting what Medicare pays for drugs has thus far not been taken seriously by decision-makers.

Instead, we have repeatedly been told that Medicare cannot be sustained and that benefit cuts are necessary. Yet all these Medicare benefit cuts combined would only equal $35.4 Billion in savings over ten years:
1. Increasing income-related Part B premiums;
2. Increasing income-related Part D premiums;
3. Increasing Part B deductible for new enrollees;
4. Adding a Part B premium surcharge for first-dollar Medigap coverage;
5. Adding home health co-pays for new enrollees.

If all of these benefit cuts, that would hurt older and disabled people, save only 25% of the savings that would be achieved by requiring drug companies to give the same discounts to Medicare as it gives to Medicaid, why don’t we choose drug discounts? How can benefit cuts be preferable if the goals are to reduce the deficit and save Medicare for future generations?

Lower Medicare payments for prescription drugs. Choose People and Medicare over PRxOFITS!

February 15, 2013 at 12:24 am Leave a comment

Medicare and … the Military?

I read David Brooks’ New York Times editorial yesterday with dismay. It seems Medicare is not only to blame for the federal deficit, but also for Sen. Hagel’s nomination and the end of America’s military might. I have been representing Medicare beneficiaries and studying Medicare since 1977. Even I was surprised by these positions.

The determination to slash Medicare seems never ending. One hardly knows where to begin responding. But we need to try, before it’s too late. Before the next deficit cutting activities get underway, we need to set the record straight.

The basic, public Medicare program was a cost-effective success. Medicare brought access to health care to older people who were refused private health insurance. It dramatically decreased poverty among older people. Unnecessary payments to private Medicare plans, unrestricted payments for prescription drugs and policies aimed at privatizing Medicare increased the program’s costs exponentially. These expensive provisions should be the targets for those whose true goal is to reduce the deficit. If the will exists, there is a way to reduce costs while preserving Medicare’s promise.
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Watch this short video from the Kaiser Family Foundation: http://www.kff.org/medicare/medicare-timeline2.cfm. It will remind you why Medicare matters.

January 9, 2013 at 9:29 pm Leave a comment

Annual Medicare Payment Limits for Home Health – Even Worse Than Co-Pays for Beneficiaries

The Center for Medicare Advocacy has represented Medicare beneficiaries since 1986. As one of the few advocacy organizations in the nation solely serving Medicare beneficiaries, we strongly oppose home health episodic payment caps or any other such defined payment limits. The counterpart to this notion, caps on outpatient therapy, has created significant barriers to necessary care for thousands of our clients with long-term and chronic conditions. We have no doubt that episode caps would be harmful to some of those in greatest need of home care. Thus, we are adamantly opposed to such limits in the home health context.

The Center has long opposed Medicare home health co-payments, and continues to do so. Like caps, co-payments will limit access to in-home care for those most in need of these services. However, we are increasingly concerned about proposals to introduce home health payment limits. There is no question that home health payment limits would be disproportionately harmful for people with conditions such as traumatic brain and spinal cord injuries, Alzheimer’s, Parkinson’s disease, MS, and other such illnesses and disabilities. Without the possibility for ongoing home health care, these individuals may well need costly nursing home or hospital care.

For example:
• Our client, Mrs. Berkowitz, who is 81 years old and receives skilled physical therapy and home health aide services for her Multiple Sclerosis and related health needs, will require a nursing home if payment caps are instituted for Medicare home health.
Payment caps contradict and undermine growing efforts to promote better care, at lower costs, by encouraging and investing in home and community-based services.

Payment caps would also undermine the settlement just arrived at with the U.S. Department of Health and Human Services in the national class action law suit, Jimmo vs. Sebelius. The Jimmo Settlement makes it clear that Medicare coverage is available for home health patients who need skilled nursing or therapy to maintain or slow deterioration of their conditions. Jimmo holds the promise of continuing care at home for people with long-term conditions who would otherwise often need more intense and expensive institutional care. Medicare home health payment caps, however, would create a barrier to this care and provide a disincentive to home health agencies to offer care to this particularly vulnerable population.

December 3, 2012 at 9:58 pm Leave a comment

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