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Under the Affordable Care Act, states will be eligible for greatly increased federal-match payments beginning in 2014 if they expand their Medicaid programs to cover adults with incomes up to 133% of the Federal Poverty Level (FPL).  In a letter dated December 10, 2012, Secretary of Health and Human Services (HHS) Kathleen Sebelius said that … Read more

Hospital Deductible: $1,184 per spell of illness Hospital Coinsurance: Days 0-60: $0 Days 61-90: $296 / day Days 91-150: $592 / day Skilled Nursing Facility Coinsurance Days 0-20: $0 Days 21-100: $148 / day Part A Premium (for voluntary enrollees only) With 30-39 quarters of Social Security coverage: $243 / month (no change) With 29 … Read more

Among proposals aimed at reducing federal spending for Medicare, some are suggesting that Medigap insurance be restructured to increase the cost-sharing burden on beneficiaries and/or add a surcharge for those that choose plans offering "first-dollar" or "near first-dollar" coverage.   These proposals operate under the assumption that charging beneficiaries more in up-front, out-of-pocket costs will deter … Read more

One of the deficit reduction proposals being discussed to achieve savings from Medicare is to introduce new cost-sharing for home health care. As a means to ward off such potential home health co-payments, some instead suggest capping Medicare payment for episodes of care, effectively limiting the duration of time individuals could access home health services. … Read more

In November, the Office of Inspector General (OIG) issued a report entitled, "Improvements are Needed at the Administrative Law Judge Level of Medicare Appeals."  The report can be found at https://oig.hhs.gov/oei/reports/oei-02-10-00340.pdf.   In the report, the OIG interprets the overall percentage of fully favorable decisions awarded to appellants by Administrative Law Judges (ALJs) as evidence that … Read more

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 … Read more

Despite Medicare's remarkable success as a health and economic lifeline for American families, proposals to dramatically alter the program have resurfaced in the context of deficit reduction. While not a new idea, proponents of increasing Medicare's eligibility age from 65 to 67, or higher, have put the proposal in the spotlight recently as policymakers search … Read more

In October 2012, the Center for Medicare Advocacy announced the settlement of the “Improvement Standard” class action lawsuit, Jimmo vs. Sebelius. For more than thirty years, the wrongful interpretation of the Medicare statue led to the illegal denial of Medicare coverage and health care for tens of thousands of Medicare beneficiaries on the grounds that … Read more

On July 30, 2012, as part of proposed rulemaking on the outpatient prospective payment system, the Centers for Medicare & Medicaid Services (CMS) asked for public comment on potential policy options related to "observation status."[1] What is Observation Status? Observation status refers to the classification of a patient in an acute care hospital as an … Read more

Although passage of the Affordable Care Act (ACA) has achieved considerable savings for the Medicare program, Medicare is still being targeted by policymakers looking to negotiate a large "grand bargain" deficit-reduction package. Many of the proposals to achieve Medicare savings would shift costs from the federal government to Medicare beneficiaries As the debt and deficit … Read more