In a report entitled “Medicare Part D: A First Look at Plan Offerings in 2016” (October 2015), the Kaiser Family Foundation analyzed the Part D market in 2016 and found, among other things, that: In 2016, beneficiaries in each region will have a choice of 26 PDPs, on average, down by 4 from 2015. The … Read more

This week, the General Accounting Office (GAO) issued a report entitled “Medicare Advantage: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy” (August 2015, publicly released September 28, 2015).  This report reviews how the Centers for Medicare and Medicaid Services (CMS) ensures adequate access to care for Medicare Advantage (MA) enrollees. The report was … Read more

If you are eligible for Medicare you can chose between getting your Medicare benefits through traditional Medicare (also commonly referred to as original Medicare) or a Medicare Advantage (MA) plan.  Making this choice is personal and requires that you consider your circumstances, including your health, your desire for flexibility, your budget and your tolerance for … Read more

The Center for Medicare Advocacy received an e-mail inquiry from an individual requesting assistance advocating for her sister, Mrs. B.  Mrs. B is a Medicare beneficiary enrolled in a Medicare Advantage plan and in need of home health services.  The questions raised demonstrate several important issues that often arise with both the home health benefit … Read more

Medicare Trustees Report – Medicare Part A Solvency Remains Stable On July 22, 2015, the Medicare and Social Security Trustees issued the 2015 Annual Report of the Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. Good News: In short, the projected solvency of the Part … Read more

Every year, the Centers for Medicare and Medicaid Services (CMS) issues payment, performance and other rules that apply to Medicare Advantage (MA) and Part D plans that choose to participate in the Medicare program in the following calendar year. Commonly referred to as the “Call Letter,” this document is first released in draft form, subject … Read more

The Kaiser Family Foundation (KFF) has published a report entitled “Comparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified Health Plans and Medicaid Managed Care Organizations.” The report is authored by Center Senior Policy Attorney David Lipschutz, former Center Policy Attorney Andrea Callow (now at Families USA) and Karen Pollitz, MaryBeth Musumeci … Read more

Every year, the Centers for Medicare and Medicaid Services (CMS) releases a draft of payment, performance and other rules that apply to Medicare Advantage (MA) and Part D plans that choose to participate in the Medicare program in the following calendar year. Commonly referred to as the “Call Letter,” this document is first released in … Read more

On February 12, 2015, the Centers for Medicare and Medicaid Services (CMS) published final rules entitled “Medicare Program; Contract Year 2016 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs” [CMS-4159-F2], otherwise known as the final 2016 rules for Medicare Parts C and D.[1] Applicable to the 2016 plan … Read more

- New legislation would protect patients from being dropped by doctors without cause – Bill is also co-sponsored by Senator Sherrod Brown – More than 10,000 Americans recently urged Congress to support this legislation October 28, 2014 ­­– The Center for Medicare Advocacy and the Medicare Rights Center held a joint telephone conference today with … Read more

A Brief Survey of Recent Reports, and a New Special Enrollment Period for 2015 Medicare's Annual Coordinated Election Period (ACEP) for Medicare Advantage and Part D plans began on October 15th and runs through December 7th.  During the ACEP, often referred to as "open enrollment," Medicare beneficiaries who do not have a Part D plan … Read more

Kaiser Family Foundation Poll: Potential Impact of Affordable Care Act (ACA) on the Mid-term Elections On September 9, 2014, the Kaiser Family Foundation issued its August – September 2014 Health Tracking Poll analyzing the potential impact of voter opinion of the Affordable Care Act on the November mid-term elections. The results found that health care broadly … Read more

Medicare Advantage (MA) plans are increasingly dropping doctors and other health care providers from their contracted networks, often in the middle of a plan year, when most plan enrollees are not permitted to change plans.  MA enrollees often get little advance warning, and some lose access to doctors they have seen for a long time, … Read more

On March 13, 2014, Center for Medicare Advocacy Executive Director and Founder Judith Stein testified before the House Energy & Commerce Committee, Subcommittee on Health, at a hearing entitled "Keeping the Promise: Allowing Seniors to Keep Their Medicare Advantage Plans If They Like Them."   That testimony is summarized below. The Center for Medicare Advocacy recognizes … Read more

Testimony of Judith A. Stein Executive Director, Center for Medicare Advocacy, Inc. United States House of Representatives Energy & Commerce, Subcommittee on Health "Keeping the Promise: Allowing Seniors to Keep Their Medicare Advantage Plans If They Like Them" March 13, 2014 I. Introduction Chairman Pitts, Ranking Member Pallone, and distinguished members of the Subcommittee on Health, thank you … Read more

On February 21, 2014, the Centers for Medicare & Medicaid Services (CMS) issued its draft 2015 Call Letter to Medicare Advantage (MA) and Part D plan sponsors, which includes a proposed rate for MA payment for 2015.[1]  Much anticipated, the draft Call Letter, which will be finalized in April, was preceded by an aggressive advertising … Read more

February 24, 2014 – The Affordable Care Act (ACA) is reining in overpayments to private Medicare Advantage (MA) plans by bringing MA payments closer to what traditional Medicare spends on a given beneficiary. The insurance industry and some legislators suggest that these overpayment reductions are harmful "cuts" to Medicare. This is not true. "Private Medicare … Read more

Dual Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage (MA) plan that enrolls only individuals dually eligible for Medicare and Medicaid. Though results have been mixed, D-SNPs were created as a possible route to better integration between Medicare and Medicaid, in turn leading to better quality, higher value care. Authority for Special … Read more

During the Annual Coordinated Election Period, which runs from October 15th through December 7th, people with Medicare can change their choice of health coverage (whether they receive that coverage through a private Medicare Advantage plan or traditional Medicare), and add, drop or change Medicare Part D drug coverage. For more information and to get help … Read more

For 2014, United Healthcare (UHC) is cutting 2,250 doctors from its Connecticut Medicare Advantage (MA) network. UHC is also closing one of its MA plans in New Haven County that serves 2,900 people and taking similar actions in other states.  Medicare Advantage enrollees who visit a doctor, hospital, specialist, or health center outside of UHC’s … Read more

The Affordable Care Act (ACA) is beginning to rein in Medicare Advantage (MA) overpayments by bringing MA payment more in line with what traditional Medicare spends on a given beneficiary.  The insurance industry is not only fighting this payment reform, but has launched a campaign against a 2.3% reduction in payment projected for 2014.[1]   This … Read more

The Medicare Advantage Disenrollment Period (MADP) lasts from January 1st through February 14th of each year.  During the MADP, a beneficiary can switch from an MA plan to traditional Medicare. The new MADP also provides an opportunity to enroll in a Part D drug plan for those who have not already done so. When disenrolling … Read more

As discussed in last week’s Alert, the current Medicare Annual Enrollment Period lasts until December 7th.[1]  During this time period, Medicare beneficiaries can choose a Medicare Advantage (Part C) or Part D plan for 2013.  This Alert discusses Part C and D plan quality ratings for 2013, and special enrollment periods related to these ratings.  … Read more

On April 23, 2012, the Government Accountability Office (GAO) released a report that concludes, among other things, that a Medicare demonstration program providing bonus payments to Medicare Advantage (MA) plans mainly benefits plans whose performance is no more than average.  While the program is supposed to reward quality, in practice it largely rewards plans receiving … Read more

  Part 1: Today (12/7/2011) is the Last Day of the Medicare Annual Enrollment Period, With a Limited Extension Today, December 7, 2011, is the last day of the Medicare Annual Coordinated Election Period (ACEP), also known as the Annual Election Period (AEP), the period during which people can make changes to their Medicare Advantage … Read more

The nearly nine million Medicare beneficiaries who are also eligible for some form of Medicaid, the so-called dual eligibles, are the subject of federal, state and local policy discussions because many of them are among the highest users of health care services in the country and thus are very costly to both Medicare and Medicaid.  … Read more

Once again the Medicare Advantage and Part D Annual Coordinated Election Period (ACEP) is upon us; it's time to contemplate Medicare prescription drug and Medicare Advantage choices for another calendar year.  The big news is that the ACEP, while one week longer than in the past, starts and ends much earlier this year.  The ACEP … Read more

Fall is the time for Medicare beneficiaries to explore their options regarding Part D prescription drug and Part C Medicare Advantage plans.  In years past, the annual enrollment period began in mid-November and lasted to the end of the year, with any changes or choices made effective January 1st.  Starting this year, that time period … Read more

On April 15, 2011, the Centers for Medicare & Medicaid Services (CMS) issued final regulations to provide policy and technical changes to the Medicare Parts C (Medicare Advantage) and D programs.[1]  The regulations address concerns raised by Medicare beneficiary advocates, and implement provisions of the Affordable Care Act.  They also codify into regulation some existing … Read more

Starting this year, the Medicare Advantage Open Enrollment Period (OEP) has been replaced by a new Medicare Advantage Disenrollment Period (MADP), which lasts from January 1st through February 14th.[1] During the MADP, one can switch from an MA plan to traditional Medicare.  The new MADP also provides an opportunity to pick up Part D drug … Read more