This article is part of a NAELA Journal symposium edition that focuses on "The Future of Elder Law and Special Needs Planning." This article will provide an overview of the policy debate that led to the creation of the Medicare program.  It will identify key cost and quality problems facing the program and review solutions … 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 →

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 →

Fall is the time for Medicare beneficiaries to explore their options regarding Part D prescription drug plans and Part C Medicare Advantage plans.  The Annual Coordinated Election Period (ACEP) for Medicare Advantage and Medicare Part D prescription drug plans will start on October 15th and end on December 7th.[1] This means that Medicare beneficiaries have … Read more →

September 20, 2012 With the Balanced Budget Act of 1997 (BBA1997), Congress began an expansion of preventive benefits and services available through Medicare.[1]   The Medicare Modernization Act of 2003 (MMA) added additional preventive services.[2]  The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) made refinements to Medicare's preventive services.[3]  Finally, the Patient Protection … Read more →

August 16, 2012 On June 1, 2012, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal No.R2480CP, which updates its instructions on the issuance of the Advance Beneficiary Notice (ABN), Form CMS-R-131.[1]  The changes are effective on September 4, 2012.[2]  The new transmittal is part of an ongoing effort by CMS to provide additional … Read more →

Caution Advocates are seeing an increase in the number of Medicare beneficiaries who have delayed enrolling in Medicare Part B, thinking, erroneously, that because they are paying for and receiving continued health coverage under COBRA, they do not have to enroll in Medicare Part B.[1]  COBRA-qualified beneficiaries who have delayed enrollment in Medicare Part B … Read more →

On March 7, 2012, the Centers for Medicare & Medicaid Services (CMS) announced the redesign of the Medicare Summary Notice (MSN), the statement that informs Medicare beneficiaries about their claims for Medicare services and benefits.  The Medicare Summary Notice (MSN) generally sets out what Medicare has or hasn't covered, provides information about a beneficiary's payment … Read more →

Medicare's limitation on liability (LOL) protections[1] apply when a provider believes that an otherwise covered Medicare item or service will be denied because the item or service is not reasonable and necessary[2] or is for custodial care.[3] In order to shift liability to the beneficiary, a provider is required to notify a beneficiary in advance … Read more →

On October 27, 2011 the Centers for Medicare and Medicaid Service (CMS) released notices detailing the Medicare Part A and Part B premiums and Deductibles for calendar year 2012. Hospital Deductible: $1,156 per spell of illness Hospital Coinsurance: Days 0-60: $0 Days 61-90: $289 / day Days 91-150: $578 / day Skilled Nursing Facility Coinsurance … Read more →