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Caution Advocates have seen 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

This week the Centers for Medicare & Medicaid Services released the Medicare premium, deductible and co-pay amounts for 2016.  As the Center for Medicare Advocacy has extensively reported, the Part B Premium, which was feared to spike outrageously for many beneficiaries, will instead remain the same for most, and increase far less for the rest.  … Read more

Hospital Deductible: $1,260.00 / Benefit period Hospital Coinsurance: Days 0-60: $0 Days 61-90: $315 / Day Days 91-150: $630/ Day Skilled Nursing Facility Coinsurance: Days 1-20: $0 Days 21-100: $157.50/ Day Part A Premium (For voluntary enrollees only) With 30-39 quarters of Social Security coverage: $224.00 / Month With 29 or fewer quarters of Social … 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. This means that Medicare beneficiaries have to … Read more

Today, the Medicare Trustees issued their annual report on Medicare's financial status.   According to this year's report, the Part A (Hospital Insurance) Trust Fund has sufficient reserves to fully pay Medicare benefits until 2026 – two more years than projected in last year's report.  Since 1970, the Trustees have projected the Medicare Trust Fund would … Read more

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

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

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

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

The Medicare Trustees issued their annual report on Medicare's financial status on Friday, May 13, 2011.  According to this year's report, the Hospital Insurance (HI) Trust Fund has sufficient reserves to pay out the full amount of Medicare Part A benefits until 2024. Should nothing else change, and the Trust Fund reserves be depleted in … Read more

The Center is concerned about the use of MSNs that do not reveal to beneficiaries that their service was denied based on a National Coverage Determination.  Such an MSN will instead provide a misleading explanation, such as "Medicare does not cover this service," or "information provided does not support the need for this service." If … Read more

"…Medicare has been a boon to the elderly and their children. Surveys show that beneficiaries are overwhelmingly satisfied with their care. Before Medicare, only 56 percent of the elderly had hospital insurance; the program has contributed to an increase in life expectancy and a sharp reduction in poverty among the elderly." Robert Pear, Walt Bogdanich, … Read more

The Annual Coordinated Election Period for Medicare Advantage and Medicare Part D drug coverage started November 15, 2010 and goes through December 31, 2010. During this period, Medicare beneficiaries who do not have a Part D plan can enroll in one, and those who do have Part D coverage can change plans. Beneficiaries can also … Read more

On November 9, 2010, the Centers for Medicare and Medicaid Service (CMS) released three notices detailing the Medicare Part A and Part B premiums and Deductibles for calendar year 2011. See, 75 Fed. Reg. 68790-68802 (Nov. 9, 2010). Advocates need to be aware of changes and complications for 2011 with regard to premiums in order … Read more

On December 9, 2009, the Centers for Medicare & Medicaid Services (CMS) issued final regulations for the Medicare Claims Appeals Process (Parts A & B combined) and for the application of certain appeals provisions to the Medicare prescription drug appeals process (Medicare Part D). Both sets of rules were effective on January 8, 2010. Appeal … Read more

So much attention is focused on the Annual Coordinated Election Period (AEP) for Medicare Advantage (MA) plans and prescription drug plans (PDPs) that beneficiaries and their advocates may be unaware of other Medicare enrollment periods. These enrollment periods and their acronyms are confusing and overlapping. A beneficiary who does not act carefully may lose needed … Read more