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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

Monday, October 17, 2011– 2:00 P.M., Eastern Time   Call-in Number: 1(888)206-2266  Pass Code: 1050263#   NOTE: We ask people calling from the same location to gather around one telephone. This frees up lines and holds down costs.   ______________________     Special Topic Presentation:   The Supercommittee and Medicare: What Advocates Need to Know    … Read more

An estimated 50,000[1] Medicare beneficiaries who are currently enrolled in Medicare Advantage "Special Needs Plans" (SNPs) but who do not meet the definition of a special needs individual for purposes of their plan will be disenrolled from those plans effective December 31, 2011. Before the end of September 2011, each such beneficiary will receive a … 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

In 2010, as in previous years, some Medicare Advantage (MA) plans and some prescription drug plans (PDPs) have decided not to renew their contracts with the Centers for Medicare & Medicaid Services (CMS) for the coming year.[1] This Alert will address the notice beneficiaries will receive and the rights they have depending on the circumstances … Read more

On February 2, 2010, the Centers for Medicare & Medicaid Services (CMS), in conjunction with the Internal Revenue Service (IRS) and the Employee Benefits Security Administration of the Department of Labor (DOL), (collectively referred to as the Departments), released interim final rules[1] implementing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). [2] … Read more

Advocates at the Center for Medicare Advocacy are working on a case involving an individual who was in a hospital bed for four days but was never "formally admitted". Instead, the hospital accorded her "observation status". Although Medicare Part B covered her, she has not only not been unable to obtain a determination of Part … Read more

In recognition of Older Americans' Mental Health Week (May 24-30, 2009), this Weekly Alert reviews the mental health services that are available under the Medicare Program. [1] Advocates seek improved access to mental health services, an expansion in the scope of services covered, and an increase in the types of providers whose services are covered. … Read more

The Medicare statute and regulations authorize payment for skilled nursing facility (SNF) care for a beneficiary who, among other requirements, was a hospital inpatient for at least three days before the admission to the SNF.  The Center for Medicare Advocacy has written before about difficulties in calculating hospital time for purposes of using Medicare's post-acute … Read more

Much of the current talk about the problems of Medicare misses the point. The proposals could end up "fixing" a successful program out of existence. Before supporting any fix, remember: Medicare has been a success Medicare assures the elderly and people with disabilities that neither they nor their families will have to bear the full … Read more

Starting July 1, 2007, hospitals participating in the traditional or Medicare Advantage Medicare program must provide beneficiaries with a new notice of discharge and appeal rights, as discussed in last week’s Weekly Alert. This Weekly Alert describes the new notice as well as beneficiary rights to question and appeal hospital discharge decisions and to receive … Read more

Medicare patients who are hospitalized sometimes find themselves being told to leave the hospital too soon, before they can safely be cared for at home or at a nursing home.[1]    The protections provided for hospital patients in this situation have recently been improved, due to a lawsuit brought by the Center for Medicare Advocacy, Inc. … Read more

Beyond QIO: Modeling a Medicare Beneficiary Complaint Process for Quality of Care A working conference convened on January 19, 2007 in Washington, DC by the Center for Medicare Advocacy, Inc., supported by the Commonwealth Fund, a New York City-based private foundation, and AARP Introduction The Center for Medicare Advocacy, Inc., (the Center), convened a working … Read more

The month of December began with World AIDS Day, an international day of action on HIV and AIDS. When advising Medicare beneficiaries with the diagnoses of HIV and AIDS, be aware that Medicare covers a wide array of services, for those living with HIV/AIDS including the terminal stages of AIDS.  Services covered include hospital, skilled … Read more

With the stark and frightening images of homeless, dispossessed, and desperate people in their thoughts, Center for Medicare Advocacy employees reacted with enthusiasm to an idea that united them with the Center in providing assistance.  They then urged other employers and employees to consider similar arrangements. The plan was simple.  Each Center employee was asked … Read more

Older Americans are not getting six key preventive services or appropriate treatment for hypertension that clinical practice guidelines indicate they generally should receive, according to two studies recently published in the Journal of the American Medical Association.  The preventive services study raises questions about disparities in health care based on economic status, and about the … Read more

Patients enrolled in AIDS Drug Assistance Programs (ADAPs) with chronic hepatitis C will now have free access to a new combination drug therapy.  Schering-Plough Corporation announced in late February that it will provide a new combination therapy of  PEG-INTRON (peginterferon alfa-2b) Powder for Injection and REBETOL (ribavirin USP) Capsules free to 1,500 ADAP patients through their new … Read more

On February 28, 2005 the manufacturers of Tysabri, Biogen Idec and Elan Corporation, announced the voluntary suspension of the Multiple Sclerosis drug from the market and from all clinical trials.  According to the companies’ press release: This decision is based on very recent reports of two serious adverse events that have occurred in patients treated … Read more

Over the years, contractors that review Medicare claims have denied coverage for Medicare services inappropriately on the grounds that the beneficiary's condition will not improve. The Center for Medicare Advocacy, through individual appeals and other advocacy efforts, has worked to assure that beneficiaries who need services to maintain their current level of functioning are not … Read more

As the New York Times reported on March 31, 2002 (p.1), Medicare advocates have been successful in convincing the Centers for Medicare and Medicaid Services (CMS) to loosen Medicare's denial practices for people with Alzheimer's disease and other cognitive impairments. Unfortunately, Medicare has a decades-long policy of denying coverage to people who need services which … Read more

The Center for Medicare Advocacy's recent conference on adding a coordinated care benefit to the traditional Medicare program achieved a high level of agreement on the importance of changing attitudes as well as institutional factors to improve care coordination.  Of particular note is that consensus was reached on the need to get physicians directly involved … Read more

The Health Care Financing Administration (HCFA) has made revisions to its Important Message from Medicare notice which all beneficiaries receive upon admission to the hospital and again at the time that the hospital establishes a discharge date. There are two forms of the notice, with essentially the same text: one for fee-for-service beneficiaries and one … Read more