The Centers for Medicare & Medicaid Services (CMS) has released a free mobile app for iOS and Android users. The app, “What’s Covered,” is designed to provide Medicare beneficiaries and their families with a general overview of covered services, coverage requirements, costs, and additional information. While the app is geared towards beneficiaries in traditional Medicare, it notes that Medicare Advantage (MA) plans are required to cover the same benefits as those in traditional Medicare. Additionally, the app states that MA enrollees should contact their plans for information about covered and additional services.
Although the Center for Medicare Advocacy’s (the Center) review of the app is ongoing, it does add to outreach and education. However, CMS could improve the app by addressing the barriers to care that beneficiaries and families commonly experience. For instance, the Center still regularly hears from beneficiaries and families about the termination of skilled nursing and/or therapy services based on an erroneous “Improvement Standard.” Based on our initial review, however, the app does not address the Jimmo Settlement in any of the relevant sections (home health services, skilled nursing facility care, physical therapy, occupational therapy, and speech-language pathology services) to inform users that, contrary to ongoing misconceptions, Medicare does in fact cover skilled maintenance care or skilled care to maintain an individual’s condition, or prevent or slow decline. This is a missed opportunity to fully educate app users at critical moments, such as when a beneficiary receives his or her Notice of Medicare Non-Coverage.
Moreover, we also regularly hear from Medicare beneficiaries classified by hospitals as outpatients on observation status. Although these beneficiaries may be in a hospital for days or weeks, and receive the same care and services as inpatients, Medicare Part A will not cover their stay in the hospital or in a skilled nursing facility. As of March 2017, hospitals are required to give beneficiaries the Medicare Outpatient Observation Notice (MOON) within 36 hours if they are receiving “observation services as an outpatient” for 24 hours. Hospitals must also orally explain observation status and its financial consequences for patients, although beneficiaries have no right to an appeal. The apps’ relevant pages (outpatient hospital services and inpatient hospital care) do not discuss the possibility that a beneficiary could be in the hospital for days without being an inpatient or that a patient should expect to receive a MOON if he or she is classified as an outpatient on observation status. Again, this is a missed opportunity to fully inform beneficiaries and help them navigate another consequential problem in Medicare.
The Center will continue to monitor the “What’s Covered” app. We hope to work with CMS to improve it.
January 2019 – D. Valanejad