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The Centers for Medicare & Medicaid Services (CMS) published a Final Rule this week implementing provisions of the Bipartisan Budget Act of 2018.[1] As detailed in this Rule, Medicare Advantage (MA) plans will be allowed to offer telehealth services as a basic benefit starting in 2020. The Rule limits this telehealth benefit to services available … Read more

Comments to Medicare Marketing Guidelines (MMG) Submitted by Center for Medicare Advocacy April 4, 2019 The following comments were submitted to CMS online via 2020 MCMG feedback tool: https://cmsgov.wufoo.com/forms/cy2020-mcmg-feedback-tool/.  Submitted by David Lipschutz, Senior Policy Attorney, Center for Medicare Advocacy – dlipschutz@medicareadvocacy.org ——————————————————————————– Section: Miscellaneous Communicating About New MA Benefit Flexibilities.  We are disappointed that … Read more

The son of a hospitalized patient recently called the Center for Medicare Advocacy. His father was ready for discharge. Physicians at both the hospital and the inpatient rehabilitation hospital (IRH) agreed that the patient would benefit from IRH services. However, the patient’s Medicare Advantage (MA) plan refused to authorize IRH care.  The plan instead said … Read more

On January 30, 2019, the Centers for Medicare & Medicaid Services (CMS) issued Part II of its draft 2020 Call Letter, an annual set of proposed rules, guidelines and clarifications for Part C Medicare Advantage (MA) and Part D plans that want to participate in Medicare in the following calendar year. In collaboration with several … Read more

Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to preserve and expand consumer protections and quality coverage for all Medicare Beneficiaries – including parity between traditional Medicare and private Medicare … Read more

Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to preserve and expand consumer protections and quality coverage for all Medicare Beneficiaries – including parity between traditional Medicare and private Medicare … Read more

The Center for Medicare Advocacy recently submitted comments to a Notice of Proposed Rulemaking issued by the Centers for Medicare & Medicaid Services (CMS) entitled “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses” (CMS-4180-P).  The Center’s comments are available at: https://www.medicareadvocacy.org/center-comments-on-modernizing-part-d-and-medicare-advantage/.   Currently, Part D prescription drug plans (PDPs) … Read more

As reported widely, including in The New York Times,[1] the Trump Administration spent this Medicare Annual Enrollment Period steering beneficiaries towards private Medicare Advantage (MA) plans. While CMS contests this conclusion, Administrator Verma stated they are “unleashing and strengthening” Medicare Advantage[2] and HHS Secretary Azar says he sees Medicare Advantage as the future of Medicare: … Read more

Dear CMA, I am a retiree and my health plan is Medicare. I am retired 13 years and never have had any problem with my Medicare coverage. Most of my doctors accept Medicare and I have been very pleased with their services. I have become increasingly troubled by the targeted ads to seniors on TV … Read more

The Medicare Annual Coordinated Election Period (ACEP) is the most crucial time of year for Medicare beneficiaries to make decisions about how they wish to receive their Medicare coverage.  This year the Administration seems to be actively promoting Medicare Advantage plans. However, at the same time that this steering toward private plans is occurring, the … Read more

As we approach the final week of the Medicare Annual Coordinated Election Period (ACEP), individuals continue to make decisions about how they want to access their Medicare benefits in 2019.  Consumer advocates are concerned, however, that the information put out by the Medicare program about coverage options is incomplete and continues to promote one option … Read more

The November 2018 New England Journal of Medicine features a article by KFF’s Tricia Neuman and Gretchen Jacobson of the Kaiser Family Foundation (KFF) that “examine[s] the extent to which Medicare Advantage plans are achieving goals with respect to benefits, out-of-pocket costs, plan choice, federal spending and quality. They also highlight areas where more evidence … Read more

The Department of Health and Human Services (DHHS) Office of Inspector General (OIG) recently issued a report entitled “Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials” (OEI-09-16-00410) (see summary and full report). Among the report’s findings are that when beneficiaries and providers appealed preauthorization and payment denials, MA plans … Read more

Providing Medicare Beneficiaries with Complete, Objective Information to Help Them Make the Best Enrollment Decision The Center for Medicare Advocacy and the National Committee to Preserve Social Security and Medicare have partnered to develop an education and outreach project to support Medicare beneficiaries and those who assist them enroll and re-enroll in Medicare. The Medicare … Read more

September 2018 Numerous changes were made to Medicare law, regulations and guidance during the first half of 2018.The changes are particularly noteworthy regarding Part C, governing private Medicare plans, known as Medicare Advantage (MA), and Part D, the prescription drug benefit.This report focuses on the impact to Medicare beneficiaries from changes to Parts C and … Read more

As reported in FierceHealthcare, “Medicare Advantage insurers scored a significant legal victory” when a U.S. District Court judge recently “struck down a 2014 rule requiring [plans] to report and return overpayments.”  Further, according to Modern Healthcare, this ruling “leaves the federal government with fewer tools to combat upcoding practices that cost the taxpayer-funded Medicare program … Read more

Researchers studying patients with hip fractures found that patients with Medicare Advantage (MA) plans have shorter stays in skilled nursing facilities (SNFs) and receive less rehabilitation than patients in traditional Medicare, but are, nevertheless, less likely to be readmitted to an acute care hospital within 30 days or to become long-term care residents.[1]  These findings … Read more

Ranking Committee Members Echo Advocates’ Complaints to CMS about Draft 2019 Medicare & You As discussed in a previous CMA Alert, the Center for Medicare Advocacy, Justice in Aging and the Medicare Rights Center recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) raising “strong objections to serious inaccuracies” in the … Read more

The Center for Medicare Advocacy, Justice in Aging and the Medicare Rights Center recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) raising “strong objections to serious inaccuracies” in the draft 2019 Medicare & You Handbook, and urged CMS to rectify the errors prior to dissemination.  As stated in a joint … Read more

On April 26, 2018, the Center for Medicare Advocacy provided comments to the Centers for Medicare & Medicaid Services (CMS) in response to an April 12, 2018  Request for Input on the 2019 Medicare Communications and Marketing Guidelines (MMG).  Unlike previous opportunities to provide comment, CMS did not offer draft language for revisions to the … Read more

Part C of the Medicare program, also known as Medicare Advantage (MA), is an option available to Medicare beneficiaries who wish to receive their benefits through private insurance companies, primarily HMOs.  In 2017, more than 19 million Medicare beneficiaries (33%) were enrolled in MA plans.  MA enrollment is projected to continue to grow, rising to … Read more

On February 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued its draft 2019 Call Letter, an annual set of proposed rules, guidelines and clarifications for Part C Medicare Advantage (MA) and Part D plans that wish to participate in Medicare in the following calendar year.  In collaboration with several other advocacy organizations, … Read more

The Journal of the American Medical Association (JAMA), recently published a Viewpoint article entitled “Time to Release Medicare Advantage Claims Data” by Niall Brennan, Charles Ornstein, and Austin B. Frakt (February 19, 2018).  After pointing out that almost 33% of the Medicare population is enrolled in Medicare Advantage (MA) plans at a cost of over $200 billion a year, … Read more

“Medicare Advantage Enrollees More Likely to Enter Lower-Quality Nursing Homes Compared to Fee-For-Service Enrollees,” a report recently published by Health Affairs, examines the quality of skilled nursing facilities (SNFs) used by Medicare Advantage (MA) enrollees and traditional Medicare beneficiaries. As the title indicates, the authors of the report found that traditional Medicare beneficiaries “tended to … Read more

Tax Cut Bill Just Got Worse. Health Care at Risk. This Week in Sabotage CMS Steering to Medicare Advantage Administration And Nursing Home Industry: Lockstep in Deregulating Nursing Facilities & Reducing Resident Protections Tax Cut Bill Just Got Worse.  Health Care at Risk. Free Webinar Series Next Webinar: Hospital Observation Status Update January 24, 2018 … Read more

CMA Alert – Remember You CAN Choose Original Medicare; Equitable Relief; This Week’s Sabotage News

You Can Choose Original Medicare: CMS Over-Emphasizes Private Medicare Advantage Plans in Open Enrollment Roll-Out CMS Extends Equitable Relief  CMA Joins 30 Organizations in Amicus Brief in Support of Court Challenge to Trump ACA Sabotage And THIS Week in ACA Sabotage… Auto-Enrollment… And No Time to Switch More Repeal Disguised as Reform You Can Choose Original … Read more

CMA Alert – Critical Issue Roundup: MA Overpayment; HH Payment; Observation; More

Former CMS Administrator Comments on Medicare Advantage Overpayments Proposed Home Health Rules – Payments Drive Delivery of Care, Harming Beneficiaries Observation Status Harms Low-Income Medicare Beneficiaries Poll: Americans Favor Making the ACA Work Former CMS Administrator Comments on Medicare Advantage Overpayments In Austin Frakt’s August 7, 2017 The Upshot blog in the New York Times … Read more

As noted in a previous Alert, the Center for Medicare & Medicaid Services (CMS) recently finalized their 2018 Call Letter.  In the same document, CMS issued a Request for Information regarding ideas for “regulatory, sub-regulatory, policy, practice and procedural changes to better accomplish” the goals of “using transparency, flexibility, program simplification and innovation to transform … Read more

April 24, 2017 VIA ELECTRONIC SUBMISSION PartCDcomments@cms.hhs.gov Seema Verma, Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Baltimore, MD 21244 Re:                  2017 Transformation Ideas – Response to Request for Information re: Medicare Advantage and Part D Dear Administrator Verma: The Center for Medicare Advocacy (Center) is pleased to provide … Read more

Last month in Connecticut, United Healthcare (UHC) set off a panic among its Medicare Advantage (MA) enrollees by sending out letters indicating that they would no longer be affiliated with Hartford HealthCare HHC), one of Connecticut’s largest provider networks. These MA enrollees often received multiple letters – one for each of their HHC providers. One … Read more

On February 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued its draft 2018 Call Letter, an annual set of proposed rules, guidelines and clarifications for Part C Medicare Advantage (MA) and Part D plans that wish to participate in Medicare in the following calendar year.  In collaboration with several other advocacy organizations, … Read more

In last week’s Alert, we posed 10 questions to ask before deciding between traditional Medicare and a Medicare Advantage Plan. This week we discuss what your answers may mean. Do you qualify for payment assistance or have access to other coverage through any of the following… Medicare Savings Program? Part D Low Income Subsidy? Employer/Military/Other … Read more

Do you qualify for payment assistance or have access to other coverage through any of the following… : Medicare Savings Program? Part D Low Income Subsidy? Employer/Military/Other Insurance? Medigap Plan? Which providers/facilities will you want to use? How important is it to you to continue seeing them? Do they accept Medicare? What Medicare Advantage Plan … Read more

In a June 2016 Weekly Alert the Center wrote about a process called “seamless conversion enrollment” used by some insurance companies that offer Medicare Advantage (MA) plans to capture enrollment among their pre-Medicare plan enrollees.  As we noted, “Medicare rules allow MA plan sponsors to ‘develop processes to provide seamless enrollment in an MA plan … Read more

Prescription Drug Pricing An excellent and well-timed (given #Epi-gate) article appeared in this week’s Journal of the American Medical Association discussing the reason drug costs are so high in the U.S. According to the article, the major cause is the “granting of government-protected monopolies to drug manufacturers, combined with restriction of price negotiation at a … Read more

A recent post by health economist Uwe Reinhardt in the Journal of the American Medical Association Forum discusses the fact that despite all the support Medicare Advantage (MA) plans have received, the vast majority of Medicare beneficiaries still prefer Traditional Medicare. 30% of Medicare recipients now receive their coverage through MA plans. This is largely because … Read more

October 21, 2016 – Update on Seamless Conversion: CMS is revisiting the seamless conversion enrollment policy and is temporarily suspending its acceptance of any new seamless enrollment proposals. Read more… Ms. M., a Medicare beneficiary living in the Southwest, turned 65 in October 2015 and became eligible for Medicare on October 1st. On September 30th she signed … Read more

This week the General Accounting Office (GAO) issued a report entitled “Medicare Advantage: Fundamental Improvements Needed in CMS’s Effort to Recover Substantial Amounts of Improper Payments.  The report states that the Centers for Medicare & Medicaid Services (CMS) estimates that about 9.5% of its annual payments to Medicare Advantage (MA) organizations were improper – totaling … Read more

On March 8, 2016, the Centers for Medicare and Medicaid Services (CMS) released a memorandum entitled “Suspension of Policy Providing for Automatic Reduction of Star Ratings for Contracts Operating Under Intermediate Sanction.” Through this memo, CMS has suspended its policy of lowering the star ratings of Medicare Advantage plans that are under sanction for violations … Read more

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

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