New data released this week shows that families and individuals who rely on Medicare continue to see direct benefits from the Affordable Care Act by saving billions of dollars on prescription drug costs.[1] So far in 2012, older and disabled Americans have saved an average of $837 on their drug purchases after reaching the donut-hole … Read more

Effective January 1, 2012, Medicare Part D plan enrollees who are unable to obtain a prescription drug at the pharmacy are now, in most instances, entitled to a written notice explaining how they can contact their Part D plan in order to initiate an appeal.  On February 2, 2012, CMS announced that the final model … 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

Once again the Medicare Advantage and Part D Annual Coordinated Election Period (ACEP) is upon us; it's time to contemplate Medicare prescription drug and Medicare Advantage choices for another calendar year.  The big news is that the ACEP, while one week longer than in the past, starts and ends much earlier this year.  The ACEP … 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

On April 15, 2011, the Centers for Medicare & Medicaid Services (CMS) issued final regulations to provide policy and technical changes to the Medicare Parts C (Medicare Advantage) and D programs.[1]  The regulations address concerns raised by Medicare beneficiary advocates, and implement provisions of the Affordable Care Act.  They also codify into regulation some existing … Read more

The Centers for Medicare & Medicaid Services (CMS) announced that it is sending "Choosers Reminder Notices" to approximately 944,000 Medicare beneficiaries who are eligible for the Part D low-income subsidy (LIS).  The notices, which are being mailed from May 26 – May 31, are designed to remind these individuals that the drug plan in which … Read more

The Social Security Administration (SSA) has released state by state information on numbers of individuals whose Part D low income subsidy (extra help) will end March 31 if they do not respond to SSA’s request for information concerning their continued eligibility.  Nationwide, 86,789 low-income Medicare beneficiaries subject to routine redeterminations had not responded to SSA … Read more

Some Medicare beneficiaries lost prescription drug coverage at the end of 2010 because their Medicare Advantage (MA) plan or prescription drug plan (PDP) either did not renew its contract with the Centers for Medicare & Medicaid Services (CMS) or reduced the service area it served, and they did not enroll in a new plan.  These … Read more

Federal poverty level (FPL) guidelines for 2011 were published in the Federal Register January 20, 2011. 76 FR 3637 (January 20, 2011).  The guidelines provide the baseline for eligibility levels for many public benefits, including health benefits for older people and people with disabilities.[1] The published poverty levels merely state a dollar figure for different-sized … Read more

Starting this year, the Medicare Advantage Open Enrollment Period (OEP) has been replaced by a new Medicare Advantage Disenrollment Period (MADP), which lasts from January 1st through February 14th.[1] During the MADP, one can switch from an MA plan to traditional Medicare.  The new MADP also provides an opportunity to pick up Part D drug … Read more

October 7, 2010 For Immediate Release Contact: Judith Stein, (860) 456-7790 Vicki Gottlich, (202) 293-5760 The Center for Medicare Advocacy, Inc., a national, non-profit organization that advocates on behalf of older people and people with disabilities, joins other aging organizations today in thanking Health and Human Services Secretary Kathleen Sebelius for making it easier … Read more

In a lengthy, detailed, and complex decision, a federal appellate court rejected the right of Part D beneficiaries to sue a plan for damages when the plan fails to enroll them in a timely manner.[1] The decision, which was issued on August 31, 2010, makes clear the Court's view that Congress did not intend beneficiaries … Read more

September, 2010 While the Medicare prescription drug benefit provides assistance for many people with their drug costs, the requirements for coverage of the off-label use of a drug are onerous and often result in beneficiaries not being able to get the drug coverage they need.  Unfortunately, the information the law requires beneficiaries to submit to … Read more

Medicare beneficiaries who enter the prescription drug coverage gap (known as the "Donut Hole") anytime before the end 2010 should receive a one time $250 rebate check from Medicare.  The first checks, for people who hit the Donut Hole by March 31, 2010, should arrive around June 10, according to Secretary of the Department of … Read more

In 2006 the Centers for Medicare & Medicaid Services (CMS) created the “Point-of-Sale Facilitated Enrollment” (POS) process, administered by WellPoint.  The purpose of the POS is to assist people who are dually eligible for Medicare and Medicaid (dual eligibles) in filling their prescriptions at the pharmacy if they have not yet been assigned to a … Read more

Medicare Part D coverage is complex, particularly when a prescription drug claim crosses multiple phases of the benefit.  These “straddle claims” make it particularly challenging to determine what a beneficiary owes, but it is important to be accurate, particularly when the claim straddles a coverage gap, resulting in expense to the beneficiary. Standard Medicare Part … 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