A new Justice in Aging fact sheet details how they can enroll in the Qualified Medicare Beneficiary (QMB) Program to get their Medicare premiums paid through their state Medicaid program. Enrolling in QMB can be confusing for people without Part A coverage and often requires visits to both the Social Security Administration office and the state’s Medicaid program offices. A further complication is that many Social Security offices have used conflicting and incorrect procedures or provided misinformation to applicants. Read More
Washington, DC 2018 – Justice in Aging, along with a diverse group of partners, released a white paper, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care. This white paper is an interprofessional, collaborative effort written and published by leaders in the consumer, healthcare and dental fields, including the American Dental Association, Center for Medicare Advocacy, the Dentaquest Foundation, Families USA, Justice in Aging, Oral Health America and the Santa Fe Group.
With an expected 72.1 million seniors living in the United States by 2030, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care, outlines the need for oral health care coverage for Medicare recipients and the importance of it being integrated with, and elevated to, the same importance as the rest of health care in Medicare. Read More
Oral health is an integral part of overall health. Oral health problems can adversely affect one’s ability to maintain optimal nutrition, self-image, social interactions, and mental and physical health. Oral health problems can lead to chronic pain, tooth loss and serious infections. Poor oral health can even worsen chronic medical conditions such as heart disease and diabetes.
Older adults need timely and affordable access to dental care in order to maintain their health and well-being, yet, there is currently no mechanism for most older adults to access care. Contrary to what many believe, Medicare does not include an oral health benefit. Most older adults cannot afford to purchase private oral health insurance or pay out-of-pocket for the care they need. As a result, 70 percent of Medicare recipients have limited or no dental coverage, and fewer than half see a dentist each year.
A new White Paper, An Oral Health Benefits in Medicare Part B: It’s Time to Include Oral Health in Health Care discusses how a Medicare Part B dental benefit would close disparities in dental use and expense between the uninsured and insured and among older adults with few financial resources and limited oral health education. The paper also details how such a benefit could be structured and the legislative changes that would need to happen before such a benefit could be established.
Older adults and their families strive each day to pay for health care and medicine, keep food on the table, have a roof over their heads, and have enough cash on hand to pay the utilities, get where they need to go and meet other basic needs. As families work together to meet these challenges, they are supported by a broad range of federal programs that provide Americans with the means to thrive as they grow older and remain at home and in their communities.
This issue brief discusses how these various programs work, who is eligible for them, and how they support the health and economic well-being of older Americans. For a quick overview, check out the fact sheet.
Federal law prohibits charging Qualified Medicare Beneficiaries (QMBs) with Medicare cost-sharing for covered services. Depending on state law, other beneficiaries who are fully eligible for both Medicare and Medicaid–full benefit dual eligibles–may also be protected from being billed for co-payments or other forms of cost sharing.
However, QMBs and other dual eligibles may still be responsible for certain charges or fees. A new Justice in Aging Issue Brief: Advance Beneficiary Notices, Administrative Fees, and Dual Eligibles explains for advocates the situations under which these types of beneficiaries may be responsible for charges.
Read the brief to learn what protections QMBs have and what charges they may have to pay.
Additional Justice in Aging resources on improper billing can be found here.
On February 9, Congress passed the Bipartisan Budget Act of 2018 (BBA of 2018). In addition to its budget provisions, the BBA extends and makes changes to several Medicare programs and provides funding for other health programs that support low-income older adults, people with disabilities, and their families.
Justice in Aging has prepared a summary of some of the major health provisions in the BBA of 2018, including funding for Community Health Centers and outreach to low-income Medicare beneficiaries, the Medicare therapy cap repeal, Part D “donut hole” closure, and authorization of Special Needs Plans and other Medicare Advantage changes. As these changes are implemented, Justice in Aging will continue to provide updates and analysis and identify advocacy opportunities.
On October 2, 2017, the Centers for Medicare and Medicaid Services (CMS) initiated changes in the Provider Remittance Advice and the Medicare Summary Notice (MSN) to show more clearly that Qualified Medicare Beneficiaries (QMBs) may not be charged for Medicare deductibles and co-insurance. Unfortunately, CMS will be temporarily suspending these system changes as of December 8 because of significant unforeseen issues affecting provider payments. CMS is working to address the problem and reinstate the new systems sometime in 2018.
The temporary suspension of the system improvements does not affect the rights of QMBs. QMBs do not owe deductibles and co-insurance for any Medicare Part A or Part B services.
The suspension also does not affect another change, instituted in November, that enables providers to confirm QMB eligibility before serving individuals, using the same systems through which they check other insurance coverage.
To learn more about these developments, read our fact sheet.
For more information on QMB protections, see the CMS QMB Program webpage. For tools that advocates can use to assist QMB clients who have been improperly billed, go to Justice in Aging’s Improper Billing page.
Congress is moving very quickly, aiming to have a bill signed into law by the end of the year. Advocates’ voices are needed to stop this reckless process that jeopardizes health care for millions. Our new fact sheet outlines the threats to health care for older adults and their families in both the House and Senate bills.