Category

Medicare

Fact Sheet: Open Enrollment for 2020 Coverage through Medicare & Covered California—Basics for Advocates

By | Affordable Care Act, CA Health Network Alert, FACT SHEET, Health Care, Medicare, REPORTS

Justice in Aging has updated our California fact sheet that provide the essential information advocates for older adults need to know about this year’s open enrollment periods for both Medicare and the Affordable Care Act Marketplaces. Changes consumers make to either their Medicare or Marketplace coverage during open enrollment will take effect January 1, 2020.

Fact Sheet: Open Enrollment for 2020 Coverage through Medicare & the Marketplace—Basics for Advocates

By | Affordable Care Act, FACT SHEET, Health Care, Medicare, REPORTS

Justice in Aging has updated our national fact sheet that provide the essential information advocates for older adults need to know about this year’s open enrollment periods for both Medicare and the Affordable Care Act Marketplaces. Changes consumers make to either their Medicare or Marketplace coverage during open enrollment will take effect January 1, 2020.

Issue Brief: Adding a Dental Benefit to Medicare – Addressing Racial Disparities

By | Health Care, ISSUE BRIEF, Medicare, Oral Health, REPORTS

The Medicare statute currently excludes nearly all dental coverage for the 60 million older adults and people with disabilities who rely on the program. This dental exclusion disproportionately impacts populations of color, who suffer adverse oral health outcomes at significantly higher rates than white older adults.

Justice in Aging’s new issue brief, Adding a Dental Benefit to Medicare: Addressing Racial Disparities, examines how adding an oral health benefit to Medicare would address disparities in access to care and oral health outcomes based on race, and puts forth additional policy options that can be implemented to further advance oral health equity.

This issue brief is the first in a series of papers that will examine how to address disparities in access to care and oral health outcomes among certain groups of Medicare beneficiaries, including people of color, people with disabilities, older adults with dementia and cognitive impairments, and nursing facility residents. 

W & M Eyes Rx Savings to add Part B Benefits, GOP Would Hike Trust Fund

By | Health Care, IN THE NEWS, Medicare

Inside Health Policy: W&M Eyes Rx Savings To Add Part B Benefits, GOP Would Hike Trust Fund (October 22, 2019)

The House Ways & Means Committee passed legislation to add vision, hearing and dental benefits to Medicare Part B. Justice in Aging is in support of this legislation because these benefits are necessary for Medicare recipients to be able to afford to pay for the care they need. Jennifer Goldberg, Justice in Aging’s Deputy Director, was interviewed for this article in which she shared Justice in Aging’s view that adding these benefits to Part B would be consistent with the growing recognition that oral health care should be more fully integrated into overall health, both in Medicare and more broadly, and that doing so will not impact the Medicare Trust Fund. Justice in Aging sent a letter to Ways & Means and the House Energy & Commerce Committee in strong support of H.R. 3. This article is behind a paywall. This is a summary.

Look-Alike Medicare Plans Have Regulators Rethinking New Rules

By | IN THE NEWS, Medicare

Bloomberg Law: Look-Alike Medicare Plans Have Regulators ReThinking New Rules (October 17, 2019)

Low-income individuals who are dually eligible for both Medicare and Medicaid are being targeted by private “look-alike” plans that imitate Dual Eligible Special Needs Plans (D-SNPS) and promise extra benefits, but often don’t deliver and can expose enrollees to extra costs. Justice in Aging Directing Attorney Amber Christ was interviewed for the article, in which she stated, “So they sign up thinking that they’re getting something more, but what ends up happening is because there’s no coordination [between Medicare and Medicaid], they end up getting billed for services that they would have gotten free under the Medicaid program. There’s just an increased risk for that kind of improper billing to happen.”

The CMS had proposed new restrictions on marketing the look-alike plans but has walked away from the proposal, saying in an April letter that some Medicare Advantage plans felt look-alikes have a “legitimate place in the Medicare Advantage marketplace in areas where there are no DSNPs.” This article is behind a paywall. This is a summary.

Medicare Races to Fix Flaw in New Tool that Lets Millions of Seniors find Cheap Drug Plans

By | IN THE NEWS, Medicare, NEWS, Newsroom

Boston Globe: Medicare Races to Fix Flaw in New Tool that Let’s Millions of Seniors Find Cheap Drug Plans (September 10, 2019)

The Centers for Medicare and Medicaid Services (CMS) released its new Medicare Plan Finder on August 27. The Plan Finder is an important tool for 45 million Medicare beneficiaries during the annual enrollment period. Advocates are concerned that the Plan Finder makes it more difficult for users to evaluate the costs of their drugs and other services in relation to the costs of their overall plans, among other problems with the plan, and could lead to users choosing a plan that is not the best one for them. Justice in Aging is mentioned in this story as one of the four advocacy groups who sent a letter to Medicare Administrator, Seema Verna, expressing concern about the Plan Finder.

FAQ: Low-Income Subsidy (“Extra Help”) for Dual Eligibles Receiving Home and Community-Based Services

By | FACT SHEET, Health Care, Health Care Defense, Home & Community Based Services, Medicaid, Medicare, REPORTS

The Affordable Care Act (ACA) enables full-benefit dual eligibles who receive certain Medicaid home and community-based services (HCBS) to receive Medicare Part D covered drugs at no cost. This requirement is called institutional cost-sharing, and was designed to put people who receive HCBS at home on an equal footing with those who are in institutions (who are also not charged any co-pays). Unfortunately, despite the institutional cost-sharing requirement, pharmacies still ask dual eligibles to pay co-pays for covered drugs.

Justice in Aging created an FAQ, Low-Income Subsidy (“Extra Help”) for Dual Eligibles Receiving Home and Community-Based Services, to give advocates working with dual eligibles the tools they need to prevent these co-pays. The FAQ discusses whom the cost-sharing rule applies to, the length of the cost-sharing protection, and what to do if a dual eligible HCBS-enrolled individual is prompted for a co-pay at the pharmacy or is entitled to a refund. Advocates should review the FAQ and make sure to their HCBS-enrolled dual eligibles are not paying any co-pays for their Part D drugs.

Free Webinar: The Qualified Medicare Beneficiary (QMB) Program—An Update for Advocates: Part 2 of 2

By | Health Care, Medicaid, Medicare, WEBINAR, Webinar Trainings

When: Wednesday, July 24, 2019 11 am-12 pm PT/2-3 pm ET​

The Qualified Medicare Beneficiary (QMB) program provides significant Medicare cost savings to low income individuals, including payment of Medicare premiums and protection from liability for any Medicare co-insurance or deductibles for health services. Those enrolled in the program also are automatically enrolled in the Part D Low Income Subsidy program (LIS). Despite its value, the QMB program is chronically under-enrolled. Many eligible individuals don’t know about the program or face barriers when they try to enroll. Those who are enrolled often face difficulties in accessing QMB protections.

This two-part webinar series gives advocates updated information on the QMB benefit and tools to use to ensure that their clients are enrolled and can use the benefit effectively.

Part One provides an overview of the QMB program, including eligibility criteria and program basics and focus on the specifics of QMB billing protections. We focus on recent improvements that make it easier for QMBs and their advocates to understand their payment responsibilities and the tools available to address problems with providers who improperly bill QMBs. We also distinguish between the QMB program and a Medicaid agency’s Part B buy-in agreement, and discuss QMB issues in Medicare Advantage.

Part Two focuses on enrollment. It looks at barriers to QMB enrollment, including problems that have arisen in various states and advocacy approaches, especially for individuals with Medicaid linked to Supplemental Security Income. We explore both ways to untangle individual problems and ways to work with your state to improve QMB enrollment systemically.

Who should participate:
Aging and legal advocates, community-based providers and others who counsel older adults on health benefits.

Presenters:
Denny Chan, Senior Staff Attorney, Justice in Aging
Georgia Burke, Directing Attorney, Justice in Aging

Part 1 occurs on Tuesday, July 23, 2019 11 am-12 pm PT/2-3 pm ET​

WATCH THE WEBINAR
DOWNLOAD THE POWERPOINT

Free Webinar: The Qualified Medicare Beneficiary (QMB) Program—An Update for Advocates: Part 1 of 2

By | Health Care, Medicaid, Medicare, WEBINAR, Webinar Trainings

When: Tuesday, July 23, 2019 11 am-12 pm PT/2-3 pm ET

The Qualified Medicare Beneficiary (QMB) program provides significant Medicare cost savings to low income individuals, including payment of Medicare premiums and protection from liability for any Medicare co-insurance or deductibles for health services. Those enrolled in the program also are automatically enrolled in the Part D Low Income Subsidy program (LIS). Despite its value, the QMB program is chronically under-enrolled. Many eligible individuals don’t know about the program or face barriers when they try to enroll. Those who are enrolled often face difficulties in accessing QMB protections.

This two-part webinar series gives advocates updated information on the QMB benefit and tools to use to ensure that their clients are enrolled and can use the benefit effectively.

Part One provides an overview of the QMB program, including eligibility criteria and program basics and focus on the specifics of QMB billing protections. We focus on recent improvements that make it easier for QMBs and their advocates to understand their payment responsibilities and the tools available to address problems with providers who improperly bill QMBs. We also distinguish between the QMB program and a Medicaid agency’s Part B buy-in agreement, and discuss QMB issues in Medicare Advantage.

Part Two will focus on enrollment. It will look at barriers to QMB enrollment, including problems that have arisen in various states and advocacy approaches, especially for individuals with Medicaid linked to Supplemental Security Income. We will explore both ways to untangle individual problems and ways to work with your state to improve QMB enrollment systemically.

Who should participate:
Aging and legal advocates, community-based providers and others who counsel older adults on health benefits.

Presenters:
Denny Chan, Senior Staff Attorney, Justice in Aging
Georgia Burke, Directing Attorney, Justice in Aging

WATCH THE WEBINAR
DOWNLOAD THE POWERPOINT

Issue Brief: D-SNP Look-Alikes – A Primer

By | DUAL ELIGIBLES, ISSUE BRIEF, Medicaid, Medicare, REPORTS

More dual eligibles—individuals with Medicare and Medicaid—are enrolling in a certain type of Medicare Advantage plan as a result of aggressive marketing efforts targeting dual eligibles. This type of plan, known as a Dual Eligible Special Need Plan (D-SNP) Look-Alike, threatens to undermine promising advancements in integrated care for duals made possible by the Affordable Care Act (ACA). D-SNP look-alikes are not subject to the regulations governing D-SNPs and therefore have no responsibility to coordinate Medicare and Medicaid benefits. Because they are marketed aggressively almost exclusively to duals, they draw dual eligibles away from coordinated options and place responsibility on the consumer to navigate two separate delivery systems, potentially exacerbating disruptions and gaps in care.

Justice in Aging created this issue brief, Dual Eligible Special Need Plan Look-Alikes – A Primer, to help educate advocates working with dual eligibles about the impact of these plans on dual eligibles and to request that advocates report experiences with D-SNP look-alikes to Justice in Aging and CMS.

This new issue brief:

  • Outlines some key requirements of D-SNPs;
  • identifies the basic characteristics of D-SNP look-alikes;
  • discusses problems look-alikes are causing for dual eligibles; and
  • proposes ways to restrict them in the Medicare market.