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HealthCare Choices Resource Center Bulletin
August 14, 2013
For access to MMW materials, including Bulletins, fact sheets, and recorded webinars, visit our MMW Coalition webpage at
http://ageoptions.org/services-and-programs_makemedicarework.html
Medicare Updates
How to Read a Medicare Summary NoticeThe Centers for Medicare and Medicaid Services (CMS) recently redesigned the Medicare Summary Notice (MSN) that is available electronically for beneficiaries who use www.MyMedicare.gov or mailed to all beneficiaries as a quarterly paper statement. The MSN lists claims for services submitted by providers and includes a list and dates of the services received, the provider submitting the claim, how much Medicare paid and how much the beneficiary may owe.
The Illinois Senior Medicare Patrol (SMP) has created a useful guide called “How to Read a Medicare Summary Notice” to help clients and counselors understand and read the new redesigned MSN. The guide is consumer friendly and provides a detailed page-by-page explanation of key terms and tips on how to check a MSN for important facts and claims. The guide is available on the AgeOptions website here.
Federal Court Settlement on “Improvement Standard” for Medicare Coverage of Therapy and Skilled Care
A settlement approved by a federal court in January (Jimmo V. Sebelius) announces that Medicare coverage of skilled care and therapy cannot be denied for a beneficiary because they do not show “medical improvement” and must be covered when the skilled care or therapy is needed to prevent or slow down deterioration.
The settlement clarifies that Medicare will continue to cover skilled care for a beneficiaries even if they are not improving. Previously, some Medicare skilled care contractors (e.g., skilled nursing facilities, home health agencies) would base Medicare coverage of skilled care and therapy on the “Improvement Standard” which required a beneficiary to be showing “improvement” in order to have Medicare cover skilled care.
CMS is revising their benefit policy manual used by Medicare contractors to clarify the language, but the settlement applies now. CMS has also created and posted a fact sheet on their website that explains the settlement. Click here to read the CMS fact sheet. The Center for Medicare Advocacy also has posted a useful a Jimmo v. Sebelius summary and FAQ on their website.
August 14, 2013
Medicare Handouts with 2013 Costs Now Available in Additional LanguagesCMS recently posted handouts in multiple languages that list the 2013 Medicare Parts A and B premium, deductible and co-insurance amounts. Click here to view the handouts. These handouts are available in the following languages:
English Arabic Armenian Bengali Chinese
Farsi French French
Creole
German Hmong Italian Khmer
Korean Laotian Polish Portuguese Russian
Samoan Spanish Tagalog Tongan Vietnamese
Medicare Part D Benefit Amounts in 2014CMS has announced the 2014 Medicare Part D benefit amounts. In 2014, the Part D benefit phases and cost sharing amounts will decrease. Please see the chart below for the amounts.
2013 2014Annual Deductible (beneficiary pays this amount out-of-pocket in the beginning on the plan year)
Up to $325 Up to $310
Initial Coverage Limit (donut hole begins) $2,970 $2,850Catastrophic coverage begins (donut hole ends) $6,733.75 $6,455True Out-of-Pocket Threshold (TrOOP) $4,750 $4,550Copayment amount for generic or preferred drugs that is a multi-source drug after Catastrophic coverage begins. A multi-source drug is a drug available in brand name and as a generic alternative or equivalent.
$2.65* $2.55*
Copayment amount for all other drugs after Catastrophic coverage begins
$6.60* $6.35*
*During the catastrophic coverage phase in 2013, the consumer pays $2.65/$6.60 or 5%, whichever is greater. In 2014, the consumer will pay $2.55/$6.35 or 5%, whichever is greater.
To view the CMS notice please click here (see pages 58 and 59).
Social Security Updates
Identity Thieves Redirecting Social Security BenefitsThe Office of Inspector General has issued a fraud advisory warning on behalf of the Social Security Administration (SSA) requesting the public, particularly people receiving Social Security benefits, to be weary of disclosing personal information. One new scam involves targeting Social Security beneficiaries and obtaining their personal information to open an account on SSA’s website under the “My Social Security” feature. The scam artist then uses that access to the person’s My Social Security account to change the bank account in which an individual’s Social Security benefits are direct deposited. “My Social Security” is a tool on SSA’s website that allows individuals to open an account and view their Social Security work earnings history, estimated benefits and designate or change where benefits are deposited. If an individual receives a notice from SSA that they have opened a “My Social Security” account but they have not, the person should contact SSA immediately so appropriate action may be taken and the issue can be referred to the Office of Inspector General. Click here to read the warning.
August 14, 2013
Affordable Care Act Updates
CMS Places Halt on Enrollment of New Home Health Agencies in Metropolitan Chicago AreaBeginning July 30, 2014, CMS, using new authority created under Section 6401 of the Affordable Care Act, placed a temporary moratorium or “freeze” on enrollment of home health providers in the Chicago area. This means that CMS is not enrolling new home health providers under Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) in the Chicago metropolitan area. New or pending home health provider applications with practice locations in Cook, DuPage, Kane, Lake, McHenry and Will counties will be denied. The moratorium is meant to address fraud, waste and abuse in certain “fraud hot spots”. According to the fact sheet released by CMS, they will “closely monitor home health billing for suspicious activity to root out fraud. The moratorium will be in place for six months and may be extended or lifted if circumstances warranting the moratorium continue or are resolved”.
CMS took this action in these Chicago area counties because these counties display certain “outliers” compared to other areas. For example, these counties have a high number of home health providers compared to the number of Medicare beneficiaries, an increase of home health provider applications submitted in a short period of time, and high utilization of home health services. Click here to view the CMS notice.
MMW Affordable Care Act Tip Sheets in Other LanguagesThe MMW website now has seven Affordable Act tip sheets available in other languages in addition to English. The tip sheets help consumers understand how the ACA helps them. Available languages include English, Spanish, Chinese, Korean, Polish and Russian. Please feel free to use these tip sheets in your outreach. The tip sheets can be found here and topics include:
The ACA and Closing the Medicare Part D Donut Hole The ACA and New Free Medicare Preventive Services The ACA and Adult Preventive Services (non-Medicare) The ACA Health Insurance Marketplace The ACA and New Rules for Insurance Companies The ACA and Hospital Care Transitions How the ACA Helps People Afford Insurance
Resources
MMW Flow Chart of Health Insurance Coverage Options for Older AdultsMMW has created a useful flow chart to help counselors navigate health care options for older adults age 65 and older. The flow chart can be used to determine if an individual is eligible for Medicare, Medicaid, both Medicare and Medicaid (dual eligible), a plan through the upcoming Health Insurance Marketplace, and other possible scenarios. Click here to view the chart.
Chart of Benefits (Updated)Click on the attachment below for an updated Chart of Benefits created by AgeOptions. The chart lists the income, asset and eligibility requirements for various public programs including the Benefit Access Program, Low-income Subsidy (LIS), Medicare Savings Programs and Medicaid. It also includes eligibility information for Supplemental Security Income (SSI), LIHEAP, Food Stamps, Access to Care, Section 8 housing, and Community Spousal Impoverishment.
August 14, 2013
Kaiser Family Foundation Brief Compares Six Proposed Dual Demonstrations Including Illinois
The Kaiser Family Foundation (KFF) has released an issue brief that compares key points of demonstration projects in six states for dual eligibles (people with Medicare and Medicaid), including the state of Illinois. In Illinois, the upcoming demonstration project is called the Medicare-Medicaid Alignment Initiative (MMAI). Enrollment for MMAI begins in January 2014. The Kaiser brief compares key provisions of these demonstration projects in six different states, including the projects’ target populations, enrollment processes, care delivery model, benefits, financing, and Ombuds Programs. Click here to read the issue brief.
New AgeOptions Facebook PageVisit the new AgeOptions page on Facebook and “Like Us” to learn about the various services and programs of AgeOptions (such as MMW) and to receive updates on topics related to older adults, health care, the Affordable Care Act and more. You can get to the AgeOptions Facebook page by going to your own page and typing “AgeOptions” into the search box or by clicking on this link: https://www.facebook.com/pages/AgeOptions/132016633550504?ref=hl.
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August 14, 2013
