|Editor’s Note: We received some feedback that our text was a bit small, so we are bumping it up for this edition. Please let us know what you think.
A Message from the Executive Director
As many of our readers know, the Center for Medicare Advocacy reached an agreement with the Medicare agency, (the Centers for Medicare & Medicaid Services, also known as CMS) of great import for older and disabled people in the national class action lawsuit, Jimmo v. Sebelius. In the Jimmo case we challenged the “Improvement Standard,” a rule widely used to justify denying Medicare coverage to beneficiaries who are “stable,” “chronic,” “not improving,” or for whom necessary services are for “maintenance only.”
The Jimmo case was filed in 2011 and settled in 2013. In 2014 the Jimmo case should begin to really help Medicare beneficiaries. The Settlement will make major changes in the way Medicare coverage decisions are made for beneficiaries needing skilled care in the home health, nursing home, and outpatient therapy settings. As a result, older and disabled people, particularly those with chronic and long-term conditions, should no longer be denied Medicare and necessary skilled care.
If you or someone you know was denied Medicare based on some form of an “Improvement Standard,” contact us here and tell us your story.
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News You Can Use… and Some WE Need
In general, people who are eligible for Medicare cannot purchase health insurance in the Affordable Care Act (ACA) Marketplace. However, in June, 2013 the IRS clarified that two groups of people eligible for Medicare can chose to forego Medicare and buy ACA Marketplace plans. These people include those who must pay Part A premiums (also called “voluntary enrollees”) and those entitled to Medicare because they have End Stage Renal Disease (ESRD). These two groups may also be eligible to receive tax credits and cost-sharing subsidies to make Marketplace plans more affordable. Read More.
The Center for Medicare Advocacy is interested in hearing from Medicare beneficiaries (or their families) who sought services like medication, therapy or medical equipment from their hospice provider but were denied Medicare coverage and hospice services. In particular, we are interested in hearing from people who meet the following criteria:
1. Their doctor prescribed or recommended a medication, service or item;
The last two criteria (#3 and #4) would be helpful, but are not essential.
Please send your stories to: firstname.lastname@example.org.
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After years of short-term fixes, Congress is finally working to permanently fix the formula by which Medicare pays physicians, known as the Sustainable Growth Rate (SGR). Permanently fixing the SGR could largely be paid for by passing The Medicare Drug Savings Act (S. 740, H.R. 1588), which would allow Medicare to obtain the same prescription drug prices for low-income individuals that Medicaid gets.
Unfortunately, some policymakers have proposed alternate ways to pay for the SGR fix that would harm people with Medicare, including further income-relating (means testing) Medicare premiums, prohibiting or taxing Medigap first-dollar coverage, adding a copayment to the home health benefit (or capping payment based upon episodes of care), or increasing deductibles, coinsurance and copayments. Read more about SGR.
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CMA In the Community
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