January 19, 2010

Troubleshooting Medicare Project Addresses Urgent Systemic Issues Affecting Beneficiaries

HAP’s Troubleshooting Medicare project was launched last summer to identify the persistent systemic issues affecting beneficiaries and their access to care in order to help improve the Medicare program. We asked SHIPs to share their experiences and stories on the issues affecting beneficiaries in four major practice and policy categories: access to care; informed decision making; health care inequities and disparities; and plan design and benefits.

Funded through a grant from the Retirement Research Foundation (RRF), the Troubleshooting Medicare project develops trainings and tools to build SHIP capacity to address identified systemic issues at the individual beneficiary level and at the same time, addresses the issues at the policy level by bringing them to the attention of policymakers and other influential audiences.

HAP has been working on the following systems-level issues based on feedback that you've provided:

• Moving and Extending the Annual Enrollment Period (AEP). HAP has been working for the past eight months to inform members of Congress on the critical need to simplify and move the yearly enrollment periods under Part C and Part D, so beneficiaries have the time they need to make informed choices about their health care. As a result, both the House-passed Affordable Health Care for America Act (H.R. 3962) and Senate-passed Patient Protection and Affordable Care Act (H.R. 3590) contain provisions that would move up the AEP to earlier in the fall. We will continue to advocate on behalf of this important issue, and will provide an update in the February issue of the HAP eNewsletter.
• The Qualified Medicare Beneficiary (QMB) program and Medicare cost-sharing. HAP alerted the SHIP network last summer to a persistent and nationwide access to care issue affecting people enrolled in the QMB program. SHIPs in a number of states reported that their QMB clients were being billed for Medicare cost-sharing amounts by providers even though beneficiaries in the QMB program are entitled to full relief from Medicare cost-sharing under the law. As a result, HAP has developed several capacity-building tools to support SHIPs when working with QMB clients:
  • Getting Started: What SHIPs Need to Know
  • Moving Forward: A Guide to CMS Policy on Cost-sharing
  • Key Terms: QMB and Medicare Cost-sharing

HAP will release an additional QMB counseling guide in the February issue of the HAP eNewsletter. On the policy level, HAP and its partners are continuing to inform the Centers for Medicare & Medicaid Services (CMS) on why this issue requires urgent attention and better coordination of care for people enrolled in the QMB program.

In the meantime, we want to keep hearing from you! Share issues you’ve encountered during the recently concluded AEP by entering them in the Troubleshooting Medicare Issue Log and by joining HAP’s January conference call to discuss your enrollment period experiences. If you have any questions, contact us at SHIPhelp@hapnetwork.org.

Thank you,
The HAP Team

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