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I. Breaking News
- Government Accountability Office to Assess 1-800-Medicare
II. HAP HAPpenings
- HAP's Annual Enrollment Period Toolkit
- Plan Offerings for 2008
III. Highlights from CMS
- CMS Posts Corrective Action Plan Data
- Revisions to Medicare Advantage Grievances and Appeals
- CMS Announces Medicare Cost-Sharing for 2008
- LIS Late Enrollment Penalties Eliminated through 2008
- Mailings Regarding LIS Changes Are Under Way
- Medigap Out-of-Pocket Limits for 2008
- Reminder: Part D Plan Comparisons Release October 11
IV. Items of Interest
- Evaluating the Success of Part D
- Exploring the Challenges of LIS Outreach
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Celebrating SHIP Successes!
NEW Medicare Protection Toolkit from Alabama
The Alabama SHIP has been busy this year developing a new tool that empowers Alabama beneficiaries to prevent Medicare fraud.
The Medicare Protection Toolkits are a joint effort of the Alabama Department of Senior Services' (ADSS) Healthcare Fraud Advocacy and Outreach Council and the Alabama Association for Justice. Each toolkit contains:
- Questions for seniors to ask salespeople,
- Facts on healthcare benefits options,
- Features to look for when considering a healthcare plan, and
- Four steps seniors can take to safeguard their Medicare.
The toolkit is available for download from the ADSS website at http://www.AlabamaAgeline.gov. Please contact the Alabama SHIP Coordinator and Senior Medicare Patrol Director, Robyn James, at Robyn.James@adss.alabama.gov with questions about how your SHIP can use this toolkit.
Great Work Alabama! |
I. Breaking News
Government Accountability Office to Assess 1-800-Medicare
Fortney Pete Stark (D-Calif.), Chairman of the House Ways and Means Subcommittee on Health, asked the Government Accountability Office to assess "key aspects of the [Medicare] call centers' customer service." Specific issues highlighted for investigation are telephone wait times for beneficiaries, how well non-English speaking callers are assisted, and the "completeness and accuracy" of information provided to callers by 1-800-Medicare.
II. HAP HAPpenings
Check out HAP's Annual Enrollment Period Toolkit
You can find tools and resources to help with Part D enrollment efforts this fall. Please send suggestions for additional tools to Kelly at kbrantley@hapnetwork.org.
Plan Offerings for 2008
CMS posted data on Medicare Advantage plans (MAs), special needs plans (SNPs), and prescription drug plans (PDPs) by state and county.
If you would like to work with HAP to create a state-specific chart for your program, please contact us at shiphelp@hapnetwork.org. An example of the Tennessee state chart is available on our website.
III. Highlights from CMS
CMS Posts Corrective Action Plan Data for MA and Drug Plans
CMS imposed Corrective Action Plans (CAP) on MA and Medicare drug plans to improve deficiencies in the following areas: appeals, marketing, enrollment and disenrollment, beneficiary protections, pharmacy access, formularies and transition policies, provider communications, record maintenance, quality assurance, and contracts. Between January 2006 and October 1, 2007, 129 plans were audited. From CMS's recently released data, it appears that only two plans have been terminated to date; however, many audits remain open.
A summary of the CAP data, along with detailed reports of each audit, are now public. CMS has a brief description of the corrective action process.
The New York Times published an analysis of Corrective Action Plans on October 7, 2007.
Revisions to Medicare Advantage Grievances and Appeals
September 21 revisions to Chapter 13 of the Medicare Managed Care Manual (Section 40.2.2) may affect the rights of Medicare Advantage (MA) enrollees to receive timely notice of their ability to appeal. With no new mandate from Congress, CMS seems to be reversing a notice procedure policy that originated more than ten years ago in response to the Grijalva line of cases and provisions of the Balanced Budget Act (BBA) of 1997. Under the new revisions, if a Medicare plan decides to deny, discontinue, or reduce services or payments, written notice is triggered only if the beneficiary believes that services should be covered.
Depending on how this change is implemented, it may impact enrollees' ability to appeal decisions, especially if beneficiaries are unaware of the timeframe they have to file appeals. These changes also raise concerns about how beneficiaries can effectively communicate their expectations regarding Medicare coverage. Please share any changes in your experiences with MA appeals processes with HAP.
CMS Announces Medicare Cost-Sharing for 2008
Part A: Medicare Part A pays for inpatient hospital, skilled nursing facility, hospice, and certain home health care services with a $1,024 deductible for 2008. The individuals that obtain Part A coverage by paying a monthly premium will see this premium rise to $423 per month in 2008, a $13 increase over the 2007 rate.
Part B: The standard Medicare Part B monthly premium will be $96.40 in 2008. In 2008, the Part B deductible will be $135, compared to $131 in 2007.
For more information regarding cost-sharing for Parts A and B, see this CMS factsheet.
LIS Late Enrollment Penalties Eliminated through December 2008
Medicare beneficiaries who qualify for the Part D low-income subsidy will not be subject to any late enrollment penalties through December 31, 2008.
Mailings Regarding LIS Changes Are Under Way
HAP's Chart, Links to Mailings, used in conjunction with CMS's chart, Guide to CMS, SSA and Plan Mailings -- Summer and Fall 2007, summarizes the letters and notices mailed to beneficiaries in the coming months, including the low-income subsidy (LIS) or "Extra Help" redetermination letters.
Medigap Out-of-Pocket Limits for 2008
CMS released the 2008 out-of-pocket limits for Medigap Plans K ($4,400) and L ($2,220).
The 2008 deductible amount for Medigap high deductible plans F and J is $1,900.
Reminder: Part D Plan Comparisons Will Be Released October 11
The Medicare Drug Plan Finder on www.medicare.gov is expected to be available October 11. To ensure plan comparisons meet beneficiaries' needs, it is important to enter all drugs and dosages and also to screen for additional plan requirements (prior authorization, quantity limits, and step-therapy).
By October 31, beneficiaries should receive the Annual Notice of Coverage (ANOC) mailings from their prescription drug plans describing 2008 changes to current coverage.
IV. Items of Interest
Evaluating the Success of Part D
In a recent article, Health Affairs reported that "Part D enrollees pay considerably more out-of-pocket for their coverage than those with either employer-sponsored coverage or Veterans Administration benefits, and they are more likely to skip medications because of those costs." Read more about the Tufts-New England Medical study.
Exploring the Challenges of LIS Outreach
The Kaiser Permanente Institute for Health Policy created an "In Focus" brief on identifying and enrolling eligible beneficiaries in the Medicare Part D Low-Income Subsidy (LIS) program. Read this four-page brief.
HAP is working on an LIS training toolkit. We'd love to hear about LIS outreach efforts that have worked well for your team. Contact Kristi, Health Education & Information Associate at kremkus@hapnetwork.org or 202-737-6340. | 
