In August's Issue:
HAP HAPpenings
- Start Logging Issues Now!
- "Troubleshooting Medicare" Issue Categories
- August Conference Call, Next Steps: Strategies and Tools to Help Your QMB-Eligible Clients
- July Shout Out Now Available
- New HAPSavers Now Available
- HAP Submits Comments on Chapter 4 of CMS's Medicare Managed Care Manual
CMS News
- CMS Releases LIS Outreach Targeting Data
- Certain WellPoint Enrollees Entitled to a
Part D SEP (July to September 2009)
Interesting Items
- Who Is Volunteering in Your Community?
- Looking for Tech-Savvy Volunteers?
- Medicare Beneficiaries and Medical Debt
- KFF's Outlook on Medicare's Financing and Fiscal Future
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Want to learn the latest on what clients are asking SHIP counselors?
This month HAP's Check Your Skills quiz is on vacation. However, we invite you to check out our FAQ section where we've added some valuable questions written to us at SHIPhelp from the field! Here are just a few:
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HAP's Next Call
Please join us for our next Conference Call:
Next Steps: Strategies and Tools to Help Your QMB-Eligible Clients
Wednesday, August 19
3 p.m. EDT
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HAP HAPpenings
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Upcoming Best Practice
SHIPs have been sharing the unique ways that they are handling the "remote placement" of counselors in order to reach the most beneficiaries with a limited staff.
If your SHIP has an interesting approach to this concept, please send your idea to SHIPhelp and a staff member will contact you to follow up. And your SHIP could be featured in our next Best Practice!
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Start Logging Issues Now!
HAP has introduced an Issue Log as part of its Troubleshooting Medicare project to help SHIPs capture persistent and systemic issues affecting their clients.
SHIPs can use the Issue Log to:
- Record and share information about a particular issue affecting a client
- Track client issues over time
- Learn about the issues that other counselors are seeing in the field
The feedback SHIPs provide will help HAP to identify systemic issues affecting beneficiaries and to develop the trainings and policy recommendations necessary to address them. To start logging issues in the Issue Log, SHIPs will need a username and password. Please contact us with your name, organization, state, and SHIP role to start logging issues now!
"Troubleshooting Medicare" Issue Categories
In order for HAP's Troubleshooting Medicare project to have a positive impact on the lives of Medicare beneficiaries, we recognized that grouping issues using a policy framework would help communicate to policy makers the challenges that beneficiaries and SHIP counselors face.
HAP has developed four broad issue categories in this vein: access to care, informed decision making, health care inequities and disparities, and plan design and benefits. We plan to use these categories to organize the issues and the feedback that are identified through the Troubleshooting Medicare Issue Log.
Here are some "real world" examples that illustrate the scope of these four categories:
Access to Care: Out-of-pocket costs for health plan deductibles and copayments prevent some beneficiaries from getting the care they need. A member of a Medicare Advantage (MA) plan who has to pay $50 for each outpatient physical therapy visit may forgo a number of prescribed visits as bills mount. The result may be an incomplete recovery from joint replacement surgery, an injury, or stroke.
Informed Decision Making: Complete and accurate information is essential to making informed decisions and choices about health care options. Medicare rules state that medical providers should only issue Advance Beneficiary Notices (ABNs) in cases where a patient’s condition makes Medicare coverage for a specific test or procedure unclear. Yet some providers, including clinics and labs, wrongly give ABNs to all of their patients, informing them that they will be liable for the bill if Medicare denies coverage. The indiscriminate use of ABNs prevents beneficiaries from making informed decisions about their health care.
Health Care Inequities and Disparities: Low income and limited resources create barriers to care for some Medicare beneficiaries. Medicare rules prevent physicians and other providers from billing Qualified Medicare Beneficiaries (QMBs) for Medicare deductibles and coinsurance charges. Yet some providers, who say they do not participate in the state Medicaid program, do so. The result is that many QMBs face bills that they cannot afford to pay.
Plan Design and Benefits: Misunderstanding about how a Medicare Advantage (MA) plan's coinsurance charges work can be disastrous. Coinsurance charges for Part B drugs are common in Medicare HMOs and Private-Fee-for-Service plans. Beneficiaries who do not understand that they are liable for 20 percent of the cost of expensive chemotherapy drugs may be overwhelmed by unexpected bills that amount to tens of thousands of dollars.
These categories will help HAP translate your experiences into recommendations for policymakers to help resolve some of the system-level problems that negatively affect you and your clients.
August Conference Call, Next Steps: Strategies and Tools to Help Your QMB-Eligible Clients
HAP continues to hear from the SHIP community about the issue of health care providers billing Qualified Medicare Beneficiaries (QMBs) for Medicare cost-sharing. QMBs are not liable under Medicare law to pay providers for these charges. We flagged the issue as one of concern for low-income beneficiaries earlier this summer, and the feedback you've since provided suggests that the problem is more pervasive than it appears.
The issue of providers billing dual-eligible Medicare beneficiaries for Medicare Advantage (MA) plan copayments is showing up in different states and with different MA plans, and is an example of the systemic type of issue the Troubleshooting Medicare project is designed to identify and address.
HAP, along with our partner, the Center for Medicare Advocacy, will review the issue in detail on our August 19 conference call. We will discuss strategies and tools that SHIPs can use to help their QMB and QMB Plus clients. As always, we will send an eAlert with additional detail, and how to join the call. Stay tuned!
July Shout Out Now Available
During our July webinar, Working Together to Help Medicare Beneficiaries, HAP continued testing a new feature — the SHIP Shout Out. The SHIP Shout Out is an opportunity at the end of each conference call or webinar for participants to anonymously shout out their thoughts, questions, comments, or concerns!
This month's Shout Out included a wide range of topics, such as beneficiaries new to Medicare, low-income beneficiaries, and beneficiaries under 65. You can find HAP's responses to the issues you raised on the July Shout Out page.
We appreciate your input, so please send us your opinions and suggestions about the Shout Out. HAP will continue to expand our efforts to build and empower the SHIP network.
New HAPSavers Now Available
HAP is proud to announce our newest HAPSavers are now available for SHIPs use — Making a Video and Distributing a Video. HAPSavers are one-page tip sheets that provide information for SHIPs on a variety of topics. Our latest two HAPSavers deal with creating videos for your SHIP and distributing those videos to your volunteers and beneficiaries.
Have an idea for a HAPSaver? Email us at SHIPhelp@hapnetwork.org. Because HAPSavers are based on research and experiences from the field, they offer practical advice to help SHIPs carry out and expand their daily activities. Thanks for providing your input, and be sure to visit our HAPSavers Resource Center where you can find other handy tip sheets to assist your program.
HAP Submits Comments on Chapter 4 of CMS's Medicare Managed Care Manual
HAP submitted comments on July 30 to the Centers for Medicare and Medicaid Services (CMS) on a draft version of Chapter 4 of the Medicare Managed Care Manual — Benefits and Beneficiary Protections. HAP incorporates the relevant issues and case studies you share with us over the course of the year in the feedback we provide to CMS.
HAP encourages SHIPs to use CMS's manuals to research answers to questions that come up during counseling sessions. Check out HAP’s April 2009 Conference Call: Mining Medicare's Manuals for more information and tips on researching CMS's manuals. If you come across discrepancies or questions, please let us know. HAP will incorporate your feedback into future CMS requests for comments, including the 2011 Medicare & You handbook and the 2011 Call Letter.
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CMS News
CMS Releases LIS Outreach Targeting Data
The Centers for Medicare and Medicaid Services (CMS) has released low-income subsidy (LIS) targeting data to assist SHIPs in their LIS outreach efforts. The data, available at the county level and the zip code level, include estimates of the number of potential LIS-eligible beneficiaries in areas identified as having high numbers of people eligible for LIS. CMS has also provided SHIPs with a How-To tip sheet on using the data.
You can also check out CMS's "drop-in" article available in four additional languages:
Spanish version
Chinese version
Korean version
Vietnamese version
For more information on the LIS program, visit HAP's Medicaid and Low-Income Benefits Web page.
Certain WellPoint Enrollees Entitled to a Part D SEP (July to September 2009)
In July, WellPoint notified approximately 4,600 beneficiaries who had been enrolled in a WellPoint Part D plan at the end of 2008 that they are entitled to a Special Enrollment Period (SEP) from July to September 2009. (WellPoint had failed to provide proper notice at the end of 2008 to these beneficiaries that their plan was terminating for 2009. As a result, CMS granted these beneficiaries a SEP.)
WellPoint sent a letter to all 4,600 beneficiaries entitled to this SEP. CMS has also provided a chart of the number of individuals affected in each state.
The SEP allows beneficiaries to enroll in a new Part D plan effective either prospectively or retroactively back to Jan. 1, 2009. And, since SHIPs may receive requests for assistance from beneficiaries who receive this letter, SHIPs might help to analyze the most appropriate effective date for the Part D enrollment change.
The Center for Medicare Advocacy (CMA) in its Weekly Alert outlines the steps a beneficiary or counselor can follow to take advantage of the SEP. Counselors should call 1-800-MEDICARE and inform the Customer Service Representative (CSR) of the WellPoint SEP opportunity.
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Interesting Items
Who Is Volunteering in Your Community?
Check out the 2009 Volunteering in America Report to learn which volunteers donate the most time, what types of agencies they volunteer for, and much more. Then, use this information to target your volunteer recruitment activities!
Looking for Tech-Savvy Volunteers?
Have you been putting off a website redesign? Do you need help setting up a wireless network? If so, now is the time to post your tech-related volunteer opportunities on Idealist.org.
Why now? Because Idealist is partnering with Mozilla (the nonprofit organization behind the Firefox browser) to match thousands of techies around the world with nonprofits that need some help.
Click here to post your opportunity now!
Medicare Beneficiaries and Medical Debt
Although uninsured people are the most at risk of accumulating medical debt, the burden of health care costs can also weigh heavily on some Medicare beneficiaries. Despite access to insurance coverage that protects most beneficiaries from financial ruin, the combination of premiums, deductibles, copayments, and the expense of uncovered care — such as prescription drugs in the doughnut hole — can add up quickly and overwhelm many seniors and people with disabilities. It is therefore important to know the following:
- Who is most likely to be affected by medical debt
- How medical debt affects people
- What Medicare beneficiaries and their advocates can do about it
A recent Kaiser Family Foundation (KFF) report found that health care spending as share of total expenditures by Medicare households (those with at least one Medicare beneficiary) averages 14.1 percent overall. But for households whose income is between 100 percent and 400 percent of the federal poverty level, health care spending ends up being about 16 percent of their total spending. Health care as a share of spending is even higher — more than 17 percent — where the oldest member in the household is 80 or older. KFF found that Medicare households in the top 25 percent of health care spending as a share of total expenses were disproportionately poor, older, and living in non-metropolitan areas. For them, health care averaged nearly one-third of their total household spending.
How does the weight of medical debt affect people? Medical debt has consequences for access to care, financial security, and a person's psychological well-being. In a report titled The Illusion of Coverage: How Health Insurance Coverage Fails People When They Get Sick, the Access Project found that people with heavy medical debt often postponed or did not get needed care because they could not afford to pay the cost-sharing charges or because they feared amassing more debt. Many also reported that unpaid medical bills added to stress and tension in their families.
SHIP counselors and others who want to learn more about how to help people who are struggling with medical debt can turn to the National Consumer Law Center (NCLC). NCLC offers several free resources under its "Consumer Concerns for Older Americans" series, including:
NCLC offers a wide range of publications that go into more depth on these and other topics.
KFF's Outlook on Medicare's Financing and Fiscal Future
For those of you following the issue in the current health care reform debate, the Kaiser Family Foundation (KFF) recently released a 20-page resource which takes a look at the projected future of the Medicare program. The primer describes Medicare’s growth spending factors, the effects of rising Medicare costs on beneficiaries' out-of-pocket costs, and the programs' solvency as a whole.
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Prepare for the AEP
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Stay tuned: MIPPA rules change the LIS application for 2010
Check out SSA's latest Fact Sheet
More details to come soon!
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With the 2009 Annual Enrollment Period (AEP) right around the corner, SHIP programs are gearing up for their fall counselor trainings and getting their resources ready to serve and assist Medicare beneficiaries for enrollment season.
Don’t forget to check out AARP's doughnut hole calculator. This tool can help beneficiaries determine if, or when, they will fall into the coverage gap in 2010. SHIPs can use the calculator in addition to the Drug Plan Finder this fall to help encourage beneficiaries likely to fall into the gap in 2010 to speak with their physicians and pharmacists now about lower-cost alternatives for drug coverage.
Also, for SHIPs interested in learning the numbers of beneficiaries in their states who reach the doughnut hole, see the State Health Care Briefs prepared by the AARP Public Policy Institute. The briefs offer a one-page overview of facts on health care data for each of the 50 states and the District of Columbia.
In addition to the numbers of Medicare beneficiaries falling into the doughnut hole, each brief also presents information about the state's uninsured, hospital readmissions among Medicare beneficiaries, the distribution of Medicaid long-term care funds, and prescription drug spending. HAP continues to support SHIPs in their efforts to learn more about the beneficiaries they serve.
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