Benefits - Public: Medicare

Issues, Articles, Publications, Organizations, Resources

For information on the ever-growing problem of Medicaid/Medicare fraud, see Fraud page.

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Patti's letter to Senators in Support of HCSCE (3/9/09)
..."The Act will exempt dually eligible individuals living in home and community settings from prescription drug co-payments. Currently, under Medicare Part D, only individuals living in skilled nursing homes are exempt from prescription drug co-payments. This change is necessary, as assisted living is one of the fastest growing long-term care options for the elderly and disabled."

More Info:
ALFA Commends Senator Bill Nelson's Commitment to Co-pay Equity for Home and Community Based Seniors (MedicalNewsToday - 3/6/09)

AARP Calls Medicare Bill "Woefully Inadequate" - AARP (Dec. 18, 2007)
As Congress approaches the end of the legislative year, AARP issued statement on efforts to pass a package of Medicare improvements.

A Case of the Medicare What Ifs (Huffington Post - 8/23/10)
Today, on Medicare's 45th birthday, I want to reflect on what the program means for me. Typically, people think of Medicare as a program that matters only for seniors. It is nearly universally available to Americans age 65 and older and pays for health care both in the event of a hospital emergency and for routine care, depending on what a person can afford. But Medicare matters not just to seniors. Medicare matters to children, to young adults and to Baby Boomers.

Advocacy Alert - Medicare Part D
On 7-15-10, U.S. Representatives Mary Jo Kilroy and MacThornberry announced introduction of the bipartisan Part D Off-Label Prescription Parity Act to allow Medicare coverage of medications when use is supported by experts. View press release.

Answers to Your Medicare and FEHB Questions - (The Washington Post - 12/19/08)
Info on the relationship between Medicare and private health insurance plans in the Federal Employee Health Benefit (FEHB).

Consumer Groups Say Medicare Agency Is Proposing The Wrong ApproachTo Protecting Drug Coverage For People With Low Incomes.
Groups that advocate on behalf of people with Medicare filed comments telling the Centers for Medicare & Medicaid Services that their approach to prevent certain Medicare beneficiaries from having to change their Medicare drug plans will not work.

Elderly Medicare, Medicaid Patients Not Receiving Quality Care (Science Daily - Oct. 2007)
If the care received by vulnerable older people concurrently enrolled in Medicare and Medicaid was evaluated on a grading scale, it would squeak by with a barely passing mark, a new UCLA study has found.

Getting Medicare While Traveling or Living Overseas (Elder Law Answers - 4/26/10)
Many retirees look forward to traveling in their retirement, and more and more are actually retiring overseas, in part as a way to stretch savings. But what happens to retirees' federal benefits while they are out of the country? The short answer is that although Social Security benefits are available to retirees in other countries, Medicare generally is not.

Gray Matters: Medicare 2010 (Time Goes By blog)
If you are of a certain age and participate in Medicare, you should have received your copy of Medicare And You 2010. And if you are like me, you’ve put it aside without reading it. Well, this year it would be a mistake not to look at the manual a bit more closely than usual.

Make Sure You Aren't Losing Money on Choice of Medicare vs. Medicare Advantage, or Medigap Plan (GrampsCare blog - 3/14/09)
You may be surprised by the differences in what the plans provide and what they may cost you. You may think you're saving a lot of money with one choice, but be totally unaware that your choice is costing you even more!

Major Changes in Both Medicaid and Medicare Affecting Your Clients (Sanford J. Mall, JD, CELA - Summer. 2007)
Recap of changes in law and policy that vastly affect basic health care, catastrophic medical, rehabilitation and long-term care for elders and persons with disabilities.

Medicaid vs. Medicare (Disabled World)
Just like there’s confusion over the difference between SSDI and SSI, there’s confusion over the difference between Medicare and Medicaid. So, here in a nutshell, is the definition of each.
Patti's Comments: If you have someone in the family with a disability of any age and your attorney cannot answer this question, get a new attorney!

Medicare & Medicaid (AGIS)
Discusses the differences between these complicated government programs.

Medicare Advantage Part C (Money Alert)
Medicare Part C (Medicare Advantage Plan) is the combination of Medicare Part A and B. Here's a look at the Part C basics.
Patti's Comments: If you get some information like this on how to get a Medicare Advantage Plan, my advise is “JUST SAY NO”.. elder law attorneys and advocates are really struggling with securing appropriate services for our clients with this type of coverage.

Medicare Part D: Crapshoot Coverage (Time Goes By - 10/14/09)
On 15 November, the six-week enrollment period for 2010 Medicare Part D plans begins. It is not too soon to investigate the details of plans available in your state particularly because most insurance companies have increased premiums for next year and some have added deductibles.

Medicare Prescription Drug Plan Finder (Medicare.gov)
Personalized information about Medicare prescription drug plans and Medicare health plans.

Medigap Insurance Helps Prepare for Health Care Cost During Retirement (Medigap Advisors)
When turning 65, many people make the mistake of assuming Medicare will cover most or all of their health care costs when they retire, and that, if they need nursing home care, that Medicaid, the health care program for the poor, will cover them. However, neither program alone can guarantee a low-cost ride when it comes to paying for your medical expenses throughout retirement.
Patti's Comments: This is a simple easy to understand what Medicare is and what it is not. Everyone that can afford to stay on traditional Medicare and purchase a gap policy should do so. We are seeing lots of problems for folks with Medicare Advantage Plans.

MMSEA & The MSP - Confusion Reigns Supreme - Medicare, Medicaid & SCHIP Extension Act (MMSEA)
Passage of Section 111 of the MMSEA and its reporting deadline of 7/1/09 has caused a tremendous amount of confusion among insurance professionals, lawyers and settlement planners alike. As a result of the MMSEA new discovery is being sought to assist insurers in complying with the reporting requirements. This article delves in the MMSEA briefly to explain what it is and what is required.

Nearly 65? Time for the Medicare Maze (New York Times - 10/14/09)
NOW that you’re about to retire, there’s good news and bad news about your health insurance. The good news: When you turn 65, you’re eligible for Medicare — all in all, a pretty affordable way to get coverage for doctor bills, hospitalizations and, more recently, prescription drugs. The bad news: You’ve got a big job ahead of you, sorting through the Medicare bureaucracy.

One Million Seniors Get More Generous Prescription Drug Benefits (Kaiser Health News - 1/8/10)
As of Jan. 1, more than 1 million low-income seniors "are newly eligible for more generous prescription drug benefits under the 'extra help' program" in Medicare.

Prescription Drug Cost Relief to More than 750,000 Medicare Beneficiaries (US Dept. of Health & Human Services - 8/10/10)
The third round of one-time, tax-free $250 rebate checks have been mailed to eligible Medicare beneficiaries whose drug costs are so high they have reached the Medicare Part D prescription drug coverage gap known as the “donut hole.”

Studies Say Private Medicare Plans Have Added Costs, For Little Gain (New York Times - 11/24/08)
Private health insurance plans, which serve nearly a fourth of all Medicare beneficiaries, have increased the cost and complexity of the program without any evidence of improving care, researchers say.

Study Spotlights Growing Role of Medicare in Propping Up Nation's Medicaid Program - (EMaxHealth - Oct. 2007)
New BDO Seidman study of the nation's Medicaid program draws much needed attention to a chronic and worsening problem: Medicare's cross-subsidization of increasingly inadequate Medicaid payments for nursing home care. Patti's note: "I could not agree more!"

Take Advantage of New Changes to Programs that Help With Medicare Costs (Medical News Today - 1/12/10)
Beginning in January, federal changes to Medicare Savings Programs (MSP) and Medicare's Low Income Subsidy ("Extra Help") mean a simplified application process and greater eligibility for these important programs.

The Basics on Medicaid and Medicare (Good Article)
The basics are described in this article. After reading through each program description, you will see how different and important Medicaid and Medicare are.

Who's Responsible for Care After Stroke? (Post-Gazette Now - 3/31/09)
With certain limitations and so long as the therapy meets the "reasonable and necessary" test, Medicare will generally pay for PT, OT and ST in the hospital, in a skilled nursing facility for up to 100 days, in the home setting under specific circumstances, and at special therapy facilities.

You're Not in the Hospital. You're in Observation! (CMA Health Policy Consultants - 7/13/10)
Medicare beneficiaries – although placed in hospital beds (often, from the emergency room) and given medications, tests, therapies, medical and nursing services, food, and a wrist-band – are told they aren’t in-patients; they’re just receiving observation services as outpatients. Patients often learn about their out-patient status just as they are leaving the hospital for the skilled nursing facility – which won’t be covered by the Medicare program because they weren’t in-patients for three consecutive days! For related article, see "Medicare Fraud Effort Gives Elderly Surprise Hospital Bills."

Center for Medicare & Medicaid Services Letter (Disabled and Elderly Health Programs Group)
Official letter re: Savings Generated by Money Follows the Person Rebalancing Demonstration implementation .

Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare
(Center for Medicare & Medicaid Services - 2010)
Explains Medigap (Medicare Supplemental Insurance) policies, what they cover and how to purchase them.

Closing the Prescription Drug Coverage Gap (CMS - May 2010)
Brochure explaining the $250 rebate for Part D beneficiaries who fall into the coverage gap/donut hole. Also see letter from Centers for Medicare & Medicaid Services for more information.
Patti's Comment: This is important information related to the refund check for folks in the "donut hole" for Medicare prescription drug coverage.

Medicare Advantage 2010 Data Spotlight: Benefits and Cost-Sharing (Kaiser Family Foundation)
This data spotlight examines trends in benefits and cost-sharing for Medicare Advantage plans in 2010, including the wide variations found across plans and the rapid increase in cost sharing requirements for some benefits, including stays in skilled nursing facilities.

Medicare and the New Health Care Law - What It Means For You (Centers for Medicare and Medicaid Services)
Medicare beneficiaries across the country should begin receiving copies of a brochure "Medicare and the New Health Law - What it Means for You" in their mailboxes. The mailing from CMS outlines key provisions of the Affordable Care Act for people with Medicare as well as members of their families. For more information, see e-lert from NLRC.

Medicare and You 2010
The official government handbook with important information about Medicare costs, what Medicaid covers, health and prescription drug plans, your rights and health information technology.

Medicare Basics for Caregivers (NIH Senior Health)
Basic information about Medicare, as well as information about managing medical conditions, prescription drug coverage and long-term care.

Medicare Hospice Benefits (Centers for Medicare & Medicaid Services)
Official government booklet for Medicare hospice benefits.

Medicare Hospice Benefits (The Federal Medicare Agency) (large print edition)
A booklet that explains the hospice program, who is eligible, how to find a hospice program and where to get more help.

Medicare Part B Medigap Finder (Medicare.gov)
Find and compare Medicare health plans

Medicare Part D - Exceptions and Appeals: A Practical Guide for Advocates (National Senior Citizens Law Center - 4/10)
Medicare Part D prescription drug plans cover a limited list of drugs. Beneficiaries enrolled in a plan often find that it does not cover drugs they need or imposes restrictions or charges high co-pays for their prescribed medications.

Medicare Part D Brief: 2010 Transition Rights to Medications Under Medicare Part D (NSCLC)
Many people who receive Medicare benefits have recently changed their Part D prescription drug coverage or have found that their current plan’s formulary has changed in 2010. To give beneficiaries some protection during this period, the Centers for Medicare and Medicaid Services (CMS) requires that sponsors of Medicare Part D prescription drug plans provide beneficiaries with access to transition supplies of needed medications to protect them from disruption and give adequate time to move over to a drug that is on a plan’s formulary, file a formulary exception request or, particularly for Low Income Subsidy (LIS) recipients, enroll in a different plan. These protections also are available in other situations, such as when a person enters or leaves a nursing home. To assist advocates with transition issues, this brief sets out the CMS minimum requirements for all plans.

Medicare Part D Prescription Drug Plan Finder (Medicare.gov)
Find and compare plans that cover drugs.

Medicare Part D (GAO)
Complaint rates are declining, but operational and oversight challenges remain.

Medicare Primer - The Henry J. Kaiser Family Foundation
Lots of useful info about this social insurance program.

Medicare Prescription Drug Coverage Costs - What to do if you no longer automatically quality for extra help - (Centers for Medicare & Medicaid Services)
Getting "extra help" means Medicare will help pay your Medicare drug plan's monthly premium, deductible and copayments.

Medicare Update (Aging and Disability in America - 10/19/09)
The Centers for Medicare & Medicaid Services (CMS) released display copies of Notices announcing Medicare Part A and Part B premiums and deductibles for calendar year 2010.

Resources on the Medicare Prescription Drug Benefit (Kaiser Family Foundation)
Key Foundation resources and data on the Medicare drug benefit.

The Medicare Counseler
A free publication of the Medicare Rights Center. Each issue will address timely topics that will help social workers, health care providers and other professionals keep up-to-date on important Medicare issues.

Center for Medicare Advocacy, Inc.
A national non profit, non-partisan organization that provides education, advocacy and legal assistance to help older people and people with disabilities obtain Medicare and necessary health care.

Centers for Medicare & Medicaid Services
U.S. federal agency which administers Medicare, Medicaid, and the Children's Health Insurance Program.

Help with Medicare Prescription Drug Costs (Social Security Online)
Medicare beneficiaries are eligible for the extra help if they have limited income and resources. The extra help can increase their cost savings by paying for part of the monthly premiums, annual deductibles and prescription co-payments under the new prescription drug program.

Home Health Compare (Medicare.gov)
This tool provides you with information on how well the home health agencies in your area care for their patients.

Incontinence Supplies and Services
If your doctor said that you or your child has a problem with incontinence, this information will tell you how to get the services and products you need.

National Health Law Program
A national public interest law firm that seeks to improve health care for America's working and unemployed poor, minorities, the elderly and people with disabilities.

Nursing Home Compare (Centers for Medicare & Medicaid Services)
Detailed information about the past performance of every Medicare and Medicaid certified nursing home in the country.

Program of All-Inclusive Care for the Elderly (PACE)
PACE is an optional benefit under both Medicare and Medicaid that focuses entirely on older people, who are frail enough to meet their State's standards for nursing home care. It features comprehensive medical and social services that can be provided at an adult day health center, home, and/or inpatient facilities. For most patients, the comprehensive service package permits them to continue living at home while receiving services, rather than be institutionalized.

Resources on the Medicare Prescription Drug Benefit (Kaiser Family Foundation - 10/08)
Key Foundation resources and data on the Medicare drug benefit are compiled here.

Medicare.gov (official government site)

Care About Medicare (blog)

Medicare Update (blog)