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Medicare ModernizationCMS issued guidance for notices of creditable coverage after May 15, 2006. There were several fairly minor changes from the guidelines for earlier notices and more clarification around notifications to CMS. Most carriers provided information to the employers about whether or not plans would be considered creditable but it remains the employer's responsibility to notify their Part D eligible members.Medicare AdvantageNAHU Committment to Education – Medicare / Senior Insurance Product s & Marketing In written statements submitted to the U.S. Senate Aging Committee and the U.S. House Ways & Means Subcommittee on Health, NAHU Executive Vice President and CEO Janet Trautwein noted strongly that the vast majority of health insurance producers work very hard every day to find quality and appropriate health coverage at the best possible price for millions of employers, individuals and families. In her statement, Janet went on to say that it would be a disservice to the thousands of high-caliber health insurance producers out there, and their millions of happily insured senior clients, if access to licensed health insurance producers was in any way limited. “The actions of a dishonest few should not be interpreted as representative of our entire industry.” Statement for Senate Select Aging Committee hearing on Marketing Practices Regarding Medicare Advantage Plans - May 21, 2007Statement for the US of Representatives Committee on Ways and Means Subcommittee on Health Regarding Medicare Advantage Private Fee-for-Service Plans - May 18, 2007 AHIP Claims on Medicare Advantage Facts on Medicare Advantage from the Galen Institute Private Fee-for Service PlansYour Guide to Private Fee-for Service Plans, U.S. Department of Health and Human Services Private Fee-for-Service - Beneficiary Questions and Answers, Centers for MEdicare and Medicaid SErvices, U.S. Department of Health and Human Services Medicare Advantage: Private Health Plans in Medicare, Congressional Budget Office Tip sheet- Describes the different people affected by the 2006 premium withholding reconciliation. “Your Guide to Medicare Private Fee-for-Service Plans” - another helpful source, a job aid that concisely lists PFFS marketing rules. At IssueThe Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) contains a number of general reforms supported by NAHU.
Outpatient prescription drug coverage in 2007:In certain situations, people with Medicare may be eligible for a Special Enrollment Period to join a plan that provides Medicare prescription drug coverage, or switch to a different plan. A Special Enrollment Period is a period of time when an individual can enroll in or switch plans outside of the annual enrollment period (November 15th – December 31st). The chart contained in this link describes the different situations in which an individual may be eligible for a Special Enrollment Period. The document can be found at: www.cms.hhs.gov/partnerships/downloads/PartDSEPs.pdf Recent DevelopmentsNew Medicare Premium, Deductible, and Coinsurance Charges for 2008The Centers for Medicare and Medicaid Services (CMS) has announced the new Medicare premiums, deductibles, and coinsurances. The standard Medicare Part B premium is increasing by 3.1 percent to $96.40 a month, the smallest increase since 2001. The increase is lower than previously expected in part due to the correction of an accounting error. Money for certain hospice benefits had been inadvertently drawn from the Part B trust fund rather than the fund that pays hospital costs. In addition, the lower premium assumes that physicians will take a 10 percent cut in their reimbursement rates. It is expected that Congress will act to offset some of or all of that pay cut, meaning that future-year premiums will reflect the additional expense. Here are all the new Medicare figures:
CMS announces new rates for 2007CMS proudly announced late last week that the cost of the prescription drug benefit will be lower next year than in 2006. The $24 average premium for Part D Medicare beneficiaries paid in 2006 will remain the same or possibly go lower in 2007, and the low-income benchmark and the national benchmark -- the amount Medicare pays plans -- will be lower as well, resulting in lower overall costs, says CMS.CMS Creditable Coverage Information There are a number of options for those who have found themselves with a gap in their Part D coverage. This document provides some resources developed by CMS, the agency that runs Medicare, and PhRMA, home to many brand drugs taken by seniors. Additional Information on the Medicare Prescription Drug Improvement Act of 2003Health Affairs paper explores difference in mail order and retail generic dispensing - An in-depth look at some of the market dynamics of pharmacy benefit managers. (July 28, 2004) Medicare Prescription Drug Coverage: Employer Disclosure Notice Requirements Basic Questions and Answers about Medicare Prescription Drug Coverage Quick facts about Medicare Prescription Drug Coverage: If you applied for extra help Quick facts about Medicare Prescription Drug Coverage: If you have limited income and resources Reaching the Hard to Reach - Following passage of the Medicare Modernization Act in 2003, the National Council On Aging (NCOA) founded the Access to Benefits Coalition to help low-income Medicare beneficiaries lower their prescription drug costs. This presentation was made the NAHU Medicare Working Group on August 4, 2005 and provides an interesting perspective on locating and signing up low-income beneficiaries including lessons learned. Establishing Regional Medicare PPOs and PDPs Under the Medicare Modernization Act - CMS has established 26 Medicare Advantage (MA) regions and 34 Prescription Drug Plan (PDP) regions, as required by the Medicare Modernization Act. The CMS website provides links to maps and fact sheets on the regions. (December 6, 2004) The Medicare Prescription Drug and Modernization Act of 2003 - Public Law 108–173 - December 8, 2003. Information for Veterans About the New Medicare Prescription Drug Benefit Further Help with Your Medicare Questions? - The State Health Insurance Assistance Program (SHIP) has counselors in every State and several Territories that are available to provide free one-on-one help with your Medicare questions or problems. MMA Assistance from CMS - This new web page is designed to provide quick and easy access to all activities associated with the Medicare Modernization Act including information on the new drug coverage and low-income subsidy. ChartsMedicare Beneficiaries Who Will Pay No More Than $5.00 Per Prescription Under Compromise Agreement NAHU's ActionsNAHU worked hard along with many others to improve and modernize Medicare, but the work isn't finished. NAHU is continuing its work with CMS to ensure that seniors know and understand their benefits and most importantly, sign up for the benefits to which they are entitled. This includes educating our agents in the senior market abotu relevant dates, benefits, costs and coverages offered by Medigap insurance, Medicare Advantage plans, PDPs and other changes made to the program. Additional ResourcesEmployers Coalition on Medicare - The Employers' Coalition on Medicare represents employers who support access to quality health care and prescription drugs for Medicare beneficiaries. American Academy of Actuaries - How is Medicare Financed? For more information, please contact John Greene.
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