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Saturday, July 4, 2009 |  |
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Medicare Modernization
CMS 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 Advantage
NAHU Committment to Education – Medicare/Senior Insurance Products and 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 Plans
Your Guide to Private Fee-for Service Plans, U.S. Department of Health and Human Services
This government booklet describes the basics of Medicare private fee-for-service (PFFS) plans, specifically
the costs and benefits of these plans, and how to go about enrolling in a PRRS plan. It is a good introductory resource for those considering PRRS plans, or advising beneficiaries,
and provides state-specific contact information for Medicare plans and Medigap policy information. The booklet also includes a glossary of Medicare terms.
Private Fee-for-Service - Beneficiary Questions and Answers, Centers for MEdicare and Medicaid SErvices, U.S. Department of Health and Human Services
This is a list of questions and answer for potential and current beneficiaries of private fee-for-service plans. It
describes how PRRS plans differ from managed care plans and from the traditional Medicare arrangement. Describes who is eligible
to join such plans, advantages and disadvantages of joining, and how to appeal is a service is denied.
Medicare Advantage: Private Health Plans in Medicare, Congressional Budget Office
This issue summary desribes how PRRS plans work, how they differ from other Medicare Advantage plans and from
traditional Medicare, how they are paid, how enrollment and spending are trending, and how spending cuts to Medicare Advantage plans would likely affect plans and beneficiaries.
Tip sheet- Describes the different people affected by the 2006 premium withholding reconciliation.
Letter- Being sent to beneficiaries who owe money to their plan(s).
“Your Guide to Medicare Private Fee-for-Service Plans” - another helpful source, a job aid that concisely lists PFFS marketing rules.
At Issue
The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) contains a number of general reforms supported by NAHU.
- The law created Health Saving Accounts (HSAs) effective January 1, 2004, which essentially replaced Medical Savings Accounts (MSAs) and fixed many of the flaws contained in the old MSA legislation. Besides payment for medical expenses, these accounts can be used to pay insurance premiums for long-term care, COBRA continuation and coverage while receiving unemployment benefits. HSA funds may also be used to pay for retiree health insurance premiums other than Medigap and Medicare premiums.
- The MMA provides increased provider payments including increased payments for rural hospitals.
- The law begins to move towards electronic prescribing in an effort to improve quality and reduce errors.
- For the first time in Medicare, new beneficiaries are provided with an initial preventive examination ("Welcome to Medicare physical"), cardiovascular disease screening and diabetes screening.
- Also for the first time, Medicare has a private-sector component creating competition with fee-for-service.
- The law provides greater financial support for Advantage. These plans can be found nation-wide.
- The law reforms the Hatch-Waxman Act (passed in 1984 to facilitate generics to market) to ensure smoother FDA approval of generics by closing several loopholes used by brand drug manufacturers to impede the speed of bringing generics to market.
- Part B premium increases will be differentiated based on income. Beneficiaries with an income starting at $80,000 in 2007 will pay a higher premium than those under $80,000. Future adjustments will be indexed to increase annually by the Consumer Price Index (CPI).
Recent Developments
New information regarding Private Fee-for Service Plans.
Medicare beneficiaries with Part A and/or Part B are eligible to receive outpatient prescription drug coverage under Medicare Part D. In addition to the voluntary drug benefit, new preventive care services have been added to the overall benefit package to reflect the way medicine is practiced today. The law creating these new benefits in Medicare were signed into law by President Bush on December 8, 2003.
Whether you decide stay in traditional Medicare or choose a PDP, or a Medicare Advantage Plan, is completely up to you.
Most people have saved $1000 onaverage on their prescription drug costs. Many people will also be eligible for further assistance. If you receive a letter from the Social Security Administration, we encourage you to complete the form and return it for processing.
Recent Developments
New Medicare Premium, Deductible, and Coinsurance Charges for 2009
The Centers for Medicare and Medicaid Services (CMS) has announced the new Medicare premiums, deductibles, and coinsurances. For standard Medicare Part B premium, there is no increase for the first time since 2000.
Here are all the new Medicare figures:
- Part B premium: $96.40/month
- Part A deductible: $1,068
- Co-payment for hospital stay days 61-90: $267/day
- Co-payment for hospital stay days 91 and beyond: $534/day
- Skilled nursing facility co-payment, days 21-100: $133.50/day
| Beneficiaries who file an individual tax return with income | Beneficiaries who file a joint tax return with income | Income-related monthly adjustment amount | Total monthly premium amount |
| Less than or equal to $85,000 | Less than or equal to $170,000 | $0.00 | $96.40 |
| Greater than $85,000 and less than or equal to $107,000 | Greater than $170,000 and less than or equal to $214,000 | $38.50 | $134.90 |
| Greater than $107,000 and less than or equal to $160,000 | Greater than $214,000 and less than or equal to $320,000 | $96.30 | $192.70 |
| Greater than $160,000 and less than or equal to $213,000 | Greater than $320,000 and less than or equal to $426,000 | $154.10 | $250.50 |
| Greater than $213,000 | Greater than $426,000 | $211.90 | $308.30 |
| Beneficiaries who are married but file a separate tax return from their spouse | Income-related monthly adjustment amount | Total monthly premium amount |
| Less than or equal to $85,000 | $0.00 | $96.40 |
| Greater than $85,000 and less than or equal to $128,000 | $154.10 | $250.50 |
| Greater than $128,000 | $211.90 | $308.30 |
Medicare Secondary Payer Coordination of Benefits
CRS Report for CongressCMS 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 2003
Health 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.
Charts
Medicare Beneficiaries Who Will Pay No More Than $5.00 Per Prescription Under Compromise Agreement
NAHU's Actions
NAHU 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 Resources
Model Appointment Confirmation Form—CMS strongly encourages the use of this form. Note that it may be modified to suit organizational needs.NAHU Reccomendations—NAHU's reccomendations for improved oversight and accountability in Medicare private insurance product sales and marketing.
NAHU comments on CMS proposed regulations—NAHU's comments on the two regulations back when they were proposed.
Employers’ 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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