All posts by Angela Scott

Medigap Plan F Will Soon End. Here’s How That Changes Retirees’ Costs. – Barron’s


Illustration by Rose Wong

The so-called Cadillac of Medicare-related insurance is being phased out at year’s end, shutting Medicare newcomers out of the plan that many retirees buy for peace of mind, and potentially boosting costs for those who remain or turn to another popular option.

People who turn 65 after 2019 won’t be allowed to pick Medigap supplement Plan F, the most popular supplemental plan that helps retirees cover medical costs that Medicare doesn’t pay. Retirees already in Plan F by year’s end will be allowed to stay. Almost 60% of the 14 million people who have Medicare supplement insurance are in Plan F, according to CSG Actuarial research.

Known as “first-dollar coverage” because people don’t have to worry about costs the moment they walk into a doctor’s office or hospital, or use a lab, Plan F is the most expensive of the Medicare supplemental plans. Nearly everything except vision, dental, drugs, and equipment such as hearing aids is covered. There are no deductibles, no copays, and no bills after a person has left a doctor or hospital, and no approvals are necessary to go to a specialist. Even overseas care can be covered.

The no-fuss nature of Plan F prompted the 2020 change. Supplements are sold by private insurance companies, but the federal government sets the rules because the insurance kicks in where Medicare leaves off.

“The government is trying to prevent overutilization,” says Adam Wasmund, chief development officer of Jack Schroeder & Associates, which advises health insurance brokers.

Trying to anticipate the future is worthwhile now because of the rules around selecting supplemental insurance. When you are new to Medicare, you can get into any supplemental plan regardless of health. After that, however, if you grow dissatisfied and want more extensive coverage, a lower cost, or a different insurance company, you may not be able to switch if your medical conditions have changed. Insurance companies ask about your health and can reject you.

That is why Maura Carley, president of Healthcare Navigation, tells anyone who chooses a Medicare supplement or Medicare Advantage Plan to think about their pick from the start. Consider it a “forever choice,” she says, because people can get sick as they age and that keeps them from switching. Also, she suggests making sure that any choice is portable to another state in case you move. Find free help through your state’s State Health Insurance Assistance Program, or SHIP.

Choosing plans isn’t simple because there are 10 different standard Medicare supplement choices with names of the alphabet from Plan A to Plan N—each with its own mixture of deductibles, copayments, and extra costs. The task is complicated by state regulations. Not all states allow the full array of plans, each state sets its own prices, and official government sites that help consumers are bumped down in Google search results by insurance companies vying for customers.

Comparison Shopping

Medigap supplemental plans pick up where Medicare leaves off, but there are many differences and exclusions among the plans. Here is a sample of some of the most popular benefits and what is covered.

Yes = the plan covers 100% of this benefit; No = the policy doesn’t cover that benefit; % of the benefit covered

Source: Medicare.gov

Some insurance experts are warning people who are already in Plan F and its closest cousin, Plan G, to brace themselves for price increases.

After the change, Plan G will survive as the most comprehensive plan for newcomers. It is identical to Plan F with one exception: People must pay Medicare’s deductible before insurance coverage kicks in each year. This year, the deductible is $185. About 27% of people in supplements are now in Plan G, according to CSG Actuarial.

Prices aren’t expected to soar immediately. In fact, some insurance companies have been cutting premiums recently in both Plan F and Plan G to lure customers in advance of changes. But insurance experts warn retirees that as insurance companies adapt to government-imposed changes after 2020, people in both Plan F and Plan G could be shaken by rate increases.

So people choosing supplements now are being advised to pick deliberately so a price shock doesn’t upset their budgets later.

Paying the deductible now seems fairly painless, and financial planners already have been urging clients to select Plan G as a bargain compared with Plan F. But there is a question about whether Plan G will remain a bargain as the 2020 changes play out.

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Nationally, monthly premiums for Plan G average about $150 compared with Plan F’s $186, according to Aon. The monthly savings in Plan G more than cover the annual $185 deductible that people usually finish paying out of pocket after the first or second visit to a doctor each year. But when Plan G becomes the only comprehensive choice for newcomers, insurance experts aren’t sure the savings will persist. Deductibles typically increase annually, and some insurance brokers think the government may try to tame Medicare spending at some point in the future with much larger deductibles.

People in Plan G could be surprised by more than the deductible in the future. After 2020, the pool of people coming into the plan will start becoming less healthy than those who previously enrolled when financial advisors pointed them toward a bargain, says Jared Strock, consulting actuary for CSG Actuarial. As Plan G takes on more unhealthy retirees, insuring them will become more expensive, and insurance companies will probably start charging higher premiums, Strock says.

“[Over] the past several years, buying G made sense” as a bargain, he says, “but with this change, that will go away.” He thinks that Plan G premiums will become similar to Plan F’s.

Questions? Comments? Write to us at retirement@barrons.com

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CMA Alert – October 17, 2019

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  1. Center for Medicare Advocacy Board President Judith Feder Testifies at Drug Pricing Hearing 
  2. Administration’s “Public Charge” Rule [Temporarily?] Blocked
  3. Drug Company Sued Over Kickbacks for Off-Label Marketing of Psychotropic Drug for Nursing Home Residents to Pay Over $115 Million
  4. Joint Issue Alert on Medicare Payment and Skilled Therapy Services in Nursing Homes
  5. Free Webinar: Medicare Enrollment Issues for 2020 

Center for Medicare Advocacy Board President Judith Feder Testifies at Drug Pricing Hearing

On October 17, 2019, the House Ways & Means Committee held a hearing entitled “Investing in the U.S. Health System by Lowering Drug Prices, Reducing Out-of-Pocket Costs, and Improving Medicare Benefits.”  The hearing focused on H.R. 3, the Lower Drug Costs Now Act (discussed in a previous Alert), as well as current gaps in Medicare coverage that could be filled using savings from lowering drug costs in Medicare.

Dr. Judith Feder, Professor at McCourt School of Public Policy at Georgetown University, and the President of the Board of Directors of the Center for Medicare Advocacy, was invited to testify about needed improvements to the Medicare program (her written testimony is available here).  Dr. Feder’s testimony focused on the need to address four gaps in Medicare coverage:

  • Out-of-pocket costs Medicare beneficiaries face;
  • Specific gaps in benefits, including dental, hearing, vision and long-term services and supports;
  • Administrative barriers or biases, including diminishing access to the home health benefit, observation status, inappropriate steering towards Medicare Advantage plans coupled with the lack of access to Medigap plans; and
  • Investments to ensure the long-term sustainability of the Medicare program, including the need for more revenue.

At the same time as the Ways & Means hearing, the House Energy & Commerce committee marked up H.R. 3 and a suite of bills that would add improvements to the Medicare program.  The House Education & Labor Committee also marked up H.R. 3.

The Center wrote letters of support for H.R. 3 and the Medicare-related bills, with suggested improvements to the Ways & Means and Energy & Commerce Committees.

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Administration’s “Public Charge” Rule [Temporarily?] Blocked

Last week federal judges in several states issued temporary injunctions against the Trump administration’s “public charge” rule, preventing it from taking effect. The rule was set to take effect this week.

The “Public Charge” final rule, which was posted on August 14, 2019 to the Federal Register, amended Department of Homeland Security (DHS) regulations regarding how an application for legal immigration into this country would be assessed, expanding the government’s ability to deny entry based on the possible future use of services like Medicaid. The “Public Charge” rule stated that determinations can include whether the applicant “is likely at any time to become a public charge,” or rely on public benefits.

The rule broadened the programs that the federal government could consider in public charge determinations to include previously excluded health, nutrition, and housing programs, and outlined the factors the federal government would consider in making a public charge consideration.

In December 2018, the Center for Medicare Advocacy submitted comments to the proposed “Public Charge” rule, expressing strong opposition. The Center for Medicare Advocacy is also proud to be one of over 1,100 organizations that signed on to a statement in opposition to the proposed “Public Charge” rule. The Center applauds these court rulings.

Additional Information:

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Drug Company Sued Over Kickbacks for Off-Label Marketing of Psychotropic Drug for Nursing Home Residents to Pay Over $115 Million

Background

When the Centers for Medicare & Medicaid Services (CMS) launched a national campaign to reduce the off-label prescribing of antipsychotic drugs for nursing home residents in 2012, Avanir Pharmaceuticals directed its sales force to talk to nursing facilities about using Nuedexta as a substitute for antipsychotic drugs. The Food and Drug Administration had approved Nuedexta for treatment of pseudobulbar affect (PBA), “which is characterized by involuntary, sudden, and frequent episodes of laughing or crying, and occurs secondary to a neurologic disease or brain injury.”[1] Nuedexta is not approved for dementia. While physicians may prescribe medications for nonapproved uses, pharmaceutical companies may not market or promote drugs for off-label uses.

A CNN investigation in 2017 reported that between 2012 and 2016, sales of Nuedexta for nursing home residents increased more than 400%. In 2011, Medicare spent $3.9 million on Nuedexta for nursing home residents; in 2015, it spent $138 million. In 2012, residents took 2.83 million Nuedexta pills; in 2016, 13.95 million pills. CNN reported that Avanir was making hundreds of millions of dollars a year by selling Nuedexta for nursing home residents.[2]

On September 26, 2019, the U.S. Department of Justice and the U.S. Attorneys Offices for the Northern District of Georgia and the Northern District of Ohio simultaneously announced four lawsuits, two criminal and two civil, challenging Avanir’s off-label marketing and promotional activities to encourage the prescribing of Nuedexta for nursing home residents. Three of the cases were settled, with Avanir agreeing to pay a total of $115,874,895. Four people await criminal trial in Ohio.

Criminal Cases

A one-count criminal indictment in the Northern District of Georgia alleges that “Avanir violated the Anti-Kickback Statute by paying a doctor to induce him [through financial incentives] to become a high prescriber of Nuedexta.”[3] Under a deferred prosecution agreement, Avanir admits that it paid the physician to increase his prescribing of Nuedexta. Avanir will pay a monetary penalty of $7,800,000 and a forfeiture of $4,074,895. Prosecution is deferred because of Avanir’s “substantial and ongoing cooperation with the investigation”[4] and because a criminal conviction would lead to the company’s mandatory exclusion from all federal health care programs for at least five years,[5] harming consumers who legitimately need Avanir’s drugs.

An 83-count criminal indictment in the Northern District of Ohio charges two physicians and two Avanir salesmen with engaging in “a kickback conspiracy in which the doctors allegedly received money and other things of value in exchange for writing prescriptions for Nuedexta for patients that did not have [PBA].”[6] One of the physicians, a psychiatrist in Cleveland, wrote more prescriptions for Nuedexta than any other physician in the country – 10,888 prescriptions between October 2011 and April 2016 – and received $1500 for approximately each of 211 speaking presentations where he promoted Nuedexta to other health care professionals. The U.S. Attorney’s Office asks people who believe they have been victims to contact the FBI at 216-622-6963.

Civil Cases

Avanir settled two False Claims Act (FCA) cases with the United States, which alleged that between October 29, 2010 and December 31, 2016, Avanir violated the FCA by giving “money, honoraria, travel, and food to physicians and other health care professionals to induce them to write prescriptions for Nuedexta.”[7] Former employees of Avanir filed the whistleblower lawsuits under the FCA in the Northern District of Georgia and the Northern District of Ohio. The company has agreed to pay the United States $95,972,017 to settle the False Claims Act cases and $7,027,983 to states to resolve state Medicaid claims.

Conclusion

The four lawsuits make clear that the misuse of psychotropic drugs on nursing home residents remains a serious problem. CMS’s focus on antipsychotic drugs since 2012 has led to the increased use of other psychotropic drugs,[8] such as the inappropriate marketing and prescribing of Nuedexta, as well as false diagnoses that appear to make antipsychotic drugs appropriate.[9]

________________ 

[1] U.S. Attorney, Northern District of Georgia, “Pharmaceutical Company Targeting Elderly Victims Admits to Paying Kickbacks, Resolves Related False Claims Act Violations” (News Release, Sep. 26, 2019), https://www.justice.gov/usao-ndga/pr/pharmaceutical-company-targeting-elderly-victims-admits-paying-kickbacks-resolves.
[2] Blake Ellis and Melanie Hicken, “The little red pill being pushed on the elderly; CNN investigation exposes inappropriate use of drug in nursing homes,” CNN (Oct. 12, 2017), https://www.cnn.com/2017/10/12/health/nuedexta-nursing-homes-invs/index.html.
[3] U.S. Attorney, Northern District of Georgia, “Pharmaceutical Company Targeting Elderly Victims Admits to Paying Kickbacks, Resolves Related False Claims Act Violations” (News Release, Sep. 26, 2019).
[4] Id. Avanir’s cooperation included “capturing and producing text messages from employee cell phones, the extensive remedial measures taken by the company, including terminating, or permitting to resign in lieu of termination, multiple employees, at various levels of the organization, including senior executives, and its enhanced compliance program.”  The company also agreed “to resolve all civil claims relating to federal health care programs arising from its conduct.”
[5] The HHS Inspector General would impose mandatory exclusion pursuant to 42 U.S.C. §1320a-7.
[6] U.S. Attorney, Northern District of Ohio, “Physicians and pharmacy sales reps indicted for kickback conspiracy in which doctors allegedly received money in exchange for writing unnecessary prescriptions of Nuedexta” (News Release, Sep. 26, 2019), https://www.justice.gov/usao-ndoh/pr/physicians-and-pharmacy-sales-reps-indicted-kickback-conspiracy-which-doctors-allegedly. [7] U.S. Department of Justice, “Pharmaceutical Company Targeting Elderly Victims Admits to Paying Kickbacks, Resolves Related False Claims Act Violations” (Press Release, Sep. 26, 2019), https://www.justice.gov/opa/pr/pharmaceutical-company-targeting-elderly-victims-admits-paying-kickbacks-resolves-related.
[8] Donovan T. Maust, H. Myra Kim, Claire Chiang, Helen C. Kales, “Association of the Centers for Medicare & Medicaid Services’ National Partnership to Improve Dementia Care With the Use of Antipsychotics and Other Psychotropics in Long-term Care in the United States From 2009 to 2014,” JAMA Internal Medicine (published on-line Mar. 17, 2018), https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2674245?resultClick=1 (click on open).
[9] Jonathan D. Winter, J. William Kerns, Katherine M. Winter & Roy T. Sabo, “Increased Reporting of Exclusionary Diagnoses Inflate Apparent Reductions in Long-Stay Antipsychotic Prescribing,” Clinical Gerontologist, Vol. 42, Issue 3 (Dec. 2017), href=”https://www.tandfonline.com/doi/full/10.1080/07317115.2017.1395378″>https://www.tandfonline.com/doi/full/10.1080/07317115.2017.1395378 (abstract).

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Joint Issue Alert on Medicare Payment and Skilled Therapy Services in Nursing Homes

On October 1, 2019, the Centers for Medicare & Medicaid Services (CMS) implemented a new payment system for Medicare-covered nursing home stays—the “Patient Driven Payment Model” (PDPM). PDPM creates new financial incentives for nursing homes and new challenges for nursing home residents. One of the biggest challenges for residents under PDPM is access to skilled therapy.

The Center for Medicare Advocacy (the Center) and the Long Term Care Community Coalition (LTCCC) have developed a new Issue Alert to help residents and their families understand the implications of PDPM as it relates to Medicare-covered skilled therapy services in nursing homes. The Issue Alert also provides information about relevant federal standards of care to help residents and families in preventing and challenging skilled therapy denials.

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Free Webinar: Medicare Enrollment Issues for 2020

This presentation will address important Medicare enrollment issues, deadlines and materials, including the Medicare & You publication, and other CMS outreach and education materials.

Presented by Center for Medicare Advocacy Senior Policy Attorney David Lipschutz and guest presenters.

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The Center for Medicare Advocacy is a non-profit organization.
Your contributions to the Center are essential to maintaining our ability to advance access
to comprehensive Medicare coverage and quality health care.


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Center for Medicare Advocacy Board President Judith Feder Testifies at Drug Pricing Hearing

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On October 17, 2019, the House Ways & Means Committee held a hearing entitled “Investing in the U.S. Health System by Lowering Drug Prices, Reducing Out-of-Pocket Costs, and Improving Medicare Benefits.”  The hearing focused on H.R. 3, the Lower Drug Costs Now Act (discussed in a previous Alert), as well as current gaps in Medicare coverage that could be filled using savings from lowering drug costs in Medicare.

Dr. Judith Feder, Professor at McCourt School of Public Policy at Georgetown University, and the President of the Board of Directors of the Center for Medicare Advocacy, was invited to testify about needed improvements to the Medicare program (her written testimony is available here).  Dr. Feder’s testimony focused on the need to address four gaps in Medicare coverage:

  • Out-of-pocket costs Medicare beneficiaries face;
  • Specific gaps in benefits, including dental, hearing, vision and long-term services and supports;
  • Administrative barriers or biases, including diminishing access to the home health benefit, observation status, inappropriate steering towards Medicare Advantage plans coupled with the lack of access to Medigap plans; and
  • Investments to ensure the long-term sustainability of the Medicare program, including the need for more revenue.

At the same time as the Ways & Means hearing, the House Energy & Commerce committee marked up H.R. 3 and a suite of bills that would add improvements to the Medicare program.  The House Education & Labor Committee also marked up H.R. 3.

The Center wrote letters of support for H.R. 3 and the Medicare-related bills, with suggested improvements to the Ways & Means and Energy & Commerce Committees.

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Joint Issue Alert on Medicare Payment and Skilled Therapy Services in Nursing Homes

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On October 1, 2019, the Centers for Medicare & Medicaid Services (CMS) implemented a new payment system for Medicare-covered nursing home stays—the “Patient Driven Payment Model” (PDPM). PDPM creates new financial incentives for nursing homes and new challenges for nursing home residents. One of the biggest challenges for residents under PDPM is access to skilled therapy.

The Center for Medicare Advocacy (the Center) and the Long Term Care Community Coalition (LTCCC) have developed a new Issue Alert to help residents and their families understand the implications of PDPM as it relates to Medicare-covered skilled therapy services in nursing homes. The Issue Alert also provides information about relevant federal standards of care to help residents and families in preventing and challenging skilled therapy denials.

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Drug Company Sued Over Kickbacks for Off-Label Marketing of Psychotropic Drug for Nursing Home Residents to Pay Over $115 Million

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Background

When the Centers for Medicare & Medicaid Services (CMS) launched a national campaign to reduce the off-label prescribing of antipsychotic drugs for nursing home residents in 2012, Avanir Pharmaceuticals directed its sales force to talk to nursing facilities about using Nuedexta as a substitute for antipsychotic drugs. The Food and Drug Administration had approved Nuedexta for treatment of pseudobulbar affect (PBA), “which is characterized by involuntary, sudden, and frequent episodes of laughing or crying, and occurs secondary to a neurologic disease or brain injury.”[1] Nuedexta is not approved for dementia. While physicians may prescribe medications for nonapproved uses, pharmaceutical companies may not market or promote drugs for off-label uses.

A CNN investigation in 2017 reported that between 2012 and 2016, sales of Nuedexta for nursing home residents increased more than 400%. In 2011, Medicare spent $3.9 million on Nuedexta for nursing home residents; in 2015, it spent $138 million. In 2012, residents took 2.83 million Nuedexta pills; in 2016, 13.95 million pills. CNN reported that Avanir was making hundreds of millions of dollars a year by selling Nuedexta for nursing home residents.[2]

On September 26, 2019, the U.S. Department of Justice and the U.S. Attorneys Offices for the Northern District of Georgia and the Northern District of Ohio simultaneously announced four lawsuits, two criminal and two civil, challenging Avanir’s off-label marketing and promotional activities to encourage the prescribing of Nuedexta for nursing home residents. Three of the cases were settled, with Avanir agreeing to pay a total of $115,874,895. Four people await criminal trial in Ohio.

Criminal Cases

A one-count criminal indictment in the Northern District of Georgia alleges that “Avanir violated the Anti-Kickback Statute by paying a doctor to induce him [through financial incentives] to become a high prescriber of Nuedexta.”[3] Under a deferred prosecution agreement, Avanir admits that it paid the physician to increase his prescribing of Nuedexta. Avanir will pay a monetary penalty of $7,800,000 and a forfeiture of $4,074,895. Prosecution is deferred because of Avanir’s “substantial and ongoing cooperation with the investigation”[4] and because a criminal conviction would lead to the company’s mandatory exclusion from all federal health care programs for at least five years,[5] harming consumers who legitimately need Avanir’s drugs.

An 83-count criminal indictment in the Northern District of Ohio charges two physicians and two Avanir salesmen with engaging in “a kickback conspiracy in which the doctors allegedly received money and other things of value in exchange for writing prescriptions for Nuedexta for patients that did not have [PBA].”[6] One of the physicians, a psychiatrist in Cleveland, wrote more prescriptions for Nuedexta than any other physician in the country – 10,888 prescriptions between October 2011 and April 2016 – and received $1500 for approximately each of 211 speaking presentations where he promoted Nuedexta to other health care professionals. The U.S. Attorney’s Office asks people who believe they have been victims to contact the FBI at 216-622-6963.

Civil cases

Avanir settled two False Claims Act (FCA) cases with the United States, which alleged that between October 29, 2010 and December 31, 2016, Avanir violated the FCA by giving “money, honoraria, travel, and food to physicians and other health care professionals to induce them to write prescriptions for Nuedexta.”[7] Former employees of Avanir filed the whistleblower lawsuits under the FCA in the Northern District of Georgia and the Northern District of Ohio. The company has agreed to pay the United States $95,972,017 to settle the False Claims Act cases and $7,027,983 to states to resolve state Medicaid claims.

Conclusion

The four lawsuits make clear that the misuse of psychotropic drugs on nursing home residents remains a serious problem. CMS’s focus on antipsychotic drugs since 2012 has led to the increased use of other psychotropic drugs,[8] such as the inappropriate marketing and prescribing of Nuedexta, as well as false diagnoses that appear to make antipsychotic drugs appropriate.[9]

October 17, 2019 – T. Edelman

________________ 

[1] U.S. Attorney, Northern District of Georgia, “Pharmaceutical Company Targeting Elderly Victims Admits to Paying Kickbacks, Resolves Related False Claims Act Violations” (News Release, Sep. 26, 2019), https://www.justice.gov/usao-ndga/pr/pharmaceutical-company-targeting-elderly-victims-admits-paying-kickbacks-resolves.
[2] Blake Ellis and Melanie Hicken, “The little red pill being pushed on the elderly; CNN investigation exposes inappropriate use of drug in nursing homes,” CNN (Oct. 12, 2017), https://www.cnn.com/2017/10/12/health/nuedexta-nursing-homes-invs/index.html.
[3] U.S. Attorney, Northern District of Georgia, “Pharmaceutical Company Targeting Elderly Victims Admits to Paying Kickbacks, Resolves Related False Claims Act Violations” (News Release, Sep. 26, 2019).
[4] Id. Avanir’s cooperation included “capturing and producing text messages from employee cell phones, the extensive remedial measures taken by the company, including terminating, or permitting to resign in lieu of termination, multiple employees, at various levels of the organization, including senior executives, and its enhanced compliance program.”  The company also agreed “to resolve all civil claims relating to federal health care programs arising from its conduct.”
[5] The HHS Inspector General would impose mandatory exclusion pursuant to 42 U.S.C. §1320a-7.
[6] U.S. Attorney, Northern District of Ohio, “Physicians and pharmacy sales reps indicted for kickback conspiracy in which doctors allegedly received money in exchange for writing unnecessary prescriptions of Nuedexta” (News Release, Sep. 26, 2019), https://www.justice.gov/usao-ndoh/pr/physicians-and-pharmacy-sales-reps-indicted-kickback-conspiracy-which-doctors-allegedly.
[7] U.S. Department of Justice, “Pharmaceutical Company Targeting Elderly Victims Admits to Paying Kickbacks, Resolves Related False Claims Act Violations” (Press Release, Sep. 26, 2019), https://www.justice.gov/opa/pr/pharmaceutical-company-targeting-elderly-victims-admits-paying-kickbacks-resolves-related.
[8] Donovan T. Maust, H. Myra Kim, Claire Chiang, Helen C. Kales, “Association of the Centers for Medicare & Medicaid Services’ National Partnership to Improve Dementia Care With the Use of Antipsychotics and Other Psychotropics in Long-term Care in the United States From 2009 to 2014,” JAMA Internal Medicine (published on-line Mar. 17, 2018), https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2674245?resultClick=1 (click on open).
[9] Jonathan D. Winter, J. William Kerns, Katherine M. Winter & Roy T. Sabo, “Increased Reporting of Exclusionary Diagnoses Inflate Apparent Reductions in Long-Stay Antipsychotic Prescribing,” Clinical Gerontologist, Vol. 42, Issue 3 (Dec. 2017), https://www.tandfonline.com/doi/full/10.1080/07317115.2017.1395378 (abstract).

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Administration’s “Public Charge” Rule [Temporarily?] Blocked

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Last week federal judges in several states issued temporary injunctions against the Trump administration’s “public charge” rule, preventing it from taking effect. The rule was set to take effect this week.

The “Public Charge” final rule, which was posted on August 14, 2019 to the Federal Register, amended Department of Homeland Security (DHS) regulations regarding how an application for legal immigration into this country would be assessed, expanding the government’s ability to deny entry based on the possible future use of services like Medicaid. The “Public Charge” rule stated that determinations can include whether the applicant “is likely at any time to become a public charge,” or rely on public benefits.

The rule broadened the programs that the federal government could consider in public charge determinations to include previously excluded health, nutrition, and housing programs, and outlined the factors the federal government would consider in making a public charge consideration.

In December 2018, the Center for Medicare Advocacy submitted comments to the proposed “Public Charge” rule, expressing strong opposition. The Center for Medicare Advocacy is also proud to be one of over 1,100 organizations that signed on to a statement in opposition to the proposed “Public Charge” rule. The Center applauds these court rulings.

Additional Information:

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How to Pick a Medigap Plan | Medicare – U.S News & World Report Money

  1. How to Pick a Medigap Plan | Medicare  U.S News & World Report Money
  2. If you’re joining Medicare for the first time, you’ll have to pay a monthly deductible now  Miami Herald
  3. The 2020 Medicare enrollment season brings fierce competition for baby boomers among insurers  CNBC
  4. How to find your Medicare guru | News  Cadillac News
  5. Are You Sure You’re Ready for Medicare Open Enrollment?  Newsmax
  6. View full coverage on Google News

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What Many Seniors Are Getting Wrong About The 2020 Exit Of Medigap Plan C And Plan F – Forbes

It’s been big news this year that as of Jan. 1, 2020, Medigap plans C and F will be discontinued. This change came about as a part of the Medicare Access and CHIP Reauthorization legislation in 2015, which prohibits the sale of Medigap plans that cover Medicare’s Part B deductible. The goal of discontinuing these plans is to make all Medicare beneficiaries have some out-of-pocket spending when they use healthcare services.

Both Medigap Plans C and F cover Medicare’s Part B deductible, which in 2019 is $185. This makes these plans into something called “first dollar coverage.”

If a Medigap plan covers all your out-of-pocket spending from the beginning, the theory is that you will be more likely to run to the doctor over every little sniffle and sneeze. This costs Medicare, and thus the federal government, money. By discontinuing these two plans, Congress hopes beneficiaries will be a bit more choosy about seeking healthcare for minor ailments. So as of Jan. 1, 2020, these plans are being phased out for new enrollees.

What do many people believe?

There is a misconception out there that only people who already have Plan C or Plan F will be able to keep their coverage. This fails to capture the whole picture.

In fact, anyone who is eligible for Medicare before 2020 will always be able to buy Plans C or F, for as long as insurance companies continue to offer them. So even if today you are enrolled in another plan, such as Medigap Plan G or N, your future options will not change from the options you have today. This even applies to beneficiaries who delayed enrolling in Medicare Part B before now, usually because they were still working and had access to employer group health coverage.

Who won’t be able to buy plans C or F?

Individuals who are eligible for Medicare beginning on or after Jan. 1, 2020, won’t be able to buy Plans C or F, but they will still have plenty of Medicare supplement options. These options will vary by carrier, as each carrier decides which plans it will offer to the public (within state rules).

The two most comprehensive plans will be Medigap Plans D and G. Neither of these plans covers the Part B deductible, but they cover most of the other cost-sharing. This means new beneficiaries will need to prepare to satisfy their own Part B deductible upon their first outpatient service of the year.

After that though, both Plans D and G will offer robust coverage of other Medicare cost-sharing, such as the Part A deductible, the Part B coinsurance, skilled nursing facility coinsurance and so on. Because you will pay your own Part B deductible, though, you may find that premiums for these two plans are more competitive than premiums for Plans C or F are today. Fewer benefits covered usually translates to lower monthly rates for the insured individual.

Will rates for Medigap Plan F skyrocket?

Medigap Plan F has been the most popular plan for decades, because it covers all of the gaps in Medicare. When new enrollees are no longer able to buy the plans that are being phased, beneficiaries insured on those plans could see higher rate increases in the future, because there are no younger and sometimes healthier 65-year-olds able to purchase Plan F.

Years ago, when Medicare phased out Medigap Plans H, I and J, many beneficiaries who remained on those plans saw higher annual rate increases over time. Something similar could happen to beneficiaries who stick with their current Plan F. However, that remains to be seen.

Some insurance carriers could also introduce new Plan F policies, looking to attract healthy beneficiaries who were eligible for Medicare before 2020. Changing from one Medigap Plan F policy to another policy offered by a different carrier generally involves health questions.

If carriers offer new Plan F policies for sale at competitively low rates, many currently insured individuals might apply to change plans so they can take advantage of lower rates. All those individuals would answer health questions on their applications, and the underwriters would approve those individuals healthy enough to qualify.

While it will be interesting to see what happens, the important message is that it’s not just people already on these plans who get to keep them. As always, you should consult with your Medicare insurance broker annually to see if any plan options exist for you that might help you reduce premiums.

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Medicare 2020: 12 questions and answers about new Medigap rule – OregonLive

Choosing Medicare coverage is bewildering enough. Now, a law change that takes effect next year appears to be complicating matters for some enrollees.

The issue: Americans who become eligible for Medicare on or after Jan. 1, 2020, can no longer buy a Medicare supplement plan that covers their Part B deductible. Those so-called Medigap plans included two types of plans — Type C and Type F, the most popular of the 10 types of Medigap plans.

Congress hoped the change would require seniors to have more skin in the game, prompting them to think twice before seeking unnecessary medical care.

But the change doesn’t apply to everyone. Those who turn 65 before Jan. 1, are already enrolled in a Medigap plan or who are already enrolled in Medicare can still switch to or purchase a Type F or C plan, with some limitations.

“Plan F is not ending,” said Casey Schwarz, senior counsel for education and federal policy at Medicare Rights Center, a Washington, D.C.-based consumer advocacy group. “Anyone who had Medicare prior to that date can enroll and may keep that plan.”

“There’s a lot of confusion,” said Lisa Lettenmaier, a health insurance broker in Tigard. “People are making an assumption they’re going to get kicked off. I’ve had to do a lot of clarifying.”

Here’s what you need to know:

What is Medigap?

It’s an additional insurance policy, also known as Medicare supplemental insurance, that fills in some or all coverage “gaps” left by traditional Medicare.

What gaps are those?

Traditional Medicare (Plans A and B) covers hospitalizations (Part A) and doctor’s visits (Part B), mostly for seniors age 65 and over. But it requires recipients to cover about 20% of their costs. There’s also an annual deductible for hospitalizations (not yet set for 2020, but $1,364 in 2019) and for Part B ($185 in 2019). Long stays in a hospital or nursing home can lead to additional and substantial out-of-pocket costs.

How does Medigap work?

There are 10 types of plans, ranging from letters A through N, that offer different levels of coverage. Most Medigap enrollees have chosen Type F, which covers all out-of-pocket costs. That means their only medical cost, aside from prescription drugs, is their monthly premium, which can be quite high.

What’s changing?

Congress now has effectively barred Medigap plans from covering Medicare’s Plan B deductible, which was $185 in 2019. Only Medigap Type C and F plans covered the Part B deductible.

Congress hoped the change might save the system money. Experts counter it could cause seniors to forgo needed care, leading to medical complications and higher expenses later.

Who’s affected?

The change applies only to those who become Medicare eligible after Jan. 1, 2020. That includes those who turn 65 or become disabled in 2020 or later.

What if I’m already in a Type F plan?

Nothing changes. You can keep your plan or even switch to another. Seniors already 65 also can enroll in a Type C or F plan if they’ve not already done so, if they want to switch Medigap plans or if their Medicare Advantage plan ends.

What if I haven’t enrolled in Medicare because I haven’t retired and am insured through work?

As long as you turned 65 before Jan. 1, you’ll still be able to enroll in a Type F plan when you do retire.

What if my Medicare Advantage plan ends after 2020? Can I still get a Type F?

Yes. If you lose your plan through no fault of your own or move out of its service area, you have 63 days to enroll in another Medicare Advantage or Medigap plan, without having to undergo screening for pre-existing medical conditions.

For instance, in Oregon, Moda Health Plan is officially terminating its PPORx plan in some counties for 2020 and replacing it with a new plan. Those affected could choose to enroll in a Medigap plan or any other Medicare Advantage plan without undergoing medical underwriting.

What’s the next best plan if there’s no F?

Type G is now the most generous. It covers everything Type F covered except for Medicare’s Plan B deductible.

“G is the new F,” said Lisa Emerson, program director for Oregon’s Senior Health Insurance Benefits Assistance program, or SHIBA.

Will Type G cost me more?

It’s more expensive than other types, but not necessarily Type F plans. In recent years, Type F plan premiums have increased more dramatically, insurance brokers say. Even with the Plan B deductible factored in, many Type G plans cost less than Type Fs, and insurance brokers have already nudged clients from F to G. “Especially our older clients, we’ve moved them to a Plan G and saved them $70 to $80 a month,” Lettenmaier said.

Is Medigap right for me?

Seniors who travel a lot or who maintain homes in different states often opt for Medigap plans because it doesn’t limit them to a specific doctor or hospital network. Those with high ongoing medical costs also find Medigap plans can protect them from large out-of-pocket expenses. But some providers won’t accept seniors without Medicare Advantage plans. So it really depends. Talk to an insurance broker or volunteer SHIBA representative about what’s right for your situation.

Brent Hunsberger is an investment adviser representative in Portland. For important disclosures and information about Brent, visit bit.ly/2dwmN7w. Reach him at oregonianmedicare@gmail.com or leave a message at 503-683-3098.

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CMA Alert – October 10, 2019

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  1. Center for Medicare Advocacy Analysis of President’s Medicare Advantage Executive Order: Among Vague Language and Proposals, Real Harm to Medicare Beneficiaries 
  2. Nursing Home Residents and Therapy Under The New Medicare Reimbursement System
  3. Important Update to Nursing Home Compare Will Enable Public to Identify Facilities with a History of Abuse
  4. Medicare’s Annual Election Period Starts Next Week – October 15th
  5. Free Webinar on New Medicare Reimbursement System For SNFs, October 15 

Center for Medicare Advocacy Analysis of President’s Medicare Advantage Executive Order: Among Vague Language and Proposals, Real Harm to Medicare Beneficiaries

On October 3, 2019, President Trump issued his “Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors” (EO).[1] Much of the language of the EO is vague, and much is unknown about what polices might emerge from it. Some of the proposals are clear in their intent, and would cause clear harm to Medicare beneficiaries. While other proposals are ambiguous in their language, we can generally infer intent based upon previous actions by this Administration. The Center’s analysis of the EO expresses some of our concerns about the impact on Medicare beneficiaries, and the Medicare program in general, if some of the proposals outlined in the President’s Executive Order are implemented. Among other thing, the EO would:

  • Exacerbate the Growing Imbalance between Traditional Medicare and Medicare Advantage – Provisions of the EO exacerbate an existing imbalance between traditional Medicare and the Medicare Advantage (MA) program, and demonstrate the Administration’s ongoing efforts to maximize enrollment in, and the scope of, coverage of MA plans. This includes a directive to “ensure that, to the extent permitted by law, FFS [aka traditional, or Original] Medicare is not advantaged or promoted over MA with respect to its administration.” It also promotes Medicare Medical Savings Programs, which would primarily benefit the wealthy, and could erode network adequacy requirements by relying on access to providers through telemedicine.
  • Push People Away from Medicare – The EO directs policy changes that would allow people to keep their Social Security retirement benefits, but decline Part A of Medicare, which would incentivize those wealthy enough to self-fund their health care to leave Medicare, eroding the universality of the program and potentially impacting the program’s risk pool. In addition, the EO requires the Medicare program to “remove unnecessary barriers” to private contracting between providers and beneficiaries, which at best would only serve those who could afford to pay for their own care, and at worst, open the door to unfair bargaining advantages and unequal power dynamics between providers and patients.
  • Roll-back Important Consumer Protections – the EO would continue this Administration’s efforts to “reduce regulatory burden” which frequently results in weakening consumer protections.

There is much in the President’s Executive Order that is unclear and must be further defined in order to assess its impact. Most of the provisions that are discernable, though, are not consumer friendly. Instead, they are a gift to both the Medicare Advantage insurance industry and beneficiaries who are well off enough to pay for their own health care.

______________

[1] Available through the White House website at: https://www.whitehouse.gov/presidential-actions/executive-order-protecting-improving-medicare-nations-seniors/ and in the Federal Register at 84 Fed Reg 53573 (Oct. 8, 2019) at: https://www.federalregister.gov/documents/2019/10/08/2019-22073/protecting-and-improving-medicare-for-our-nations-seniors.

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Nursing Home Residents and Therapy Under The New Medicare Reimbursement System

The Centers for Medicare & Medicaid Services (CMS) implemented a new Medicare Part A reimbursement system for skilled nursing facilities (SNFs), called Patient-Driven Payment Model (PDPM), on October 1, 2019.[1] Therapists immediately began reporting that nursing homes and therapy companies were laying them off and demanding that they change their therapy practices, shifting residents from individual therapy to group and concurrent therapy.[2]  Medicare beneficiaries and their advocates need to oppose cutbacks in therapy that deprive them of necessary services. Medicare eligibility and coverage rules for beneficiaries have not changed. Eligibility for Part A coverage in a SNF requires needing and receiving daily skilled care – either skilled nursing services seven days a week or skilled therapy services five days a week.[3] Residents who need therapy and who have therapy services included in their care plans continue to be entitled to receive the medically necessary therapy that is ordered. Medicare continues to cover therapy for improvement and maintenance[4] goals alike.

How the New Payment System Works

Payments for most residents under the most recent system, Resource Utilization Groups (RUGs), were based on the number of minutes of therapy that a resident received.  The more minutes of therapy, the higher the reimbursement rate. CMS, the HHS Office of Inspector General, and the Medicare Payment Advisory Commission (MedPAC) believed that RUGs encouraged overutilization (or at least overbilling) of therapy.[5]

The new reimbursement system explicitly changed the financial incentives. CMS’s own analysis of the impact of the new system, included in the final rules for PDPM that CMS published in 2018, indicated that payments would be higher for residents who did not receive any therapy in the SNF and lower for residents who received all three types of therapy, physical, occupational, and speech therapy.[6]

Under RUGs, 99% of residents received individual therapy.[7] Nevertheless and while recognizing that individual therapy is the preferred method of providing therapy to residents,[8] CMS allows up to 25% of therapy services to be provided in group or concurrent settings under PDPM.[9] In final rules published in 2019, CMS expanded the permissible number of residents in group therapy to six.[10]

What CMS Says about Therapy in the New Payment System

CMS is fully aware that allowing more group and concurrent therapy under PDPM changes the financial incentives for SNFs: “We appreciate the commenters’ concern that the proposed change in the definition of group therapy may give providers an incentive to place the maximum number of patients in a group for financial reasons.”[11]

However, in Frequently Asked Questions, CMS confirms the continuing availability of therapy services under PDPM: “PDPM does not change the care needs of SNF patients, which should be the primary driver of care decisions, including the type, duration, and intensity of skilled therapies, made on behalf of SNF patients.”[12]

The preamble to the 2019 rule also includes several observations that may be useful to residents who are facing changes in their therapy services and to their advocates.

First, CMS confirms that financial considerations should not override clinical judgment, writing in 2019:

As we have stated previously, therapists treating SNF patients should use their own clinical judgment to determine the appropriate frequency, duration, and modality of therapy services and the size of a therapy group based on the individual needs of each patient.  Financial motives should not override the clinical judgment of a therapist or therapy assistant or pressure a therapist or therapy assistant to provide less than appropriate therapy, including putting patients in large groups that are not clinically appropriate for those patients.[13]

Second, CMS announces its “plan to implement a robust monitoring program to assess compliance with the 25 percent cap [on group and concurrent therapy].” Although the 2018 rules had indicated that facilities exceeding the cap would receive only “a non-fatal warning edit,” a “reminder” that it is out of compliance[14] – that is, no consequence for exceeding the cap – the 2019 rule says, “based on our findings [from the robust monitoring program], we may propose taking additional action in future rulemaking.”[15]

What Can Residents and Their Advocates Do?

Residents and their advocates can insist that residents receive the therapy services that are included in their comprehensive person-centered care plans.[16] Residents and their representatives are included in care-planning.[17]

If a facility suggests that group or concurrent therapy is appropriate, residents and their advocates can point to preamble language identifying individual therapy as the primary mode of therapy residents should receive and the need for the therapist to document the appropriateness of non-individual therapy:

[W]hile group therapy can play an important role in SNF patient care, group therapy is not appropriate for either all patients or for all conditions, and is primarily effective as a supplement to individual therapy, which we maintain should be considered the primary therapy mode and standard of care in therapy services provided to SNF residents.  Additionally, we stated that we continue to maintain that when group therapy is used in a SNF, therapists must document its use in order to demonstrate why it is the most appropriate mode of therapy for the patient who is receiving it…because group therapy is not appropriate for either all patients or all conditions, and in order to verify that group therapy is medically necessary and appropriate to the needs of each beneficiary, SNFs should include in the patient’s plan of care an explicit justification for the use of group rather than individual or concurrent therapy. This description should include, but need not be limited to, the specific benefits to that particular patient of including the documented type and amount of group therapy; that is, how the prescribed type and amount of group therapy will meet the patient’s needs and assist the patient in reaching the documented goals. [bold font supplied][18]

On a policy level, advocates need to assure that CMS fulfills its pledge to engage in robust monitoring of facilities’ use of group and concurrent therapy. Early reports of cutbacks in therapists’ hours make monitoring essential.

Residents and their advocates can work with their therapists and professional therapy associations. The national therapy associations – the American Physical Therapy Association (APTA), the American Occupational Therapy Association, and the American Speech-Language-Hearing Association – are closely monitoring implementation of PDPM and, already, jointly providing CMS with stories of therapists’ layoffs and other policy issues related to implementation. A clear one-page statement by APTA confirms that PDPM does not change patient needs or criteria for skilled therapy coverage in SNFs.[19]

______________________

[1] 83 Fed. Reg. 39162, 39183-39265 (Aug. 8, 2018).  See Center for Medicare Advocacy, “Final Rules for New Medicare Reimbursement System for Skilled Nursing Facilities: Goodbye Therapy” (CMA Alert, Aug. 23, 2018).
[2] See  https://www.modernhealthcare.com/payment/therapists-decry-layoffs-amid-snf-reimbursement-overhaul;  Danielle Brown, ‘Therapist advocates sharing layoff concerns with CMS,” McKnight’s Long-Term Care News (Oct. 3, 2019), Alex Kacik, “Therapists look to CMS for aid as SNFs restructure,” Modern Healthcare (not sure of the date; it says Oct. 4 now but I’m quite certain it came out earlier, maybe Oct. 1)https://www.mcknights.com/news/therapist-advocates-sharing-layoff-concerns-with-cms/, Alex Kacik, “Therapists look to CMS for aid as SNFs restructure,” Modern Healthcare.
[3] 42 U.S.C. §1395f(a)(2)(B).
[4] See https://www.medicareadvocacy.org/?s=maintenance&op.x=0&op.y=0.
[5] 83 Fed. Reg. 39162, 39184-39185 (Aug. 8, 2018).
[6] 83 Fed. Reg. 39162, 39257-39259 (Table 37).
[7] 83 Fed. Reg. 39162, 39238.
[8] 83 Fed. Reg. 39162, 39238.
[9] 83 Fed. Reg. 39162, 39237-39243.
[10] 84 Fed. Reg. 38728, 38745-38746 (Aug. 7, 2019).
[11] 84 Fed. Reg. 38728, 38748.
[12] CMS, Patient-Driven Payment Model, Frequently Asked Questions, Question 12.1 (Aug. 27, 2019), https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM.html (click on Frequently Asked Questions).
[13] 84 Fed. Reg. 2728, 38748.
[14] 83 Fed. Reg. 39162, 39239 (Aug. 8, 2018).
[15] 84 Fed. Reg. 28728, 38748.
[16] 42 C.F.R. §483.21(b).
[17] 42 C.F.R. §483.21(b)(ii)(E).
[18] 84 Fed. Reg. 38728, 38746.
[19] https://www.apta.org/uploadedFiles/APTAorg/Payment/Medicare/Coding_and_Billing/SNF/APTAHandout_PDPM.pdf.

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Important Update to Nursing Home Compare Will Enable Public to Identify Facilities with a History of Abuse

Joint alert from the Center for Medicare Advocacy and the Long Term Care Community Coalition.

On October 7, 2019, the Centers for Medicare & Medicaid Services (CMS) announced changes to Nursing Home Compare that make it easier for residents and families to identify facilities with a history of resident abuse, neglect, or exploitation.

NHC Abuse Icon
New Icon

Starting on October 23rd of this year, consumers will see a new icon (a red circle with a hand – at right) on a facility’s Nursing Home Compare profile if that facility has been cited for either or both of the following deficiencies:

  1. A harm-level (scope and severity level G or higher) abuse citation on the most recent standard survey cycle or complaint survey within the past 12 months.
  2. An abuse citation where residents were found to be potentially harmed (scope and severity level D or higher) on the most recent standard survey cycle or complaint survey within the past 12 months and on the previous standard survey cycle or complaint survey in the prior 12 months.

Additionally, revisions to the Five Star Technical Users’ Guide reveal that facilities meeting either of these criteria will have their health inspection rating “capped at a maximum of two stars . . .  [and that] the best overall quality rating a facility that has received the abuse icon can have is four stars.”

The changes come after several years of increased recognition of, and concern about, nursing home resident abuse. Most recently, the U.S. Senate Committee on Finance held two hearings on resident abuse and federal reports issued this past summer documented persistent, widespread resident abuse across the country.

The Center for Medicare Advocacy and the Long Term Care Community Coalition (LTCCC) thank CMS for taking steps to improve nursing home transparency. Our organizations look forward to working with CMS to ensure that the new icon is beneficial to nursing home residents and their families.

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Medicare’s Annual Election Period Starts Next Week – October 15th

The Annual Coordinated Election Period (ACEP), between October 15th and December 7th, is the time period during which Medicare beneficiaries can make coverage elections effective January 1st (this period is often referred to as the Open Enrollment period).

As discussed in previous Alerts here and here, advocates have been concerned about a number of factors affecting this ACEP, including an update to the Medicare Plan Finder (MPF), changes in marketing rules, and new policies taking effect in 2020 that can make it more challenging for consumers to weigh their options (such as new supplemental benefits available to some, but not all enrollees of MA plans, and new Medigap restrictions).

For assistance with exploring options during the ACEP, we encourage beneficiaries to contact their local State Health Insurance Assistance Program (SHIP) – it may have a different name in your state. You can find your local SHIP program by calling 1-877-839-2675 or online online here.

Medicare Plan Finder (MPF) Updates

As discussed in the previous Alerts referenced above, and in various media reports, including a recent Kaiser Health News story, challenges with the new MPF remain – less than a week from the start of the ACEP.

In an email sent to partners on Monday October 7th, the Centers for Medicare & Medicaid Services (CMS) stated that they are continuing to work on improvements to the MPF and have added additional resources to their Plan Finder page on CMS’ National Training website. These new resources include new videos and an Updated Top Q&As.

Contrary to assertions made publicly and in a previous Q&A published on the same website (no longer available), the updated Q&A says that individual drug lists created outside of MyMedicare accounts will not be available, “[b]ecause the previous technology is proprietary.” (The previous Q&A stated “[w]e are working to extend access to any drug lists created in the old Plan Finder through the end of the 2019 Open Enrollment.”) People can still do anonymous drug searches, but they will not be able to save such searches unless they create a MyMedicare account.

The Updated Q&As also includes a “list of improvements that are still planned to be in place by the start of the Open Enrollment on October 15, 2019”:

  • Display drug tier costs
  • Link directly from MyMedicare.gov to new Plan Finder
  • Integrate partial gap coverage into cost sharing
  • Adding Original Medicare info and card for comparison
  • Add sort option for total cost (plan premium + drug costs)
  • Add footnote for excluded drugs
  • Maintain filters and SNP selections when using back button
  • Add option to add mail order on pharmacy selection page
  • Refine the ZIP code entry process
  • Show distinction between preferred in-network versus in-network pharmacy on the Costs-by-Phase table
  • Add note about over-the-counter drugs to drug lookup page
  • Add option to compare a third retail pharmacy when mail order isn’t selected
  • Improve Print Format
  • Various backend technical updates to prepare for display of 2020 plans

CMS notes that feedback on the new Plan Finder can be emailed to eMedicare@cms.hhs.gov.

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Free Webinar about the New Medicare Payment System For SNFs

The Long Term Care Community Coalition is hosting a webinar on Medicare’s new payment system for skilled nursing facilities, Patient-Driven Payment Model (PDPM) on Tuesday, October 15, 2019, at 1:00 p.m. The Center for Medicare Advocacy’s Senior Policy Attorney Toby S. Edelman will discuss how the new system works and what it means for residents.

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