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New Medicare Scam Targets Part B Participants

Seniors should be leery of promise of free glucose meter

Nevada's attorney general is warning seniors that a new scam is targeting Medicare recipients, trying to obtain personal information that could be used for identity theft.

Attorney General Catherine Cortez Masto has issued a consumer alert after a senior in her state reported an attempt to steal his Medicare number.

According to Masto, the scam worked like this: a caller reached the senior by telephone and told him they are eligible for new diabetic meters that are generally covered by Medicare under Medicare Part B.

The caller claimed to be a government agency representative and informed the Medicare beneficiary he was eligible for a new glucose meter. The caller then asked the beneficiary to confirm “you are who you say you are” and requested the beneficiary’s Medicare number.

Didn't fall for it

In this particular case, the Nevada beneficiary told the caller he was not comfortable providing that information over the phone and asked the caller to send a form to provide the information. The caller then promptly hung up.

“Luckily, this senior was aware enough to realize that the caller was a scammer looking for personal information in an attempt to victimize him,” said Masto. “Although seniors are becoming increasingly more vigilant in protecting

their Medicare numbers and other personal information, there’s always the possibility that a scammer calling a senior could persuade him or her to provide information that could open the senior to potential ID theft and medical identity theft.”

Research shows that people are usually more vulnerable to a scam if it involves getting something for free. Consumers should be especially wary of offers of free items that require you to provide personal or credit card information.

Medicare, or course, will never make unsolicited calls to a beneficiary. If seniors receive any phone calls such as this scam, they should report it to their state attorney general and the Medicare Fraud Line in Washington.

The attorney general of Nevada is warning seniors about a new Medicare scam....
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Medicare Fraud Strike Force Takes Down 111 Suspects

Doctors, nurses, health care companies among those nabbed

The Medicare Fraud Strike Force today charged 111 defendants in nine cities, including doctors, nurses, health care company owners and executives, and others, for their alleged participation in Medicare fraud schemes involving more than $225 million in false billing.

Also today, the Department of Justice (DOJ) and HHS announced the expansion of Medicare Fraud Strike Force operations to two additional cities—Dallas and Chicago. Today’s operation is the largest-ever federal health care fraud takedown.

With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country. We have safeguarded precious taxpayer dollars. And we have helped to protect our nation’s most essential health care programs, Medicare and Medicaid,” said Attorney GeneralEricHolder. “As today’s arrests prove, we are waging an aggressive fight against health care fraud.”

The defendants charged today are accused of various health care fraud-related crimes, including conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes, money laundering, and aggravated identity theft.

The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, physical and occupational therapy, nerve conduction tests, and durable medical equipment.

According to court documents, the defendants charged today participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. In many cases, indictments and complaints allege that patient recruiters, Medicare beneficiaries, and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided.

Collectively, the doctors, nurses, health care company owners, executives, and others charged in the indictments and complaints are accused of conspiring to submit a total of more than $225 million in fraudulent billing.

Every American bears the burden of health care fraud, and the FBI, in conjunction with our inter-agency partners, will continue to dismantle criminal networks that bilk the system,” said Shawn Henry, Executive Assistant Director of the FBI’s Criminal, Cyber, Response, and Services Branch. “Our agents and analysts use task forces and undercover operations to identify individuals who treat the health care system as a vehicle to line their pockets.”

  • In Miami, 32 defendants, including two doctors and eight nurses, were charged for their participation in various fraud schemes involving a total of $55 million in false billings for home health care, durable medical equipment, and prescription drugs.

  • Twenty-one defendants, including three doctors, three physical therapists, and one occupational therapist, were charged in Detroit for schemes to defraud Medicare of more than $23 million. The Detroit cases involve false claims for home health care, nerve conduction tests, psychotherapy, physical therapy, and podiatry.

  • In Brooklyn, New York, 10 individuals, including three doctors and one physical therapist, were charged with fraud schemes involving $90 million in false billings for physical therapy, proctology services, and nerve conduction tests.

  • Ten defendants were charged in Tampa for participating in schemes involving more than $5 million related to false claims for physical therapy, durable medical equipment, and pharmaceuticals.

  • Nine individuals were charged in Houston for schemes involving $8 million in fraudulent Medicare claims for physical therapy, durable medical equipment, home health care, and chiropractor services.

  • In Dallas, seven defendants were indicted for conspiring to submit $2.8 million in false billing to Medicare related to durable medical equipment and home health care.

  • Five defendants were charged in Los Angeles for their roles in schemes to defraud Medicare of more than $28 million. The cases in Los Angeles involve false claims for durable medical equipment and home health care.

  • In Baton Rouge, Louisiana, six individuals were charged for a durable medical equipment fraud scheme involving more than $9 million in false claims.

  • In Chicago, charges were filed against 11 individuals associated with businesses that have billed Medicare more than $6 million for home health, diagnostic testing, and prescription drugs.

The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.

More than 700 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in today’s operation. In addition to making arrests, agents also executed 16 search warrants across the country in connection with ongoing strike force investigations.

Over the last two years our joint efforts have more than quadrupled the number of anti-fraud strike force teams operating in fraud hot spots around the country from two to nine—with the latest additions in Chicago and Dallas—bringing hundreds of charges against criminals who had billed Medicare for hundreds of millions of dollars. Last year alone, our partnership recovered a record $4 billion on behalf of taxpayers. From 2008-2010, every dollar the federal government spent under its health care fraud and abuse control programs averaged a return on investment of $6.80,” said HHS SecretaryKathleenSebelius.

Medicare Fraud Strike Force Takes Down 111 Suspects. Doctors, nurses, health care companies among those nabbed....
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Last Chance to Disenroll from Medicare Private Health Plan

Medicare Advantage Disenrollment Period Ends on February 14

Medicare consumers who are dissatisfied with their Medicare private health plans, also known as “Medicare Advantage” plans, have until Monday, February 14, to disenroll. Consumers have had the opportunity to drop their private plan and enroll in Original Medicare since January 1, when the Medicare Advantage Disenrollment Period (MADP) began.

After the MADP, most people with Medicare will be unable to make another change to their health coverage until the Fall Open Enrollment Period, which begins on October 15, 2011.

“Time is running out for consumers to take advantage of the Medicare Advantage Disenrollment Period,” said Joe Baker, president of the Medicare Rights Center. “People who are unhappy with their plan and wish to make the change back to Original Medicare should do so promptly, but also thoughtfully. The window of opportunity is closing, but you should review your coverage options carefully and understand how your coverage will change before you disenroll.”

Your options

If you have:

  • A Medicare Advantage private health plan with prescription drug coverage, you can switch to Original Medicare plus a prescription drug plan OR Original Medicare without a prescription drug plan

  • A Medicare Advantage Private Fee-For-Service (PFFS) plan that does not include prescription drug coverage and a stand-alone prescription drug plan, you can switch to Original Medicare, but you must keep your current prescription drug plan

  • Original Medicare or Original Medicare and a prescription drug plan, you cannot make any changes during this time

Original Medicare, the traditional fee-for-service program offered through the federal government, covers most necessary services and is accepted by most doctors and facilities across the country. However, it does not cover the full cost of care. Many people who enroll in Original Medicare choose to purchase supplemental coverage to help pay for out-of-pocket costs such as deductibles and coinsurance.

Consumers who disenroll from their Medicare private health plan should be aware that they may have limited ability to buy coverage that supplements Original Medicare. State laws vary on when consumers can purchase Medicare supplemental policies, also known as Medigaps. Call your State Health Insurance Assistance Program (SHIP) to find out if and when you can enroll in a Medigap plan in your state. You can find the number for your local SHIP by visiting www.shiptalk.org or calling 800-MEDICARE.

 Consumers who disenroll from their private plan may need to join a stand-alone Medicare prescription drug plan in order to maintain drug coverage. Medicare Rights advises consumers who are choosing a plan to consider not only premium and copayment costs, but also whether the drugs they take are on the plan’s formulary (list of covered drugs). Consumers should also check to see whether the plan places any restrictions on the drugs they take. Restrictions can take the form of quantity limits, prior authorization and step therapy. To learn more about choosing a Medicare prescription drug plan that best meets your needs, visit Medicare Interactive.

Medicare Rights advises consumers who wish to change their health coverage, and enroll in a drug plan if necessary, to do so by calling 800-MEDICARE rather than their plan. Changes made before the end of the MADP are effective March 1.

Last Chance to Disenroll from Medicare Private Health Plan. Medicare Advantage Disenrollment Period Ends on February 14....
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Lawsuit Challenges Unwritten Medicare Policy

Widespread practice cuts funding to chronic patients who don't show improvement

A group of consumers has filed suit against the federal government, claiming that Medicare benefits are being improperly cut for many recipients with chronic conditions.

The suit, filed in federal court in Vermont, is challenging a Medicare requirement that chronic patients must achieve objective improvements in their functioning in order to qualify for services such as speech and occupational therapy, according to an account in The Chicago Tribune. If a patient can't demonstrate improvement, Medicare will often refuse to pay for such services, and the patient's medical provider will stop offering them.

Denial of such services can in turn cause the cancellation of other Medicare benefits, leading to a slippery slope where patients lose many of the services on which they have long relied.

Making matters worse, the vast majority of Medicare recipients are at least potentially affected by the regulation; the suit says that 78 percent of Medicare's 46 million recipients suffer from at least one chronic illness.

Health care advocacy groups join in

The suit was filed on behalf of five Medicare recipients, all of whom hail from New England. Five health care advocacy groups joined the recipients as plaintiffs.

Judith Stein, executive director of the Center for Medicare Advocacy, one of the five groups involved, told the Tribune that the policy “has been and is creating major harm.”

Stein called the policy “illegal and unfair and an inappropriate application of the Medicare law,” and “a major barrier to access to medical care and access to necessary care. This is not just a theoretic problem but one that affects patients every day.”

Covert rule of thumb”

According to the suit, the policy is a “covert rule of thumb” that isn't explicitly spelled out in Medicare law. Additionally, the suit alleges that the policy has never gone through a federal rule-making process, which would allow comment from the public.

Many of those affected by the policy have serious chronic illnesses, such as Parkinson's, Alzheimer's, and multiple sclerosis (MS).

Indeed, Dr. Nicholas LaRocca, of the National MS Society -- another of the plaintiff organizations -- told the Naples News that the policy prevented many MS sufferers from using physical therapy to improve their prognosis.

“Maintenance therapy can help hold the line and manage those and other effects of chronic MS,” LaRocca said. “Maintenance therapy can really help them lead more productive lives and maintain quality of life.”

The policy has long been a source of controversy. The Naples News, citing statistics from the Centers for Medicare and Medicaid, said that administrative law judges have heard 36,000 appeals from denials of coverage.

Suit follows Congressional probe

The suit, which seeks a permanent injunction stopping the practice, points out that the policy leads to higher costs down the road, since recipients are unable to seek therapy that could improve their condition, or at least prevent it from deteriorating.

The suit follows a letter sent last May, signed by Rep. Joe Courtney (D-CT) and several other lawmakers, declaring the policy illegal.

“Medicare coverage determinations should not be based on whether the patient's underlying condition is likely to improve,” that letter said, as reported in The Hill. “In fact, federal regulation actually states the opposite.”

Ellen Griffith, a Medicare spokeswoman, said the government would wait to comment until it has reviewed the suit.

Lawsuit Challenges Unwritten Medicare Policy Widespread practice cuts funding to chronic patients who don't show improvement...
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Boomers Will Quickly Drain Medicare, Analyst Warns

Seniors are taking out much more than they put in

Now that the first Baby Boomers are turning 65 Medicare, the health benefit program for seniors, is set to feel a mighty strain, according to an analysis by a senior fellow at the Urban Institute.

Eugene Steuerle, an Institute fellow and the Richard B. Fisher Chair at the nonpartisan institute, is also a former deputy assistant secretary of the Treasury. He says, while Social Security's woes get the most attention, Medicare is actually in much worse shape.

The problem, he says, is that past and current retirees, and most working-age adults, will never pay for all their Medicare benefits. The government's Medicare costs now top three percentage points of GDP and are headed to above six percentage points of GDP by 2055.

But Medicare taxes and escalating premiums cover ranges from about 51 to 58 percent over time.

Borrowing from China

"To pay for the rest, we borrow from China and elsewhere, and use up ever-larger shares of income tax revenues, leaving ever-smaller shares for other government functions," Steuerle said. "Bottom line: without reform, current workers would continue to shunt many of their future Medicare costs onto younger generations, just as their parents did with Social Security."

Both Medicare and Social Security are threatened by a rather positive development; people are living longer. But with that extended lifespan, come medical needs that simply haven't been paid for.

But Medicare has an additional problem. Health care costs are exploding, must faster than the overall rate of inflation.

Structured like much other health insurance, Medicare essentially lets us consumers deal with doctors over what someone else in our government or private insurance system will pay.

"For years, numbers that Medicare actuaries and many others have been crunching have pointed to the system's unsustainability," Steuerle said. "Sadly, the lack of agreement on an alternative has led us and our elected representatives to blink when it comes to tackling this core structural problem."

Not only does this current structure lead to more borrowing from abroad, Steuerle says it saddles future generations with most of the costs of cutting edge medical break-throughs.

'I want a new drug'

"A better type of hip replacement comes along. A new drug for congestive heart failure. A more effective treatment for prostate cancer. Sign me up," Steuerle said.

But the benefits from these medical advances come at a steep price, and so far, says Steuerle, no one is paying it. The older among us are not required to work longer or pay for more than a minor share of these extra benefits. Providers, in turn, have come to expect ever-larger shares of national income as a reward for science's leaps.

This is not an economic problem that leads to a political one, Steuerle says, but a political problem that threatens undesirable economic consequences.

"Only political reform of how we make economic decisions -- addressing inconsistent promises for low taxes and high benefits that people have come to expect -- can move us away from a system where promised benefits supposedly rise forever faster than GDP and where future, not current, workers must be left to bear most of the costs and consequences," he said.

Retiring Baby Boomers will put unprecedented strain on an already over-burdened Medicare system....
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The First Wave of Baby Boomers Is Turning 65 in 2011

Is the country ready or will this be a shock to the system?

The oldest of the Baby Boomers -- that 78 million person "bump" in our population -- turns 65 in 2011, and for the next 18 years that bump will be grinding through some of our most important systems of survival for the elderly. We're talking about Medicare, Medicaid and Social Security -- the three pillars of senior living support.

The key question on most boomer's minds is can the system handle it, or will this be the generation that breaks the foundation on which so many Americans are depending on?

Demand for benefits

Boomers started burning through Social Security three years ago when the first ones turned 62 and became eligible for benefits. And now they're going to be eligible for Medicare. Some may have even signed up already because you're supposed to sign up for medicare three months before the month you turn 65.

Coverage typically begins on the first day of your birth month. If your birthday is on the first day of the month, your coverage will start the first day of the prior month. Individuals who wait until their birth month or later to turn in the paperwork may experience coverage delays.

Baby boomers turning 65 next year should sign up right away to avoid a 10 percent Part B premium increase for each 12-month period they could have had Part B, but didn't sign up for it. Those who delay Medicare enrollment because they're still working and covered by a group health insurance plan must sign up within eight months after their coverage ends to avoid the penalty.

Many boomers are looking forward to joining Medicare this year, especially if they're paying a lot for their own health insurance. More than 6,000 Medicare beneficiaries with the birth date January 1, 1946, have already pre-enrolled in Medicare, so that their coverage will go into effect on the first day of 2011.

Some are even postponing serious or expensive medical procedures until they qualify for Medicare so that it's covered.

As for Social Security, even though the oldest baby boomers already qualify for partial benefits, they are still a year away from qualifying for the full amount. For 1946-born boomers, that's age 66. Those who have already signed up for Social Security, or plan to this year, will receive reduced payouts for the rest of their lives.

Many baby boomers plan to delay their Social Security as long as possible to lock in higher payments later on in retirement. Some even plan on waiting until they're 70 because they'll receive even more.

The perks

According to insurance actuarial tables, most of us will live another 20 years or so. So that means you have plenty of time to enjoy the perks that come with being a senior citizen. Turning 65 means you receive a number of breaks beyond being able to get Medicare.

Some will receive a break on property taxes, and discounted airline and movie tickets. You may not even be aware of it, but when you turn 65 you can get free hunting and fishing licenses along with reduced fees at state parks. You can even ride the bus and subway for less.

Medicare is still by and far the best deal of all and will mean thousands in savings related to medical and healthcare expenses.

And the two perks with the most impact for seniors are government programs relating to property taxes and health insurance.

The Sunshine State

Since 2002, many Florida property owners 65 and older who earn less than $25,480 have gotten property tax breaks with increased homestead exemptions above the standard $25,000. And you thought it was just the weather that attracted the seniors to Florida.

Florida has long been one of the centers for senior citizen discounts. The state has the largest proportion of senior citizens in the nation. An estimated 2.8 million Floridians are older than 65, representing 17.6 percent of the state's population.

If there were a Mecca for seniors, it would be Charlotte County in southern Florida. By percentage, has more people 65 and older than any other county in the country. Four of the top nine metropolitan areas in the country for seniors stretch from Bradenton to Naples. Senior discounts are everywhere.

What has most state and municipal governments concerned is will this huge influx of people break these systems that were designed to make senior living easier.

Trouble in Texas

Texas Governor Rick Perry (R) recently threatened to pull  out of Medicaid because the state couldn't afford it anymore. Across the country, state budgets continue to be strapped. Federal stimulus dollars are running out. And the latest federal tax and stimulus package will not provide much relief at the state and local levels. Meanwhile, looming provisions of health reform will add a projected 16 million to the Medicaid rolls. Where are the facilities to take care of these folks? Where is the money?

Most eyes are on the federal government's massive budget deficits. Safety net programs would be affected by deficit reduction proposals that have been introduced to generally favorable receptions. Politicians on both sides of the aisle agree that Social Security, Medicare, and Medicaid have to be reined in for meaningful deficit reduction to occur.

The crunch

The battle over these programs has already begun and will intensify when the new Republican majority takes office next year in the U.S. House of Representatives.

Even as the lines are drawn for the federal deficit-reduction war, the states have become a battleground for resources to fund Medicaid. States share the funding for Medicaid services with Washington and have been increasingly hard-pressed to come up with their portion of Medicaid funding.

Meanwhile, demand for services continues to rise. That's particularly the case for seniors, who face a second straight year with no cost-of-living increases in Social Security. The poverty level of people aged 65 and older compares favorably with other age groups in the United States. That's almost entirely due to Social Security payments, which are large enough to keep most seniors above the poverty line. However, millions of older Americans live on incomes that are very near the poverty level.

Mandated increases in federal benefits under the health reform law are not the only source of financial pressures on safety nets. Baby boomers begin turning 65 next year at the rate of an estimated 7,500 people a day, taxing a Medicaid program that already is hurtling toward insolvency.

While federal support for Medicare is being reduced in the Medicare Advantage program, health reform will require that many preventive office visits and tests, including an annual physical, must be provided at no charge to Medicare participants. Federal support to pay for prescription drugs is also being increased for seniors with large drug bills.

As the song goes, "Something's Got To Give.”

The first of what will eventually be 78 million baby boomers begins to move through Medicare, and Medicaid in 2011, can the system handle them?...
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It's Time To Review Your Medicare Drug Plan

Seniors should check the federal website each year for the best Medicare drug plan

If you're a senior over 65, you've probably gone through the painful process of enrolling in what's called a Medicare Part D drug plan. It's complicated and confusing and something you probably never want to have to go through again.

Well guess what? You should and for two important reasons. First, you're getting older and the medication you're taking may have changed. Plus, there are different plans available next year, and a different plan could save you a lot of money.

And now is the time to do it while we're still in the open enrollment period which lasts until December 31.

Financial columnist and author Terry Savage says seniors should check the federal website www.Medicare.gov each year for the best Medicare drug plan. They can do it by using the "planfinder tool."

In a recent column for the Chicago Sun Times, Savage writes extensively about why seniors should bit the bullet and go through the process of selecting a Medicare Part D plan annually. She says they could be taking different medicines or dosages or the drug plan they now have could be changing its prices in January for the drugs they take.

She also points out that there is new competition among those who offer these plans -- most notably Wal-Mart who has partnered with Humana to create a program that promises savings of as much as 30% for the average senior's total cost.

For seniors who take a lot of medicines, they already know about the "doughnut hole" which is what they call the point where you have to pay for your drugs before the catastrophic coverage provided by the government kicks in.

Savage says that this year, as part of the health reform bill, if you fall into that doughnut hole category, you'll receive a discount on branded drugs. Again, that makes it important to figure out which plan has the lowest overall cost.

According to Savage, here's what you should know.

You must sign up for Medicare Part D -- even if you don't take prescription medicines. It's required. If you don't sign up, then when you do need coverage you'll always pay higher premiums. The only exceptions to the need to sign up are those seniors with "equivalent" or "creditable" drug coverage from an employer's health care plan or retiree health plan. Your employer will give you a letter attesting to that coverage. Also, those many who receive medical benefits from the VA can get equivalent coverage.

There are two ways to get Part D: You can buy Part D coverage from the private Prescription Drug Plan that is the least expensive based on the drugs you take. Each of these plans has its own monthly premium, deductible and co-pay per prescriptions above the deductible level. That's why you need to use the tool at Medicare.gov to figure out which plan is overall the least expensive for your situation.

Or you can sign up for a Medicare HMO, known as Medicare Advantage. Then you won't need a separate Part D plan because all of your drugs will be covered by your HMO.

Of the 27.7 million people enrolled in Medicare Part D drug plans, one-third are covered by Medicare Advantage plans.

There is assistance for low-income beneficiaries: If your income is below $16,245 and you have few other assets, you qualify for assistance.

As complicated as all this sounds, Savage says it's easier than you think. She says the only way to find the best and cheapest plan is to use the "planfinder tool" at www.Medicare.gov -- or call for help at (800) Medicare. All you need is your Medicare number and the names and dosages of all your prescriptions. Just enter that information, and the computer will generate a list of PDPs that are available in your neighborhood, with the least expensive on top, based on the drugs you're currently taking. You'll want to compare not only the monthly premium but the overall cost for the year before making a choice.

As for the Humana/Wal-Mart RX plan, Savage says you might be able to save an average $450 a year. And you can access the Medicare tool right from the Wal-Mart website.

If you're an adult child or grandchild, or neighbor of a senior, Savage encourages you to take the time to sit down with him or her and go through the process. In fact, she adds, you could probably do this while you're waiting for the turkey to cook on Thanksgiving. It will make them very thankful, says Savage.  

Medicare drug plans are always changing so even if you have one, it might be worth your while to go through the process again ...
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The New Medicare Rules Will Make Coverage More Expensive for Some

Anyone who pays more for doctor’s visits and other “Part B” coverage will also pay more for “Part D” prescription drug coverage

There's some good news and some bad news once the new Medicare rules go into effect January 1. The changes will benefit some recipients but it will also make coverage more expensive for people with incomes over $85,000 or $170,000 for couples.

It's all part of the health-care reform and while premiums for most beneficiaries will remain relatively stable in 2011, those who already pay higher premiums for doctor's visits and other "Part B" coverage will also pay more for "Part D" prescription drug coverage starting January 1.

Medicare's annual open-enrollment period starts this week so it's important to know what's in store for you next year. It could impact your decision as to whether to change your current plans or if you're just starting out what to begin with. During the annual open-enrollment period, anyone in the federal health insurance program for people 65 and older — and their caregivers — can make changes to their coverage by December 31.

Moreover, many insurers are eliminating or consolidating hundreds of Medicare-related plans to comply with recent regulations aimed at reducing duplicative plans. As a result, according to the AARP, as many as one million Medicare recipients will have to choose new coverage.

How the changes being instituted might impact you will depend on whether you have plain-vanilla Medicare or a federally subsidized private Medicare Advantage plan. That works like a conventional insurance plan and often includes prescription-drug coverage.

Many who choose the traditional fee-for-service Medicare also buy a "Medigap" policy, as well as a separate prescription-drug policy, to cover gaps in their coverage.

For those with traditional Medicare, the biggest change on the horizon is an expansion of benefits. Starting January 1, Medicare will completely cover the cost of many preventative services, including mammograms, Pap tests and screenings for prostrate and colorectal cancer, as well as one annual physical examination.

Benefits will also grow richer under the Part D prescription-drug program. Currently, privately managed plans cover 75% of a participant's drug costs up to a limit that will rise to $2,840 in 2011. After that, participants fall into a "doughnut hole" gap where they are required to pay 100% of their drug costs until expenditures reach $6,440. Then catastrophic coverage kicks in, capping outlays at 5%.

Under the health-care overhaul, the estimated 14% of Part D participants who fall into this coverage gap will start to receive discounts that will reduce the amount they pay—from 100% in 2010 to 50% for brand-name drugs and 93% for generics in 2011. As a result, those who have "enhanced" Part D plans, which provide some coverage in the doughnut hole, should consider whether it makes sense to pay the extra premiums.

For single participants who have a modified adjusted gross income of more than $85,000 a year—and couples who exceed $170,000—will pay between $12 and $69.10 more in monthly premiums for Part D than other beneficiaries.

Partial solution

According to the Wall Street Journal, there is a way to get around the increase: Move into a Medicare Advantage plan. They offer medical and drug benefits with lower monthly premiums than what's charged for original Medicare plus supplementary policies. But some of these plans change their benefits or fees from year to year, and some restrict where policyholders can seek care.

Participants will also enjoy some new protections. Advantage plans must cap — at $6,700 — recipients' annual out-of-pocket expenditures for Medicare-covered services within their networks. The plans will also be barred from charging higher copayments or coinsurance rates for some services, including chemotherapy, than patients would pay under traditional Medicare — although the plans can charge higher deductibles and copayments for other services.

Starting in 2011, Advantage participants who wish to switch to another Advantage plan will no longer be allowed to do so between January 1 and March 31. Instead, they must make such a move by December 31. From January 1 to February 14, participants can still drop an Advantage plan, but they'll have to switch to traditional Medicare. 

Starting January 1, 2011, new rules for Medicare go into effect and the cost for coverage is going to be more if you are single and earn more than $85,000...
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Seven Ways To Avoid Medicare Traps and Costly Blunders

Consumer Reports Health offers free rankings of Medicare Advantage HMOs

If you're about to turn 65, you'll be part of the first wave of baby boomers signing up for Medicare. Consumer Reports Health recommends signing up as early as three months ahead of your birthday.

Failing to do so could potentially cost you thousands of dollars down the road. That's one of seven tips for navigating the Medicare maze available in the December issue of Consumer Reports.

"If you don't stay on top of the process when you first sign up, you can blunder into decisions that could lock you out of certain types of coverage, costing you thousands in extra premiums and out-of-pocket costs,” said Nancy Metcalf, senior program editor, Consumer Reports Health. "Medicare is filled with traps so it's well worth your time to dig into the details of the program and make sure you choose wisely based on your individual needs.”

In addition to the do's and don'ts spelled out in the report, free rankings of 183 Medicare Advantage HMOs are available online. The rankings are produced by the non-profit National Committee for Quality Assurance (NCQA), the main U.S. group that sets measurement standards for health insurance, accredits plans, measures the quality of care they achieve, and publicly reports the findings.

Navigating the Medicare maze:

  • DO sign up for Medicare before you turn 65. Even if you're still working and have health benefits, you need to sign up for Medicare Part A, which covers hospital expenses. The initial enrollment period spans the three months before, the month of, and the three months after your 65th birthday.

If you sign up during the first three months, your Medicare coverage starts at the beginning of your birthday month. If you sign up during your birthday month, then coverage starts at the beginning of the following month. If you wait until the last three months, you'll face increasingly lengthy delays in the start of your coverage.

  • DON'T delay Medicare Part B signup after you stop working. While Medicare Part A is free to anyone who has paid Medicare taxes for more than a decade (or is married to someone who has), Medicare Part B has a monthly premium ($96.40 or $110.50). Part B covers most other medical expenses, except for prescription drugs.

If you don't sign up for Medicare Part B the minute you or your spouse stops working, then you will fall into what is potentially Medicare's biggest trap and you'll be hit with a permanent increase in your premium of 10 percent for every year that you could have signed up but didn't.

  • DO understand that Part D, the prescription-drug benefit, has different rules. Part D is delivered exclusively through private plans with an average premium of about $41 a month in 2011. As with Part B, you will pay a premium penalty for late enrollment, but for Part D, it's one percent extra for every month that you could have enrolled but didn't.

If you have low drug bills now and feel that Part D is unnecessary, think through that calculation and weigh your immediate savings against the penalty later on should you need costly prescription drugs. Use Consumer Reports' Best Buy Drugs, which provides drug ratings for more than 35 common medical conditions, to gauge the cost of drugs. The free program provides ratings based on cost, safety and efficacy, detailing the costs associated with different doses for most available drugs in each category.

  • DON'T confuse original Medicare and Medicare Advantage. There's the original government-run Medicare that comes with substantial deductibles and co-insurance (for example, an $1,100 deductible for a hospital stay and 20 percent of outpatient doctor visits). People who don't have a secondary retiree plan from their employer usually buy a separate private Medigap policy to help with those deductibles and coinsurance. About one in four Medicare recipients opt for the newer Medicare Advantage plans.

These are private plans -- mostly HMOs -- that take the place of original Medicare plus Medigap, and usually the Part D drug plan as well. While you'll probably pay lower monthly premiums, bear in mind that you will not have Medigap to cover any deductibles and co-pays, which can vary from plan to plan. Thus, one of the downsides of an Advantage plan is potentially higher out-of-pocket costs if you get seriously ill.

  • DO find out how your retiree plan works with Medicare. Retiree plans take many forms such as stand-alone plans and plans similar to active-employee plans. Either type will pay secondary to Medicare. Declining your retiree coverage and signing up for a Medicare Advantage plan on your own can become a major pitfall. It's worth noting that your employer might not let you re-enroll if you leave your retiree plan, so before signing up for anything, find out exactly how your retiree plan works with Medicare.
  • DON'T accidentally lock yourself out of Medigap coverage. Buying a Medigap plan can be tricky, particularly if you have developed a pre-existing condition. State laws vary, but in most locations you have the right to buy a Medigap plan without medical screening only at certain times, such as when you first sign up for Medicare Part B, when you lose your Medicare Advantage coverage because a plan shuts down or you move out of its service area, or when you lose your retiree coverage. Find out the rules of Medigap in your state by checking with your State Health Insurance Counseling and Assistance Program.
  • DO recheck your Plan D formulary every year. All Part D plans have a formulary, a list of covered drugs. Bear in mind that the formulary can change from year to year, meaning that your drug could drop off the formulary or move to a more expensive payment tier. Plans can also put new restrictions on drugs, such as requiring your doctor to get approval from the insurer before prescribing them. You can change to a new plan once a year if your plan makes changes that don't work for you. Use the interactive formulary finder at Medicare.gov and stay on top of the best drug choices for your condition by using drug reports published for free at www.ConsumerReportsHealth.org.
Seven Ways To Avoid Medicare Traps and Costly BlundersConsumer Reports Health offers free rankings of Medicare Advantage HMOs ...
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Seniors At Risk In Medicare Enrollment Scams

Open enrollment period, Nov. 15 - Dec. 31, fraught with pitfalls

It's not just the holidays that are on the horizon, but the Medicare enrollment season. Medicare's open enrollment is from November 15 to December 31, and scammers are poised to take advantage of it.

One reason is the new complexity of the process. Because of the new health care law, there will be many more coverage options, requiring choices by current retirees and the first wave of newly eligible baby boomers.

"It's a complicated year for Medicare beneficiaries," Judith Stein, executive director of the Center for Medicare Advocacy, a nonprofit group that helps Medicare beneficiaries, told the New York Times recently

"While Medicare undoubtedly offers Ohioans many beneficial options, we anticipate that this year's enrollment period will bring about a new wave of scams," said Ohio Attorney General Richard Cordray. "Scam artists will attempt to use the new healthcare reform law to confuse seniors who are not familiar with the system. So far this year, my office has received more than 60 reports of Medicare-related scams, and we expect the number to climb as the enrollment period approaches."


If you're on Medicare, you could be the target of a stranger trying to gain access to your personal information. Complaints filed with Cordray's office already describe unsolicited callers requesting personal information such as Social Security numbers and checking account information as well as Medicare ID numbers, which sometimes mirror the policyholder's Social Security number.

This trend mirrors data collected by Cincinnati-based Pro Seniors Inc., a nonprofit that provides legal guidance to older Ohioans.

Cordray warns that scammers will also use high-pressure sales tactics and claim that seniors must re-enroll in Medicare in order to claim their benefits. Also, some seniors may hear a sales pitch that offers special, limited-time offers or phony add-on discount prescription drug plans, he said.

Cordray offers these tips for senior citizens enrolling in Medicare this year:

  • Never provide any personal information over the phone if you are unsure about who is requesting the information.
  • Hang up on callers that pressure you for personal information or request that you enroll in a Medicare product over the phone. It's shrewd to be rude!
  • Always review your quarterly Medicare Summary Notice to determine possible fraud or errors.

Ohio Attorney General Richard Cordray warns seniors that scammers are trying to exploit new complexities in Medicare....
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Medicare Tightens Rules On Power Wheelchairs

New law designed to reduce fraud by equipment salesmen

The TV commercial for a chain of motorized wheelchair stores features a geriatric spokesmodel who exclaims, "I didn't pay a penny for my Scooter, Medicare paid it all!"

If that was ever the case, things may be changing. A new law ends the first month purchase option for Medicare patients, as well as expansion of the competitive bidding process to provide equipment to Medicare recipients.

Companies that make and market these high-tech chairs to Medicare patients see the change as a threat. Jay Broadbent, CEO ofSalt Lake City-based Alpine Home Medical, noted that these changes are coming at a time when power mobility providers are already experiencing increasing government audits, delays in reimbursement payments, and reimbursement cuts of more than 35 percent over the last five years.

Provider push-back

"Providers are at the point where we can't endure any more financial pressure and continue to offer quality products and services to Medicare beneficiaries," said Broadbent. "There has to be a realization inWashingtonthat the fallout from the competitive bidding fiasco and elimination of the first-month purchase option is going to have a major impact on Medicare beneficiaries.  There simply are not going to be enough providers left standing to supply them with mobility equipment."

By eliminating the option for the first-month purchase, the government plans to pay providers rental payments over the first 13 months that a patient has the equipment. But with credit tight in the sluggish economy, many providers say they can't obtain the lines of credits and loans they need to afford the upfront cost of purchasing power wheelchairs from manufacturers.

The new law is scheduled to take effect onJanuary 1, but providers are asking Congress to delay implementation for one year so they can have time to adjust their business models to account for the cash flow problems created by the new policy. Currently, Medicare will pay 80 percent of the Medicare-approved amount for a qualifying wheelchair, assuming you have met your Part B deductible and your doctor tells Medicare the wheel chair is medically necessary.


The new law comes at a time when Medicare has been cracking down on fraud related to the purchase of power wheelchairs, which can cost thousands of dollars.

Last month the Justice Department announced the guilty pleas of three people in connection with a Medicare fraud scheme operated out of a Houston-area durable medical equipment (DME) company.

In their pleas, the defendants admitted that they were paid kickbacks in exchange for referring Medicare beneficiaries to the DME company, Luant & Odera Inc. Luant & Odera submitted false and fraudulent claims to Medicare for medically unnecessary DME, including power wheelchairs, wheelchair accessories, and motorized scooters.

On its website, Medicare explains its concern with fraud, noting that most doctors, health care providers, suppliers, and private companies who work with Medicare are honest, but a few aren't.

"For example, some suppliers of medical equipment try to cheat the Medicare Program by offering power wheelchairs and scooters to people who don't qualify for these items under Medicare," the agency says. "Medicare is trying harder than ever to find and prevent fraud and abuse by working more closely with health care providers, strengthening oversight, and launching a national program to review claims."

Medicare offers the following red flags when dealing with equipment suppliers:

  • Suppliers offer you a free wheelchair or scooter
  • Suppliers offer to waive your copayment
  • Someone bills Medicare for equipment you never got
  • Someone bills Medicare for home medical equipment after it has been returned
Medicare is changing the way it pays for motorized wheelchairs for seniors and some equipment makers are crying foul....
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No Social Security Cost Of Living Increase In 2010

COLA wasn't triggered because prices remained flat

The Social Security Administration has made it official, announcing Thursday what many had predicted; there will be no cost of living increase in Social Security Benefits next year.

It will be the first year without an automatic Cost-of-Living Adjustment (COLA) since the adjustment mechanism went into effect in 1975.

"Social Security is doing its job helping Americans maintain their standard of living," Michael J. Astrue, Commissioner of Social Security said. "Last year when consumer prices spiked, largely as a result of higher gas prices, beneficiaries received a 5.8 percent COLA, the largest increase since 1982. This year, in light of the human need, we need to support President Obama's call for us to make another $250 recovery payment for 57 million Americans."

But senior advocacy groups were quick to label the announcement a disaster for seniors.

"This is a serious problem and unless Congress acts, millions of seniors will see their checks stay flat or even reduced while the costs of prescription drugs, utilities and health care continue to climb fast," said Barry Jackson, AARP's online advocacy manager in an email sent to the organization's millions of members just minutes after the announcement was made.

The Social Security Act provides that Social Security and Supplemental Security Income benefits increase automatically each year if there is an increase in the Bureau of Labor Statistics' Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) from the third quarter of the last year to the third quarter of the current year. This year there was no increase in the CPI-W from the third quarter of 2008 to the third quarter of 2009.

In addition, because there was no increase in the CPI-W this year, under the law the starting point for determinations regarding a possible 2011 COLA will remain the third quarter of 2008.

But Jackson said the CPI-W is not a reliable indicator of the expenses faced by seniors. "The reality is that the bad economy this year has hit seniors particularly hard. They spend an average of $4,400 out of pocket every year on health care alone. With home values dropping, losses in the stock market, and low returns on interest bearing accounts, it's no wonder that more Americans are counting on the promise of Social Security," he said in his email.

Jackson said seniors should demand that Congress provide "at least modest relief."

Some other changes that would normally take effect in January 2010 based on the increase in average wages also will not take effect, even though average wages did increase. Since there is no COLA, the statute prohibits an increase in the maximum amount of earnings subject to the Social Security tax as well as the retirement earnings test exempt amounts. These amounts will remain unchanged in 2010.

Medicare changes?

The Department of Health and Human Services has not yet announced if there will be any Medicare premium changes for 2010. Should there be an increase in the Medicare Part B premium, the law contains a "hold harmless" provision that protects about 93 percent of Social Security beneficiaries from paying a higher Part B premium, in order to avoid reducing their net Social Security benefit.

Those not protected include higher income beneficiaries subject to an income-adjusted Part B premium and beneficiaries newly entitled to Part B in 2010. On September 24th, the House passed legislation by 406-18 that would, on a fully paid-for basis, prevent abnormally large premium increases.

President Obama has asked the Senate to enact this legislation before it becomes too late for the Social Security Administration to update its computer systems to implement this needed change, the agency said.

No Social Security Cost Of Living Increase In 2010...
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AARP Report Finds Seniors' Drug Costs Rising

Drug prices 'exploded' after Medicare Part D began

Food and gasoline aren't the only prices going up. Prices of 220 brand name prescription drugs most commonly used by people in Medicare Part D have surged since the drug benefit was implemented in 2006, according to AARP.

The seniors' group said it has studied drug prices since 2002 and reported the findings in a series of Watchdog reports. The latest report expands on the series by focusing its analysis on those brand prescription drugs most widely used by people enrolled in Medicare Part D.

The Watchdog report, which was produced by AARP's Public Policy Institute (PPI), found that prices of brand name drugs most commonly used by people in Medicare Part D rose by an average of 7.4 percent in 2007 nearly two and a half times the rate of general inflation.

The report concludes that rising prices threaten consumers by increasing the likelihood of higher insurance premiums and the chance that people will fall into the Medicare coverage gap, and increasing the out-of-pocket expenses of those who find themselves in this "donut hole."

"Medicare Part D is helping millions of people afford their prescription drugs, but as brand name drug costs continue to soar more needs to be done to keep drugs affordable," said John Rother, AARP Director of Public Policy. "The Medicare Part D benefit helps more people afford their prescription drugs. But we must make greater progress in putting downward pressure on drug prices."

Costs 'explode'

The average treatment cost exploded from $80 per year per prescription in 2002, to $151 in 2007, according to the report.

A person who took three brand name prescriptions to treat a chronic condition over this period saw an increase in their yearly costs of more than $1,600 between 2002 and 2007. The study found brand name drug prices increased far greater than general inflation since 2002, with dramatic spikes since 2006, the period when Medicare Part D was implemented.

"This report raises questions about why the pharmaceutical companies so dramatically increased the costs of popular brand name drugs at the same time Medicare began offering drug coverage," said Rother. "When pharmaceutical companies raise wholesale prices, consumers are ultimately stuck with the bill.

"In the meantime, our elected leaders need to find sustainable solutions to the skyrocketing costs of drugs that are squeezing government programs like Medicare, employer-sponsored health plans, and individual consumers."

AARP Report Finds Seniors' Drug Costs Rising...
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Seniors Bemoan "Donut Day" - Medicare Drug Coverage Stops for Millions

Medicare Drug Coverage Stops for Millions

Today is "Donut Hole Day," when the average Medicare enrollee falls into Medicare Part D's donut hole, the gap in coverage for those beneficiaries with annual drug costs between $2,250 and $5,100.

As a result, millions of seniors caught in the donut hole will go to the pharmacy this fall and be forced to pay thousands of dollars for prescriptions.

Democrats on the House Ways and Means Committee released a report this week saying that about 7 million Americans in stand-alone prescription drug plans are at risk of falling into the donut hole. This is in addition to the nearly 6 million Americans with Medicare Advantage plans, most of which are also at risk of falling into the donut hole.

Their report estimated that 88 percent of the Medicare beneficiaries with stand-alone coverage ended up with plans that contained a gap.

The day did not go unnoticed. Seniors groups, consumer organizations and Democrats issued statements and held rallies. Wal-Mart unveiled a plan to cut the price of generic drugs to $4 at its pharmacies in the Tampa area, expanding by January to all of Florida.

Seniors have complained about the provision since the new drug program was enacted but the complaints are getting louder now that millions of Americans find themselves suddenly with no drug coverage.

"This costly, confusing and corrupt prescription drug plan written by and for the pharmaceutical and insurance companies exemplifies the conservative ideology of governance -- outsource essential government services to corporate cronies and pass the bill on to the taxpayers," said Roger Hickey of the Campaign for America's Future.

Sen. Debbie Stabenow (D-Mich.), and Rep. Jan Schakowsky (D-Ill.), joined Hickey in a conference call with reporters urging Congress to fix the harmful coverage gap.

"Seniors in Michigan and around the country are stunned to learn they are falling into Medicare's donut hole -- a gap in coverage that will have them scrambling to pay thousands of dollars for prescriptions they thought would be covered," said Stabenow.

"It didn't have to be this way, but unfortunately, this Medicare prescription drug program was created for the drug companies and not for seniors."

The Alliance for Retired Americans (ARA) held events through the country to highlight the day and rally seniors to ask Congress to eliminate the donut hole.

Many seniors and persons with disabilities were unaware of the donut hole when they enrolled in the new Part D plans, said Edward Coyle, executive director of the Alliance. Even if they were aware, it would have cost nearly $40 more per month for a plan without a coverage gap.

Since the Medicare Part D prescription drug plan was passed in 2003, there have been three amendments introduced in the House of Representatives and one amendment introduced in the Senate authorizing Medicare to use its bulk purchasing power to negotiate the price of drugs, thereby reducing the cost of the program and providing Congress with the funds to fill in the gap in coverage. All four amendments have been rejected along partisan lines.

"Because the drug companies' interests were put ahead of seniors, taxpayers are paying a Cadillac price for a Pinto prescription drug benefit for seniors. Part D must be fixed to provide a real prescription drug benefit that puts seniors first," said Brad Woodhouse, spokesman for Americans United.

Seniors Bemoan...
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AARP Wants Changes in Medicare Rx Plan

Wants Government to Help Control Drug Prices

AARP says it will ask Congress to change the new Medicare prescription drug program, giving more help to elderly people with low incomes and creating a bigger government role in policing drug prices.

AARP initially supported the program but said just before its passage that it might want to "build on it in the future." In a statement, AARP President Bill Novelli said problems with implementation of the drug assistance program needed to be addressed.

Additionally, John Rother, AARP's chief lobbyist, said his organizations wants Congress to change the way Medicare recipients' assets are counted in determining which ones are poor enough to qualify for special low-income subsidies, The Washington Post reported.

Also, Rother said AARP wants to reopen debate over a provision that would have directed health officials to negotiate directly with drug manufacturers over the prices they charge through the program. The White House has said that President Bush would oppose any attempt to revise the program.

AARP and Congressional Democrats had pressed for government price controls when the legislation was being debated. The Bush Administration favored a market-oriented approach that was eventually adopted, in which drugmakers negotiate prices with the insurance plans that sell the drug benefit to patients.

In his statement, AARP's Novelli said there had clearly been problems with implementation of the program.

"The bottom line is that some people are not getting the drugs they need. This is unacceptable," he said. "If an individual has proof of eligibility, there is absolutely no reason they should pay more than required or leave a pharmacy empty-handed."

AARP has been under attack from conservatives, who accuse it of pushing liberal programs, and from many of its own members, who accuse it of caving in to Republican pressure to support the GOP-backed Medicare plan.

Democrats in Congress have been promoting a bill that would make fundamental changes in the drug benefit. One of those changes would be empowering the government to jawbone drug makers, one of the revisions AARP now says it supports.

Cheaper than Canada

Novelli and other AARP executives insist the Medicare drug assistance program is not all bad.

An AARP investigation last month found that for many Americans, Medicare drug plans that cover all of a beneficiary's drugs can cost less than buying the same drugs across the border. The calculation takes into account premiums, deductibles, and copayments.

Pill for pill the actual price of some drugs may be cheaper in Canada but Medicare coverage is insurance, and so enrollees are therefore charged only copayments instead of full price.

The findings, detailed in the AARP Bulletin, emerged from an analysis of real combinations of drugs taken by people across the country. Using the drug plan finder on Medicare's website, AARP found the least expensive Medicare "stand alone" plan that covered their drugs and compared that plan's total cost to what that person spent in a year buying the drugs from an online Canadian pharmacy.

AARP used the plans' 90-day mail-order options because that's how more than 1 million consumers over 65 routinely get their drugs from Canada.

An example can be found with an interviewee named Donna from Anaheim, California.

Donna would pay $2,323.68 overall under a Medicare plan in her area for coverage of her six drugs nearly $1,400 less than the $3,718.40 charged by a low-cost Canadian pharmacy. This Medicare plan charges relatively high monthly premiums of $50.91 but has no deductible and gives continuous coverage for all her drugs through the "doughnut hole" gap. Her copays would range from $17.50 to $150 for every 90-day supply.

AARP's free publication, "The New Medicare Prescription Drug Coverage: What You Need to Know," is available in Spanish and English to members and non-members alike. This easy-to-understand resource describes how the new plans work and how to find enrollment assistance. To order the publication or get help, people can call AARP toll-free operators at 1-888-687-2277 or go to AARP's educational guide.

Enrollment information is available through state health insurance counseling programs (SHIP) in all 50 states and at many senior centers and offices on aging. Beneficiaries can find their local SHIP office online or by calling 1-800-677-1116.

Medicare's drug plan finder and other details are also available online. Or beneficiaries can call Medicare toll free at 1-800-633-4227 for assistance.

AARP Wants Changes in Medicare Rx Plan...
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Scam Artists Target Medicare Drug Cards

May 24, 2004

The Medicare drug discount cards have been fertile ground for scam artists around the country. The Illinois attorney general's office is investigating 13 complaints related to the new cards. Nine involved telemarketers looting up to $299 out of the bank accounts of seniors, who were tricked into thinking they bought legitimate Medicare-approved drug cards.

The Massachusetts attorney general's office issued a warning after receiving complaints about a company that sent solicitations crafted to look like an official government mailer - it could fool people into believing the company was selling a Medicare-approved drug-discount plan.

Medicare-approved card sponsors:
  • Aetna Health Management LLC;
  • Caremark Advantage, Inc.;
  • Catalyst Rx;
  • Medco Health Solutions Inc.;
  • PMB Plus Inc.;
  • PharmaCare Management Services Inc.;
  • Pharmacy Care Alliance Inc.;
  • Scrip Solutions LLC;
  • SXC Health Solutions Inc.;
  • United Healthcare Insurance Co. (with AARP);
  • WellPoint Pharmacy Management;
  • Express Scripts Inc.;
  • Argus Health Systems Inc.;
  • Computer Sciences Corp.;
  • WHP Health Initiatives Inc.;
  • AdvancePCS Health LP;
  • First Health Services Corp.; and
  • Long Term Care Pharmacy Alliance LLC.
  • "Anytime there is a new government program, unfortunately there are those out there who will try to take advantage of people," said Mark McClellan, the administrator of the Centers for Medicare & Medicaid Services (CMS), which along with the Office of Inspector General recently issued a warning cautioning people to be careful if they are approached to buy a drug-discount card.

    Reported cases of possible fraud have come from Medicare beneficiaries around the country, McClellan said.

    "We haven't seen large-scale fraud yet, but we've seen enough to make us want to make sure Medicare beneficiaries are protected," McClellan said.

    California Attorney General Bill Lockyer warned seniors to be on guard against fraudulent solicitations. Deceptive sales practices already have occurred in other states. Seniors should especially be careful about buying cards from non-Medicare-approved companies, said Lockyer, and about giving out personal identification information. He added consumers should never provide solicitors their bank account numbers or passwords.

    To avoid costly errors:

    • Don't give out any personal or financial information over the phone or face-to-face. Medicare-affiliated discount card providers will not solicit business by going door-to-door or by making phone calls.
    • Don't pay large sums of money up front. Medicare discount drug cards don't cost more than $30 a year.
    • Legitimate Medicare cards will have the official Medicare seal on them.
    • Don't rush into choosing a plan. The Medicare discount drug card is a voluntary program and benefits can be taken advantage of at any time after June 1.

    Card sponsors can advertise their cards on television, radio, in newspapers and via direct mail. But they can't make cold calls or send representatives door to door.

    If you're a Medicare beneficiary, you should not be getting a call out of the blue from a card sponsor unless you requested information based on an ad you saw or direct mail you received.

    For help in determining which cards are approved by Medicare, or if you need help selecting the most cost-effective card, go to www.medicare.gov or call the agency toll-free at (800) 633-4227.

    Scam Artists Target Medicare Drug Cards...
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    Medicare Boosts HMO Payments

    Critics lost no time attacking the Centers for Medicare & Medicaid Services' newly announced Medicare Advantage (formerly Medicare + Choice) payment rates for 2005.

    "The Medicare Rights Center's analysis shows that the Administration is on track to subsidize private insurance companies with $83 billion in overpayments over the next ten years. The $83 billion is the excess payments above what it would cost Original Medicare to provide coverage to the same targeted populations," said Robert Robert M. Hayes, president of the Medicare Rights Center.

    Medicare managed care plans will receive a 6.6% increase in payments in 2005 -- an additional $1.3 billion in payments over two years, when coupled with the 10.3% increase in 2004. An April report by the Medicare Payment Advisory Commission revealed that the government was paying 7% more to Medicare managed care plans than costs for treating beneficiaries in traditional Medicare. In some cases, payments exceeded traditional Medicare expenses by more than 20%.

    "Medicare Advantage offers more comprehensive benefits at a lower cost for Medicare beneficiaries, leading to lower costs for our health care system," Health and Human Services Secretary Tommy G. Thompson said.

    "It's no wonder that millions of beneficiaries, particularly those with limited means and no access to subsidized Medigap coverage, depend on these plans. They struggle the most to pay for their medical needs, and they need our help in getting reliable, affordable health care options now more than ever," Thompson said.

    But critics said the higher rates accomplish nothing more than increasing insurance companies' profits.

    "It is senseless to continue extravagant over-payments to the for-profit insurance industry. It is absurd to defend these overpayments on the ground that private plans are more cost-effective than Original Medicare," Hayes said.

    "Seniors worry how to pay for their drugs, while HMOs continue to reap financial rewards," said Ruben Burks, secretary-treasurer of the Alliance for Retired Americans. "Increasing payments to HMOs to lure seniors will undermine traditional Medicare. This shameless corporate giveaway comes at the expense of America's seniors and they deserve better."

    Only 10% of Medicare's 41 million beneficiaries are enrolled in managed care plans. But Medicare officials hope the increased payments will encourage Medicare's managed care plans to maintain and expand their services, particularly since the 2003 Medicare prescription drug legislation requires a larger role for private insurance companies in Medicare.

    "The new funding is expected to help ensure that Medicare beneficiaries who count on Medicare Advantage plans will have reliable access to the additional benefits and significantly lower out-of-pocket costs typically provided by these plans," CMS said in releasing the payment rates.

    CMS also issued a report showing the impact of Medicare Advantage plans in Medicare and the plans impact on Medicare beneficiaries. The report claims that beneficiaries in Medicare Advantage spend, on average, 34 percent less than beneficiaries in traditional fee-for-service Medicare.

    Medicare Boosts HMO Payments...
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    Medicare Wheelchair Rules Faulted

    Medicares coverage rules for wheelchairs and other mobility devices force over 140,000 Americans into unnecessary isolation and lead to higher health care costs, according to a study released today by the Medicare Rights Center, a national consumer group.

    The administrations interpretation of the Medicare law imprisons people in their homes, causing unnecessary pain and suffering, said Robert M. Hayes, an attorney who is president of the Medicare Rights Center. It is wrong and it is illegal.

    Forcing Isolation: Medicare In the Home Coverage Standard for Wheelchairs, recommends that the Centers for Medicare and Medicaid Services (CMS) change its interpretation of the Medicare law that currently denies coverage of mobility devices, such as power wheelchairs, for use outside of ones home.

    Under current policy, the administration will pay 80 percent of the cost of a power wheelchair for a person with Medicare who needs it to move from a bedroom to a kitchen, but not for a person who requires such assistance to leave home for medical care, shopping or even employment, the report found.

    Changes in technology, medicine and law require coverage of equipment that allows a person with disabilities to participate in community activities, Mr. Hayes said.

    The consumer group also recommends that CMS require case-by-case assessments and evaluations by specially trained professionals to guard against unnecessary expenses and ensure that people receive the proper equipment for their needs. Currently, doctors prescribe mobility devices and certify their medical necessity, but there is no requirement that they have training in rehabilitative medicine.

    In December, the administration further tightened Medicare coverage of wheelchairs which has prompted widespread criticism from an array of consumer groups.

    Mr. Hayes said he was hopeful that the President would support the studys key recommendations. Although CMS will not modernize its interpretation without White House approval, he said, President Bushs father was a strong supporter of the Americans with Disabilities Act. This President has said that he is too.

    The ADA, common sense, and common decency cry out to change a policy that sentences people with disabilities to needless isolation.

    The Medicare Rights Centers study Forcing Isolation: Medicare In the Home Coverage Standard for Wheelchairs, is available online.

    Medicare Wheelchair Rules Faulted...
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    Seniors Warned About Phony Rx Discount Card Scams

    Medicare officials warn that scam artists in a number of states are targeting Medicare beneficiaries with "fraudulent ... schemes" related to the new prescription drug discount card program.

    The discount card program, which will begin in May, was created as part of the new Medicare law to help beneficiaries save about 10% to 25% on their prescription drug costs until the program's prescription drug benefit takes effect in 2006. Medicare plans to announce which companies will be authorized to offer the prescription drug discount cards in the next few weeks, and it will begin advertising the program in May.

    Eleven states have reported instances of individuals making phone calls or door-to-door solicitations of seniors, ostensibly to register them for the new program. The individuals allegedly offer to enroll beneficiaries in exchange for their bank information, social security number or credit card number.

    States reporting such scams include Alabama, Georgia, Idaho, Maryland, Nebraska, New York, Oklahoma, Pennsylvania, Rhode Island, Virginia and Washington.

    Officials of the Centers for Medicare and Medicaid Services warned that seniors should be on guard against such solicitations and emphasized that Medicare contacts its beneficiaries only by mail.

    Seniors Warned About Phony Rx Discount Card Scams...
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