Articles (Medicare) « Medicare

Articles About Medicare

• 5 Things You Should Know About Your Medicare Coverage (Women's Institute for a Secure Retirment)
  According to the 2010 Census, many do not fully understand what is and is not covered under Medicare. It is important to know some basic information about Medicare so that you can take full advantage of the system, plan accordingly, and avoid costly mistakes.  
• 10 FAQs: Medicare’s Role in End-of-Life Care (KFF – 9/26/16)
  About eight of 10 of the 2.6 million people who died in the US in 2014 were people on Medicare, making Medicare the largest insurer of health care provided during the last year of life.
• 10 Things You Need to Know About Medicare (Kiplinger – 7/24/18)
  Heading into retirement brings a slew of new topics to grapple with, and one of the most maddening may be Medicare. Figuring out when to enroll in Medicare and which parts to enroll in can be daunting even for the savviest retirees. To help you wade into the waters of this complicated federal health insurance program for retirement-age Americans, here are 10 essential things you must know about.
• A Case of the Medicare What Ifs (Huffington Post – 8/23/10)
  Today, on Medicare's 45th birthday, I want to reflect on what the program means for me. Typically, people think of Medicare as a program that matters only for seniors. It is nearly universally available to Americans age 65 and older and pays for health care both in the event of a hospital emergency and for routine care, depending on what a person can afford. But Medicare matters not just to seniors. Medicare matters to children, to young adults and to Baby Boomers.
• A Prescription for Despair (Freep.com – 2/4/11)
  In 2009, the Detroit rehabilitation hospital where Clay Bell got physical therapy told him that his Medicare coverage no longer would pay for it because he had stabilized and showed no signs of improvement. "It was very depressing," said Bell. Within weeks of stopping therapy, Bell's condition began to decline.  
• An Overview of the Medicare Part D Prescription Drug Benefit (KFF – 10/12/18)
  Medicare Part D is a voluntary outpatient prescription drug benefit for people with Medicare, provided through private plans approved by the federal government. Beneficiaries can choose to enroll in either a stand-alone prescription drug plan (PDP) to supplement traditional Medicare or a Medicare Advantage prescription drug plan (MA-PD), mainly HMOs and PPOs, that cover all Medicare benefits including drugs.
• Answers to Your Medicare and FEHB Questions – (The Washington Post – 12/19/08)
  Info on the relationship between Medicare and private health insurance plans in the Federal Employee Health Benefit (FEHB).
• Consumer Groups Say Medicare Agency Is Proposing The Wrong ApproachTo Protecting Drug Coverage For People With Low Incomes.
  Groups that advocate on behalf of people with Medicare filed comments telling the Centers for Medicare & Medicaid Services that their approach to prevent certain Medicare beneficiaries from having to change their Medicare drug plans will not work. 
• CMS Adds Resources Regarding Medicare Coverage To Help People Who Need Skilled Maintenance Nursing or Therapy 
  As ordered by the federal judge in Jimmo v. Sebelius, the Centers for Medicare and Medicaid Services (CMS) published a new webpage containing important information about the Jimmo Settlement on its CMS.gov website.   
• Does Medicare Cover Long-Term Care? (KTVA – 9/27/19)
  Medicare helps many seniors pay for their medical expenses. But does Medicare cover long-term care costs? Before you reach retirement, it’s important to understand what costs you’ll be responsible for. Read on to discover what long-term care costs Medicare will cover. We will also outline options to help you pay for the costs that Medicare won’t cover.
• Elderly Medicare, Medicaid Patients Not Receiving Quality Care (Science Daily – Oct. 2007)
  If the care received by vulnerable older people concurrently enrolled in Medicare and Medicaid was evaluated on a grading scale, it would squeak by with a barely passing mark, a new UCLA study has found.

• Failure to Improve Is Still Being Used, Wrongly, to Deny Medicare Coverage (NY Times – 9/12/16)
  Despite a 2013 settlement of a class-action lawsuit that specified that maintenance must be covered by medicare, patients are still being denied medicare due to "failure to improve". As indicated in the 2013 settlement, medicare must cover skilled care and therapy when they are “necessary to maintain the patient’s current condition or prevent or slow further deterioration.”

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

• How to Complain to Medicare  (New York Times – 8/28/2014)
  ​How Medicare handles complaints and appeals is no trivial matter — the Centers for Medicare and Medicaid Services says it reviews more than 100,000 of them a year.
•  Is it Medicare or Medicaid? (SSA – 11/16/17) 
  A lot of people have a difficult time understanding the difference between Medicare and Medicaid. Both programs begin with the letter “M.” They’re both health insurance programs run by the government. People often ask questions about what Medicare and Medicaid are, what services they cover, and who administers the programs.
• Jimmo Settlement (cms.gov)
  The Centers for Medicare & Medicaid Services (CMS) reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met). 
• Major Changes in Both Medicaid and Medicare Affecting Your Clients (Sanford J. Mall, JD, CELA – Summer. 2007)
  Recap of changes in law and policy that vastly affect basic health care, catastrophic medical, rehabilitation and long-term care for elders and persons with disabilities. 
• Medicare and Long-Term Care: What’s Covered? (Association for Long-Term Care Planning – 8/3/18)
  Many long-term care patients are surprised by the fact that their Medicare coverage doesn’t pay for everything they thought it would. Knowing the relationship between Medicare and long-term care can better prepare you for your financial future. 
• Medicare & Medicaid (AGIS)
  Discusses the differences between these complicated government programs.
• Medicare Advantage Part C (Money Alert)
  Medicare Part C (Medicare Advantage Plan) is the combination of Medicare Part A and B. Here's a look at the Part C basics.
  Patti's Comments: If you get some information like this on how to get a Medicare Advantage Plan, my advise is “JUST SAY NO”.. elder law attorneys and advocates are really struggling with securing appropriate services for our clients with this type of coverage. 
• Medicare Information for Caregivers Now Available on NIHSeniorHealth (NIH – 5/13/09)
  An easy-to-read overview, "Medicare Basics for Caregivers," is now available at NIHSeniorHealth.gov, the Web site for older adults from the National Institutes of Health. This brief, yet comprehensive introduction to Medicare gives caregivers the basics and helps them find answers to their questions.
• Medicare [and Medicaid]] Far More Cost-Efficient Than Private Insurance (Firedog Lake – 8/10/12)
  The public debate has focused on transforming Medicare and Medicaid in the coming years, constraining cost in the very programs that are the most cost-efficient. If anything, the opposite should be true, and more and more of the system should be converted into public programs to increase the risk pool, allow for greater bargaining leverage on prices, and provide stability.
• Medigap Insurance Helps Prepare for Health Care Cost During Retirement (Medigap Advisors)
  When turning 65, many people make the mistake of assuming Medicare will cover most or all of their health care costs when they retire, and that, if they need nursing home care, that Medicaid, the health care program for the poor, will cover them. However, neither program alone can guarantee a low-cost ride when it comes to paying for your medical expenses throughout retirement.
  Patti's Comments: This is a simple easy to understand what Medicare is and what it is not. Everyone that can afford to stay on traditional Medicare and purchase a gap policy should do so. We are seeing lots of problems for folks with Medicare Advantage Plans.
• MMSEA & The MSP – Confusion Reigns Supreme – Medicare, Medicaid & SCHIP Extension Act (MMSEA)
  Passage of Section 111 of the MMSEA and its reporting deadline of 7/1/09 has caused a tremendous amount of confusion among insurance professionals, lawyers and settlement planners alike. As a result of the MMSEA new discovery is being sought to assist insurers in complying with the reporting requirements. This article delves in the MMSEA briefly to explain what it is and what is required.
• National Council on Disability Applauds New CMS Medicaid Managed Care Resources (NCD Newsroom – 8/15/12)
  The National Council on Disability – an independent federal agency that advises the President, Congress, and other federal agencies on the policies and programs that affect Americans with disabilities – commends the Centers for Medicare & Medicaid Services (CMS) for two new resources aimed at enhancing Medicaid managed long-term supports and services (MLTSS).
• Nearly 65? Time for the Medicare Maze (New York Times – 10/14/09)
  NOW that you’re about to retire, there’s good news and bad news about your health insurance. The good news: When you turn 65, you’re eligible for Medicare — all in all, a pretty affordable way to get coverage for doctor bills, hospitalizations and, more recently, prescription drugs. The bad news: You’ve got a big job ahead of you, sorting through the Medicare bureaucracy.
• Observation Services: What Can Beneficiaries and Advocates Do? (Center for Medicare Advocacy)
  Being in a hospital bed in a Medicare-participating hospital is no guarantee that a Medicare beneficiary is an inpatient. In our December 11, 2008 Alert, the Center for Medicare Advocacy described the increasingly common practice of placing Medicare beneficiaries in acute care hospital beds and calling them outpatients.
• One Million Seniors Get More Generous Prescription Drug Benefits (Kaiser Health News – 1/8/10)
  As of Jan. 1, more than 1 million low-income seniors "are newly eligible for more generous prescription drug benefits under the 'extra help' program" in Medicare.
• Prescription Drug Cost Relief to More than 750,000 Medicare Beneficiaries (US Dept. of Health & Human Services – 8/10/10)
  The third round of one-time, tax-free $250 rebate checks have been mailed to eligible Medicare beneficiaries whose drug costs are so high they have reached the Medicare Part D prescription drug coverage gap known as the “donut hole.”   
• Special Needs Plans: A Primer on I-SNPs (the Playbook – 7/11/19)
  Special Needs Plans (SNPs) are a type of Medicare Advantage (MA) plan for individuals with special needs. This can mean an institutionalized individual (i.e., someone who lives in nursing home), a dually eligible individual (i.e., eligible for both Medicare and Medicaid), or an individual with a severe or disabling chronic condition.
• Studies Say Private Medicare Plans Have Added Costs, For Little Gain (New York Times – 11/24/08)
  Private health insurance plans, which serve nearly a fourth of all Medicare beneficiaries, have increased the cost and complexity of the program without any evidence of improving care, researchers say.
• Study Spotlights Growing Role of Medicare in Propping Up Nation's Medicaid Program – (EMaxHealth – Oct. 2007)
  New BDO Seidman study of the nation's Medicaid program draws much needed attention to a chronic and worsening problem: Medicare's cross-subsidization of increasingly inadequate Medicaid payments for nursing home care. Patti's note: "I could not agree more!"
• Take Advantage of New Changes to Programs that Help With Medicare Costs (Medical News Today – 1/12/10)
  Beginning in January, federal changes to Medicare Savings Programs (MSP) and Medicare's Low Income Subsidy ("Extra Help") mean a simplified application process and greater eligibility for these important programs.
• The Gap in Medigap (9/27/16)
  Medicare provides coverage for a wide array of medical and drug benefits, but, with its deductibles, cost-sharing requirements, and lack of an annual out-of-pocket spending limit, many people on Medicare purchase Medigap supplemental insurance to help cover their out-of-pocket costs.
• Top Ten Myths of Medicare (TaxProf Blog – 9/25/12) 
  ​Readers could not find a better article to explain Medicare’s basic workings, its budgetary and political realities, and its combination of shortcomings and truly significant benefits to American society.  Even if the next U.S. President were not going to be chosen on the basis of his commitment to protecting Medicare, reading this article would be worth anyone’s time.
• Who's Responsible for Care After Stroke? (Post-Gazette Now – 3/31/09)
  With certain limitations and so long as the therapy meets the "reasonable and necessary" test, Medicare will generally pay for PT, OT and ST in the hospital, in a skilled nursing facility for up to 100 days, in the home setting under specific circumstances, and at special therapy facilities.
• Why Medicare Cards Still Show Social Security Numbers (New York Times – 9/10/12)
  Images of a woman waving her Medicare card on television at the Democratic convention last week in Charlotte, N.C., prompted the folks at Credit.com and others to ask: Why do Medicare cards still have Social Security numbers on them anyway, when access to the numbers can post a risk of identity theft?
• You're Not in the Hospital. You're in Observation! (CMA Health Policy Consultants – 7/13/10)
  Medicare beneficiaries – although placed in hospital beds (often, from the emergency room) and given medications, tests, therapies, medical and nursing services, food, and a wrist-band – are told they aren’t in-patients; they’re just receiving observation services as outpatients. Patients often learn about their out-patient status just as they are leaving the hospital for the skilled nursing facility – which won’t be covered by the Medicare program because they weren’t in-patients for three consecutive days!