CMS Promotes Value for Seniors and Persons with Disabilities in Medicare Plans

By Jonathan Blum, Acting Principal Deputy Administrator and Director, Center for Medicare

With today’s regulation limiting overhead and profits for Medicare Advantage and prescription drug plans, the Affordable Care Act continues to promote value for consumers’ and taxpayers’ health care spending. These new requirements apply to Medicare health and drug plans offered by private insurance companies serving over 37 million seniors and persons with disabilities, and build on a similar regulation we issued last year requiring a minimum medical loss ratio for health plans serving consumers in the private insurance market. Medicare health and drug plans, beginning next year, must meet a minimum medical loss ratio, limiting their spending on non-health related items such as administrative costs, profit, or overhead. More specifically, this means that the plans must spend at least 85 percent of their revenue on direct benefits to Medicare enrollees such as clinical services, prescription drugs and quality improving activities.

The new Medicare MLR requirements will also give people with Medicare and their caregivers more information about Medicare plans when comparing their health care options during enrollment periods. They will be able to consider a plan’s medical loss ratio, along with quality ratings, coverage, premiums and other factors that influence their health care decisions.

By ensuring that plan payments are spent on health care and activities that improve the quality of care received, seniors and persons with disabilities will have more opportunities to work with their doctors and other health care professionals to stay healthy. With Medicare spending already growing at a slower pace, the new requirements are just one more way the Affordable Care Act is creating more value for seniors and persons with disabilities. We are excited about new initiatives and projects that are improving the health of people with Medicare and are committed to making a stronger Medicare program.

Older Americans Month 2013: Unleash the Power of Age!

For 50 years, May has been the month we celebrate older adults across the nation. You could say that Older Americans Month is coming of age. This year’s theme—“Unleash the Power of Age!”—emphasizes older Americans’ potential for energy and activism and urges them to embrace it.

There’s no age limit on achievement—and older Americans are doing incredible things. They make a difference in their communities by continuing their careers, pursuing new business ventures, and volunteering in their retirement years.  To find ways to get involved in your community, visit Serve.gov.

Staying active, engaged, and healthy is good advice for everyone, but it’s especially important for older people. The U.S Administration on Aging (AoA), supports older adults through programs and resources to encourage healthy living. In addition, the Affordable Care Act is making certain vital preventive services, such as mammograms, diabetes screening, and an annual wellness visit, available for seniors with Medicare.  Also, check out Go4Life, an exercise and physical activity campaign from the National Institute on Aging at NIH.

Throughout the year, and especially during Older Americans Month in May, we urge all Americans to appreciate and celebrate the vitality, aspirations, and achievements of elders and their contributions to society.

Protect yourself from Hepatitis B

Did you know that 1.2 million people in the U.S. have chronic Hepatitis B, but many more people don’t know they’re infected because they have no symptoms? Hepatitis B is a contagious liver disease that can range in severity from a mild illness lasting a few weeks to a serious illness that can lead to liver disease or liver cancer.

Medicare can help keep you protected from Hepatitis B. The best way to prevent Hepatitis B is by getting the Hepatitis B vaccine, which is usually given as 3 shots over a 6-month period. You need to get all 3 shots for complete coverage. If you’re at high or medium risk for Hepatitis B, Medicare Part B will cover Hepatitis B shots for free.

Are you at risk for getting Hepatitis B? If you have hemophilia, End-Stage Renal Disease (ESRD), diabetes, or certain conditions that lower your resistance to infection, you have a higher risk for getting Hepatitis B increases.  Additionally, if you have a profession that puts you in frequent contact with blood or bodily fluids, you may be at a higher risk.

May is Hepatitis Awareness month. To find out more about preventing and treating Hepatitis B, visit the Centers for Disease Control.

Get your blood pressure checked regularly

Do you or does someone you know have high blood pressure? Most likely, your answer is yes. More than one-third of adults in the United States have high blood pressure, and many don’t even know it. High blood pressure increases your risk of heart disease, the #1 killer worldwide, and many other diseases. That’s why it’s important to get your blood pressure checked regularly.

Medicare helps make checking your blood pressure easy. A blood pressure screening is covered in your “Welcome to Medicare” visit and your Yearly Wellness visit at no cost to you.

There are also many ways to prevent and help treat high blood pressure. Eating a healthy diet and avoiding sodium are easy ways to lower blood pressure. Maintaining a healthy weight and being physically active are also important. The surgeon general recommends at least 30 minutes of moderate physical activity most days of the week. You can also check your blood pressure between your yearly visits for free at many pharmacies, senior centers, and health fairs.

May is National High Blood Pressure Education Month, watch our video to learn more.

Making complaints less complex

We hope every healthcare experience you have is a positive one. That’s why we offer you a variety of tools to express your concerns. One of those tools is the ability to file a complaint (sometimes called a “grievance”).

Do you have a complaint?

If you have a concern or a problem that isn’t a request for coverage or reimbursement, you have the right to file a complaint. Not sure if you need to file a complaint or an appeal? Read some examples of situations where you might need to file a complaint.

Things to know before you file a complaint:

Each plan has specific rules you’ll need to know and follow when filing a complaint.  If, after filing a complaint, your plan doesn’t address the issue, call 1-800-MEDICARE for assistance. You can also call your State Health Insurance Assistance Program (SHIP) for free, personalized help filing a complaint.

Information you’ll need to have ready when you file a complaint: 

Basic information about you 

  • First and last name
  • Date of birth
  • State you live in
  • Zip code
  • Email address
  • Preferred call back time, phone number, and response language

Medicare card information 

  • Medicare number
  • Effective date

Health or drug plan information

  • Your health or drug plan name
  • Your health or drug plan contract ID

Complaint topic

  • Benefits
  • Prescription drugs
  • Services
  • Something else

 

2 tools Medicare offers that can help…

1. A Personal Health Record (PHR) is a record with information about your health that you, or someone helping you, can keep for easy reference using a computer. You control the health information in your PHR and can get to it anywhere, at any time, with Internet access.

2. The Blue Button tool provides you an easy way to download your personal health information to a file. You can download the file of your personal data and save the file on your own personal computer.  You can access the Blue Button through your account on MyMedicare.gov.

Need help with your health care costs?

Susan, a woman in her mid-80’s, went to her local SHIP for help with her finances and healthcare decisions. Susan hasn’t had prescription drug coverage since 2011, and she currently isn’t getting any help to pay her prescription drug costs. Susan spoke with a SHIP counselor about her situation and learned she could get Extra Help with paying her prescription drug costs. Susan’s now enrolled in a plan where she can afford her medications.

If you have limited income and resources, like Susan, you may be eligible for “Extra Help” or one of Medicare’s savings programs. These programs may help you save on premiums, deductibles, copayments, or prescription costs.

Get help with one of our 4 savings programs

Medicare offers 4 kinds of programs that may help with your costs.

1.     Qualified Medicare Beneficiary (QMB) Program

2.     Specified Low-Income Medicare Beneficiary (SLMB)

3.     Qualified Individual (QI) Program

4.     Qualified Disabled and Working Individuals (QDWI)

Applying for Extra Help is simple and free.

Don’t go without your prescriptions even if you’re having trouble paying for them. If you have limited income or resources, you may be eligible for Extra Help to help pay Medicare prescription drug costs, like premiums, deductibles and copayments.

Take a minute to see if you qualify to get help with your health care costs – it could mean money in your pocket.

Bundled payments, DMEPOS, regulatory reform, and ESRD

By Jonathan Blum, Acting Principal Deputy Administrator and Director, Center for Medicare 

In the past few days, the Centers for Medicare and Medicaid (CMS) announced four critical initiatives that are designed to enhance health care delivery for millions of Medicare beneficiaries by improving care or lowering costs, or both.  Taken together the announcements illustrate the breadth and diversity of efforts underway to ensure a better, stronger, more patient-centered Medicare program.

Last week, we announced a new health care delivery system reform, made possible by the Affordable Care Act, to test how bundling of payments for episodes of care, for example a heart attack or stroke, instead of paying for each test or procedure or physician’s visit, can result in more coordinated, higher quality care for beneficiaries.  By bundling payments for services that beneficiaries receive during an episode of care, CMS hopes to encourage doctors, hospitals, and others  to work together to improve care and health outcomes, while also lowering Medicare costs.  Over 500 organizations, nationwide, have already signed-on to participate.

We also announced a major expansion of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.  In its first year of operation, competitive bidding, where prices are based on suppliers’ bids, saved the Medicare program, and taxpayers, over $202 million, while maintaining access to quality products for Medicare beneficiaries in the nine areas of the country where the program launched.   It’s a great example of the Administration’s determination to put the brakes on runaway healthcare costs.  With this expansion in the program, Medicare beneficiaries in 91 major metropolitan areas will save an average of 45 percent on certain DMEPOS items beginning in July.  Between 2013 and 2022, we estimate that the expansion of the DMEPOS program will save Medicare $25.7 billion, while saving beneficiaries, who pay a percentage for medical equipment and supplies, $17.1 billion through lower prices.

This week, we issued a proposed rule which will help health care providers and hospitals to operate more efficiently by getting rid of regulations that are outdated, obsolete, or excessively burdensome.  Many of the rule’s provisions streamline requirements that health care providers must meet in order to participate in the Medicare and Medicaid programs, without jeopardizing patient safety, and they will save providers nearly $676 million annually.  Just as important, by eliminating burdensome requirements, health care providers can improve the quality of health care delivery for Medicare beneficiaries by spending more time focusing on patient care and less time filling out forms.

Finally this week, we announced the Comprehensive End-Stage Renal Disease (ESRD) Care Initiative.  It will help identify, test and evaluate new ways to improve care for Medicare beneficiaries living with ESRD.  We’ll be working with the health care provider community to care for a population that significant and complex health care needs.  Through better care coordination, beneficiaries can more easily navigate the multiple providers involved in their care, ultimately improving their health outcomes.

These four initiatives demonstrate that CMS is employing new and novel tools and programs, thinking outside the box and beyond the usual way of doing things, in order to improve health care delivery for people with Medicare and, in the process, strengthen the Medicare program for current and future beneficiaries.

Making a Heart Healthy Resolution

Richard Gilfillan, Director, CMS Center for Medicare and Medicaid Innovation

It’s the New Year, which means it’s time for those annual resolutions, whether it’s eating right or tackling a new skill.  But none may be more important than making the resolution to get heart healthy in 2013.

Did you know heart attacks and strokes are the first and fourth leading cause of death in the U.S.? The Million Hearts™ initiative, launched in 2012, is aiming to prevent 1 million heart attacks and strokes by 2017. CMS and the Centers for Disease Control and Prevention are working with other federal agencies, communities, health systems, non-profit organizations and private-sector partners to help educate Americans on how to make a long-lasting impact against cardiovascular disease.

If you’re at risk for, or are already suffering from, heart disease, now’s the time to practice the “Million Hearts ABCS”:

  • Aspirin for people at risk
  • Blood pressure control
  • Cholesterol management and
  • Smoking cessation

Medicare can help you take control of many of the major risk factors for heart disease. People with Medicare can get cardiovascular screenings, counseling to stop smoking, and blood pressure and weight checks during their yearly wellness visit with their doctor.

Make a New Year’s resolution and give your loved ones one more gift they’ll be sure to treasure—a healthier you in 2013. Help prevent a heart attack or stroke by joining the Million Hearts™ initiative.

Protect yourself – Get screened for cervical cancer

Cervical cancer and human papilloma virus (HPV) affect thousands of women each year. Regular screening tests like pap tests and pelvic exams can help find cancer and other health problems early and improve recovery and survival rates. Talk to your doctor about scheduling your next test!

Find out more about Medicare’s pap test and pelvic exam coverage.

For more information about HPV, check out the American Cancer Society’s HPV Frequently Asked Questions.

To learn more about Cervical Cancer, go to the American Cancer Society’s Web site for Cervical Cancer Information.

At risk for glaucoma? Find out before it’s too late

At risk for glaucoma? Find out before it’s too late

Do you have diabetes, a family history of glaucoma, or are you African American and age 50 or older? If so, your risk of getting glaucoma may be higher. With the start of a new year, it’s the perfect time to schedule a regular eye exam to check for glaucoma. You can prevent vision loss by finding and treating problems early.

Find out more about Medicare’s glaucoma screening coverage.