Medicare

Last week we hosted our Inaugural Elder Care Symposium regarding the future of elder care! We had an expert panel that discussed the topic of The Landscape of Elder Care Today & Tomorrow.  All of the panelists agreed that there is too much fragmentation in our current health care system.  An example of such fragmentation is Medicare’s […]

In February, Congress passed and the President signed a sweeping spending bill.  Included in the bill are important changes for Medicare beneficiaries.  Among the positive changes included the repeal of the Medicare Part B therapy caps, the accelerated closure of the Medicare Part D ‘donut hole,’ and the move to make Medicare coverage of speech generating devices […]

As we celebrate the life and legacy of Dr. Martin Luther King on Monday, many people overlook the important role that Medicare played in the Civil Rights movement. By threatening to withhold federal funding from any hospital that practiced racial discrimination, as required by Title VI of the Civil Rights Act, passed in 1964, Medicare forced […]

As our loved ones age their need for healthcare and personal assistance tends to increase.  Whether your loved one is in the early stages of dementia, undergoing short term rehabilitation after a hospital admission, or in need of long term nursing home care, accessing the best care and figuring out how best to pay for […]

Medicare health and drug plans make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks. October 15 – December 7 marks the annual Open Enrollment Period when individuals with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs. Per […]

The Centers for Medicare & Medicaid Services 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 […]

Decision in Alexander v. Price Means Medicare Patients Could Gain Right to Appeal Placement on “Observation Status” and Avoid Large Medical Bills On July 31, 2017, a Connecticut federal district court issued decision  certifying a nationwide class of hospital patients who may gain the right to appeal their placement on observation status.  In Alexander v. Price, 3:11-CV-1703 (MPS), Judge […]

Although the Republican health care plan was defeated, we still have work to do to have an optimal health care system for all Americans.  The Affordable Care Act known as Obamacare still needs improvement.  The existing American health care system is extremely complex. More than 57 million seniors and disabled adults depend on Medicare, but too many people […]

On February 16, 2017, the Jimmo v. Sebelius court approved a Corrective Statement to be used by the Centers for Medicare and Medicaid Services (CMS) to affirmatively disavow the use of an “Improvement Standard” for Medicare coverage.  The government will use the statement as part of its Corrective Action Plan, which was ordered by the court last […]

Observation Status is a designation used by hospitals to bill Medicare. Unfortunately, it can hurt hospital patients who rely on Medicare for their health care coverage.  People who receive care in hospitals, even overnight and for several days, may learn they have not actually been admitted as inpatients. Instead, the hospital has classified them as […]

A settlement agreement in Jimmo v. Sebelius required the Secretary of Health and Human Services to follow a “maintenance coverage standard” under which skilled nursing services would be covered by Medicare if they were necessary to maintain the patient’s current condition or prevent deterioration, rather under a so called “improvement standard.” The federal district court […]

Premiums for Medicare Part B will rise by a modest amount in the new year. The average premium for Part B, which covers physician services, outpatient hospital services and medical equipment, will rise to approximately $109 for most retirees, according to an announcement from the Centers for Medicare & Medicaid Services. That’s just slightly more […]