Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
DECEMBER 2001 NICA NEWS
CHANGES
The Department of Health and Human Services (HHS) announced legally mandated increases in the Medicare premium, deductible and coinsurance amounts to be paid by beneficiaries in 2002.For Medicare Part A, which pays for hospital, skilled nursing, hospice care and some home health care, the beneficiary deductible will increase to $812. The premium for Medicare Part B, which helps pay for physician services, ambulatory care and other services, will rise to $54 per month.
The Medicare statute requires that the deductibles and premium be updated annually in accordance with statutory formulas. Medicare law sets the Part B premium at the amount needed to cover 25 percent of estimated program costs for aged enrollees; general revenue tax dollars cover the other 75 percent of the costs.
The Part A deductible is a beneficiary's only cost for up to 60 days of Medicare-covered inpatient hospital care. However, for extended Medicare-covered hospital stays, beneficiaries must pay an additional $203 per day for days 61 through 90 and $406 per day for hospital stays beyond the 90th day in a benefit period. For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 will be $101.50.
Most of Medicare's 40 million beneficiaries choose the optional Part B coverage, which helps pay for physician services, hospital outpatient care, durable medical equipment and other services, including some home health care. Moreover, nearly 90 percent of Medicare beneficiaries have some form of third-party payer (such as Medigap, Medicaid, or Medicare+Choice) to help reduce out-of-pocket medical costs.
The Part A premium, paid by only a small percentage of beneficiaries, also is increasing in 2002. For the estimated 392,000 beneficiaries who pay a premium for Medicare Part A coverage, premiums will increase by $19, to $319. This amount is paid by seniors with less than 30 quarters of Medicare-covered employment (and by certain people with disabilities who are under age 65, have lost disability benefits because of work and earnings, and have less than 30 quarters of Medicare-covered employment).
Prescription Drug Discount Card Moving Ahead
As a result of an appeal by CMS, Judge Paul Friedman last week lifted the preliminary injunction that prevented CMS from moving forward with the prescription drug discount card. CMS Administrator Scully was pleased with the decision and stated that CMS would now continue to move forward with plans for notice and comment on a prescription drug discount card. Twenty-eight pharmaceutical companies have expressed interest in offering the discount card, and independently, Novartis AG announced that it would provide its own discount prescription card, CareCard, beginning in January, 2002. (Washington Post, 11/8/01)1-800 Medicare Helpline
The helpline has been enhanced to provide service 24-hours a day and 7-days a week. State-specific information will be available through the helpline for Medicare recipients who want to know about their available health plan choices. You can direct your clients to this toll-free line or you can call on behalf of a client who needs assistance.www.medicare.gov web site
CMS is developing an interactive web site feature to give people on Medicare information about health plans for which they are eligible. Individualized information on the best health plan for a person's particular needs will be provided - based on the data entered by the person or a representative.THANK YOU VOLUNTEERS!
We have decided to send the Thank You cards to Volunteers only two times a year. Previously, when you sent in your Client Contact Form, we returned a thank you to the Volunteer by mail. It isn't that we don't appreciate everything you do every month, but some Volunteers requested that we send the Thank You cards less frequently.BIPA Law Provides Expanded Benefits
BIPA (the Benefits Improvement and Protection Act of 2000) increases benefits for more people on Medicare. Some parts of this wide-ranging law are in effect now while others will start later. Here are some of the highlights. In effect now- Pap test/pelvic exam/clinical breast exam - covers people on Medicare one time every 2 years
- Colonoscopy screening - covers everyone on Medicare one time every 10 years
- Amyotrophic Lateral Disease (Lou Gehrig's Disease) - for people with ALS, waives Medicare's
- 24-month waiting period for disability coverage
- Special Medigap provisions - gives people in a 12-month trial period a renewed trial period when changing Medicare + Choice (M+C) plans because their M+C plan terminates
- Effective date for changing plans - all elections and disenrollments are effective the first day of the following month
- ESRD enrollment rights - patients with end-stage renal disease (ESRD) can enroll in another M+C plan if their M+C plan terminates; retroactive to plan terminations on or after Dec. 31, 1998
- Moratorium on therapy caps - the removal of dollar limits to cover physical therapy and speech therapy is extended through 2002
- Immunosuppressive drugs - no time limit on prescriptions for this class of drugs when the transplant is covered by Medicare
- "Homebound" defined - relaxes the definition to include adult day care as a treatment plan; also allows attendance of religious services outside the home Starting January 1, 2002
- Glaucoma screening - annual coverage for certain high-risk people
- Medical nutrition therapy - coverage for people with diabetes or renal disease