Nebraska Department of Insurance

Home Consumer Producer Company About NDOI Quick Links Outside Links

THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM

DECEMBER 1999 NICA NEWS

ISSUES

MEDICARE PART B PREMIUM UNCHANGED FOR 2000

The Department of Health and Human Services today announced that the Part B premium paid by Medicare beneficiaries next year will remain unchanged for the second time in three years.

"The Clinton Administration's efforts to protect Medicare are ensuring this essential program will be preserved for the future, and also helping beneficiaries save money," said HHS Secretary Donna E. Shalala.

The Part B premium covers physician services, hospital outpatient care, durable medical equipment and other services outside hospitals. The Part B premium will stay at the 1999 rate of $45.50.

Last year, it rose by $1.70.

"This is welcome news for the millions of senior and older Americans who rely on Medicare," said Michael Hash, deputy administrator of the Health Care Financing Administration, which oversees Medicare and Medicaid.

The Medicare Part A deductible for inpatient hospital care is rising by $8, only about 1 percent, to $776. The small increase largely reflects savings from reductions in Medicare hospital payments and other program changes signed into law in the Balanced Budget Act to help protect and preserve the Medicare Hospital Insurance Trust Fund. Last year, the deductible rose by $4. The Part A deducttible is a beneficiary's only cost for up to 60 days of inpatient care. The cost to beneficiaries for hospital stays longer than 60 days is rising by $2, to $194 per day, and by $4, to $388 per day, for stays longer than 90 days. The skilled nursing facility deductible, which must be paid after the first 20 days of such care, is rising by $1, to $97 per day.

The vast majority of Medicare beneficiaries do not pay premiums for Part A coverage. However, these premiums are actually dropping in 2000 for the 365,000 beneficiaries who do pay them. The full monthly Part A premium, paid by seniors with less than 30 quarters of Medicare-covered employment and by disabled individuals under 65 who lost disability benefits because of work and earnings, is dropping by $8, to $301. Seniors with from 30 to 40 quarters of Medicare-covered employment are entitled to reduced premiums that are dropping by $4, to $166.

Attorney General Don Stenberg Says Sweepstakes Fraud Targets Elderly Nebraskans

Sweepstakes fraud continues to be a major problem, especially among the elderly in our state. We estimate that consumers are losing literally millions of dollars responding to sweepstakes and prize offers that promise everything from trips to new cars to large cash prizes.

We suggest the best way for Nebraskans to fight sweepstakes fraud is to Just Toss It - to just toss all of those "free gift" and "prize" notifications in the trash.

If a "prize" is received at all, the product turns out to be cheaply made and worth only a fraction of its cost. Nearly every day, our office is notified of another Nebraska citizen who has fallen victim to one of these scams. Often the calls to our office come from adult children of an elderly parent.

A Nebraska resident, who has been the victim of sweepstakes scams in the past, reported a "re-scam" attempt. He was called by someone who claimed to represent the Canadian government and reported that he was to receive a "court ordered settlement" to repay the money he had lost in an earlier sweepstakes scam. He was then told that he must pay the taxes on the settlement before he could receive his payment. This is just another cruel attempt to put more money in the scam artist's pocket, as there is no "court ordered settlement".

In another case, the son of an elderly Nebraska resident contacted the Attorney General's Office because his father was sending several checks a day in response to sweepstakes offers. Regardless of the fact that these bogus sweepstakes made promises of cash and fabulous prizes, the promised awards were never received.

We offer the following warning signs of sweepstakes scams:

Requests for a credit card or a bank account number as a credit reference or to "verify " your identity.
High pressure sales tactics to convince the consumers that this truly is a once-in-a-lifetime opportunity.
Use of over night mail courier to pick up a check or money order to "speed up the process."
Requests for money up-front to claim the prize, or requirement to purchase merchandise to receive a prize.
Being asked to send a large amount of money to pay taxes or delivery charges.
Requests for your personal numbers - social security, credit card or bank account.
Being told to keep your win a secret from your family.

For more information or to file a complaint, contact the Office of Attorney General Don Stenberg, Consumer Protection Division, 2115 State Capitol Building, Lincoln, NE, 68509, or call our Consumer Protection Line toll-free in Nebraska 1-800-727-6432.

HOW CAN I GET HELP PAYING MEDICAL EXPENSES?

If your monthly income is below $1222 for an individual or $1633 for a couple, and your financial resources (including things like bank accounts, savings and interest, stocks, bonds, or pensions) are below $4,000 for an individual and $6,000 for a couple, you may qualify to have part of your Medicare Part B premiums paid. If your income is even less than the amount listed, you may qualify to have your out-of-pocket expenses (like coinsurance or deductibles) paid, as well.

There are programs that save money for millions of people with Medicare deductions in their Social Security checks. This extra money can help you pay for living expenses or prescription drugs. But, many people who could get this money never apply.

It is very important to call if you think you qualify for any of these savings, even if you are not sure. Call your nearest medical assistance office. You can find the number in the phone book under Medicaid, Health & Human Services or Social Services, or call NICA at 1-800-234-7119, and we will assist you in finding the right number in the county where you live.

MEDICARE WILL COVER INSULIN PUMPS FOR BENEFICIARIES

Expanding treatment options for Medicare beneficiaries with diabetes, HCFA Deputy Administrator Michael Hash today announced Medicare will cover insulin infusion pumps for eligible beneficiaries with Type I diabetes.

Today's announcement of the benefit expansion is the first coverage decision made under Medicare's new coverage process announced earlier this year.

After reviewing the scientific evidence of the insulin infusion pump's effectiveness in treating Type I diabetes, the Health Care Financing Administration announced a national coverage decision to cover insulin infusion pumps. Under the new coverage policy, Medicare will pay for the pump when prescribed for beneficiaries who have Type I diabetes, also known as juvenile onset diabetes. In Type I diabetes the pancreas fails to produce insulin, the hormone necessary for the metabolism of blood glucose.

"Making the insulin pump available to Medicare beneficiaries will improve the quality of their lives. The infusion pump offers them a choice to better control their condition so that they are more active and productive," said Hash.

The decision to expand Medicare benefits to include insulin infusion pumps was made within the 90-day deadline HCFA established when it announced a new Medicare administrative process in April 1999. Medicare's new coverage process is designed to be open, understandable and predictable. The process relies on medical and scientific evidence to make national coverage decisions including medical literature and data, discussions with medical experts and technology assessment.

"We are pleased that HCFA responded promptly to a need to examine new scientific evidence about the insulin pump. Based on an analysis that used evidence-based research, HCFA decided that Medicare beneficiaries should have access to this new state-of-the-art therapy," said Jeffrey Kang, M.D., Director of HCFA's Office of Clinical Standards and Quality.

The insulin pump permits users to maintain tight control of glucose by propelling insulin from the pump reservoir through an infusion set into a catheter inserted under the skin of the abdomen or hip.

HCFA decided to re-evaluate Medicare's previous policy which did not allow coverage of insulin infusion pumps. HCFA staff conducted a technology assessment which involved an analysis of peer-reviewed medical journal articles, consultations with the American Diabetes Association and American Association of Clinical Endocrinologists, manufacturers of insulin pumps, physicians who treat diabetes in their practices and others with an interest in diabetes treatment.

Medicare already covers diabetes self-management training provided in outpatient settings. Blood glucose monitors and testing strips are covered for all diabetic patients as durable medical equipment.

HCFA next will issue a coverage instruction, including coding and billing information, to all of its contractors that will specify an effective date that payment will become available for insulin infusion pumps for Type I diabetics.

Type I diabetes is less common than Type II diabetes which is more prevalent in the Medicare population. Type I diabetes accounts for 5 to 10 percent of all diabetes in the United States. Type II , a disorder resulting from the body's inability to make enough insulin, accounts for 90 to 95 percent of diabetes. Infusion pumps have not yet been shown to be effective for Type II diabetic patients.

"The insulin infusion pump is an effective means of intensive insulin control that will protect many Medicare beneficiaries from dangerous complications," said Grant Bagley, M.D., J.D., Director of HCFA's Coverage and Analysis Group.