On June 21, 2011 Robert Egge, Vice President for Public Policy, testified before the House Energy and Commerce Subcommittee on Health about efforts to improve care in the dual eligibility community.

Medicare

Medicare is a federal health insurance program generally for people age 65 or older who are receiving Social Security retirement benefits or who are under 65 and received Social Security disability benefits for at least 24 months. Medicare covers inpatient hospital care and a portion of the doctor’s fees and other medical expenses. There are specific eligibility requirements in order for a person to receive assistance from this program. Medicare covers some, but not all, of the services a person with Alzheimer’s disease or a related dementia may require. Applications for Medicare may be sent to a local Social Security office.

Medicare Updates: Changes in 2012

Cost-sharing changes:
Waiver of Part D cost-sharing for Medicare-Medicaid beneficiaries receiving certain HCBS:
Beginning January 1, many Medicare-Medicaid beneficiaries receiving home and community- based services (HCBS) will no longer have any cost-sharing when getting their drugs that are covered under a Part D plan. Previously, only dual-eligible beneficiaries who were institutionalized would have their cost-sharing waived for their Part D drugs.

Reduction of cost-sharing for mental health services:
Beginning January 1, Medicare beneficiaries in original fee-for-service Medicare will pay 40% for outpatient mental health treatment. Medicare will pay 60% of the approved amount. Medicare’s payment for mental health services is being increased annually until 2014, when Medicare will pay 80% for these services, as it does for other Part B services.

New Notice of Non-coverage of Part D drugs at Pharmacy:
Beginning January 1, the pharmacy must provide a Medicare beneficiary a written notice if the Part D plan denies payment of the drug. The notice will inform the beneficiary that the claim was denied and that the beneficiary should contact the Part D plan to request a coverage determination or to request an exception.

Special Enrollment Opportunity for “5 Star” Quality Plans:
From December 8, 2011 – November 30, 2012, Medicare beneficiaries have a one-time opportunity to enroll in a prescription drug plan or a Medicare Advantage plan that has received an overall 5-star (excellent) rating of quality from CMS, if a 5-star plan is available in the beneficiary’s state. The plan quality ratings can be found on the Medicare Plan Finder on the Medicare website at www.medicare.gov.  See the chart showing which Medicare national plans cover Alzheimer's drugs.

Annual Wellness Visit now includes Health Risk Assessment:
Prior to or during an annual wellness visit appointment, a Medicare beneficiary (or caregiver) will be asked by his or her doctor or health professional to complete a Health Risk Assessment (HRA).  The HRA includes some questions about the beneficiary’s health which may provide important information to discuss with the health professional during the annual wellness visit.
For additional information about Medicare, see the updated fact sheets and topic sheets.  If you have questions about Medicare, contact Leslie Fried, Director of the Medicare Advocacy Project at Leslie.Fried@alz.org

Medicare Web sites:

Medicare Web site
This Web site for both the consumer and the health care professional includes frequently asked questions and information on local Health and Human Services offices.

Ask Medicare
Medicare's site to help family caregivers — those who are family members or friends who help people with Medicare — access and use valuable health care information, services and resources.

Medicare Basics for Caregivers
Online version of Medicare's booklet, "Medicare Basics: A Guide for Families and Friends of People with Medicare."

Medicare and the new Health Law

Closing the “donut hole” for seniors
At a certain point under the Medicare prescription drug program – a point known as the "coverage gap" or "donut hole" – Medicare stops paying part of the costs of a senior's prescription drugs, requiring seniors to pay the full cost themselves. This gap will be phased out by 2020. In 2012, all seniors who reach the coverage gap will get a 50% discount for brand drugs and Medicare will pay 14% for generic drugs.

The Center for Medicare and Medicaid Services (CMS) has prepared a brochure that explains some of the changes to Medicare that are in the new health law.

 Medicare and the New Health Law – What it Means for You (English)

 Medicare and the New Health Law – What it Means for You (Spanish)

Medicare topic sheets from the Alzheimer's Association:

 Medicare: An Outline of Benefits (4 pages) 

 Fee-for-Service Medicare (6 pages)

 Medicare Hospice Benefit: Frequently Asked Questions (2 pages)

 What Can a Beneficiary Do if Medicare Refuses to Pay for a Medical Service? (1 page)

 Medicare Savings Programs: Assistance with Meeting the Costs of Medicare Premiums and Deductibles (2 pages)

 Medicare Home Health Benefit for Caregiver Training in 16 States (2 pages)

 Medicare Annual Wellness Visit Fact Sheet (2 pages)

Medicare prescription drug coverage is available to all people with Medicare. For information and resources, see our Medicare Drug Coverage page.

Medigap

Medicare coverage can be supplemented with Medigap, a private insurance that covers copayments and deductibles required by Medicare. The more expensive policies may cover prescription drugs. 

For more information, visit Medigap's Web site.  

Medicare HMO (Medicare Managed Care)

A Medicare HMO offers some additional benefits and less paperwork in exchange for restrictions on choices of hospitals, doctors and other professionals. Most Medicare HMOs cover nursing home and home health care for limited periods only under special circumstances.

For more information, visit Medicare’s Web site.

Medicaid

Because Medicaid is a federal program typically administered by each state’s welfare agency, eligibility and benefits vary from state to state. The program is typically administered by a state welfare agency. Medicaid covers all or a portion of nursing home costs. A person with Alzheimer’s can qualify for long-term care only if he or she has minimal income and cash assets.

For more information, visit the Medicaid Web site.