Medicare & Medicaid News for Seniors

Medicare Annual Election Period Opens Oct. 15Medicare & Medicaid News

Medicare premiums, deductibles for 2016 add to woes of no COLA

Part B deductible jumps for all, most won't pay higher premiums

Nov. 11, 2015 - Medicare late yesterday released the 2016 premiums and deductibles for inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs. The good news is most senior citizens will not pay more for outpatient care. The bad news is many will. And, no one will be pleased with the $19 increase in the Part B deductible. More...

Political News for Seniors

Trump Plan will allow veterans to get their care from Medicare doctors

Vets will be able to get care from any doc of facility that treats Medicare patients

Veteran being briefed on health benefitsNov. 2, 2015 - All U.S. military veterans can go to any doctor that treats Medicare patients to receive healthcare, according the campaign proposal yesterday by Republican presidential candidate Donald Trump. More...

Medicare & Medicaid News

CMS wants better discharge plans for Medicare, Medicaid patients

To improve patient quality of care, reduce complications, adverse events, readmissions

doctor escorts patient being dischargedOct. 30, 2015 - The Centers for Medicare & Medicaid Services (CMS) yesterday proposed to revise the discharge planning requirements that hospitals, including long-term care hospitals and inpatient rehabilitation facilities, critical access hospitals, and home health agencies, must meet in order to participate in the Medicare and Medicaid programs. More...

Medicare & Medicaid News

CMS issues rule to ensure Medicaid beneficiaries access to services

Response to Court decision that beneficiaries do not have private right of action to contest state-determined rates in federal courts

elderly woman talking on telephoneOct. 29, 1025 - Today the Centers for Medicare & Medicaid Services (CMS) issued a final rule that it says allows states and CMS to make better informed, data-driven decisions when considering whether proposed changes to Medicaid fee-for-service payment rates are sufficient to ensure that Medicaid beneficiaries have access to covered Medicaid services. More...

Medicare & Medicaid News

Senior citizens may pay much more for drugs if they don’t switch Medicare plan

Graphic reminder of Medicare Open Enrollment dates 2015

Staying with same plan could mean giant price jump in drugs you have been taking – but most seniors just renew during open enrollment

By Michelle Andrews - Kaiser Health News

Oct. 20, 2015 - When Mildred Fine received the annual notice informing her about changes to her Medicare prescription drug plan for 2016, she was shocked. If she stayed with the same plan, her monthly premium would more than triple, from $33.90 to $121.10, and her annual deductible would rise from $320 to $360. More...

Medicare & Medicaid News

Medicare pushing hard for Medicare Advantage, Drug Plans as Open Enrollment begins

For Medicare information about Open Enrollment, click

This fact sheet may be helpful to seniors considering new options in Medicare for 2016

Oct. 13, 2015 – The Administration continues to boost of the growing benefits of Medicare Advantage and Part D programs as senior citizens begin to consider their options during the annual open enrollment period that begins Thursday, October 15 and runs through December 7. A recent Fact Sheet from the Centers for Medicare & Medicaid Services points out that almost a third of all beneficiaries now have MA plans and about a third of those with drug plans are now in plans with 4 or 5 star ratings. Below is the CMS fact sheet that may benefit you in choosing your Medicare for 2016. More...


Medicare & Medicaid News

AARP encourages seniors to compare drug plans to save money

Medicare Open Enrollment Opens This Week, October 15 - December 7; AARP has assistance online

couple using computer to see options in Medicare drug plansOct. 12, 2015 - It’s that time of year again: Medicare Open Enrollment. AARP has issued a news release encouraging all Medicare beneficiaries to review their health and prescription drug plan choices for 2016 during open enrollment (October 15– December 7). With the explosive rise in prescription drug prices, consumers should pay particular attention to their drug coverage options to help save money. More..

Medicare & Medicaid News

Big Medicare Part B price jump for some: 70 groups ask Congress to act

Part B will increase to $159 monthly for select beneficiaries in 2016; Part B deductible jumps to $223 for all on Medicare

Oct. 9, 2015 - Seventy national organizations representing people with Medicare, health insurers, workers, federal employees, and more sent a letter last week to key Congressional committees urging swift action to shield senior citizens, people with disabilities, and state Medicaid programs from anticipated increases in Medicare Part B premiums and the Part B deductible in 2016.

Medicare & Medicaid News

Medicare launches new dialysis model to improve kidney care

Medicare Annual Election Period Opens Oct. 15Affordable Care Act model designed to improve care for patients with kidney failure while reducing costs

Oct. 9, 2015 - More than 600,000 Americans have end-stage renal disease (ESRD), also known as kidney failure, and require life sustaining dialysis treatments several times per week. Medicare has a new plan. In 2012, ESRD beneficiaries comprised 1.1% of the Medicare population but accounted for an estimated 5.6% of total Medicare spending.

Medicare & Medicaid News

Medicare releases data on those who refer medical equipment

Data serves as comprehensive resource for information on durable medical equipment costs and services

Oct. 9, 2015 - As part of efforts to make the healthcare system more transparent, affordable, and accountable, the Centers for Medicare & Medicaid Services (CMS) has posted a new data set for the Provider Utilization and Payment files. It provides information on physicians and other healthcare professionals who referred DMEPOS products and services, such as wheelchairs, walkers, and diabetes supplies for Medicare beneficiaries.

Medicare & Medicaid News

Medicare project aims at better results at less cost for drug program

It is Part D Enhanced Medication Therapy Management (Enhanced MTM)

Oct. 6, 2015 - An effort to improve medication therapy among Medicare beneficiaries enrolled in the Part D prescription drug program has been announced by the Center for Medicare and Medicaid Innovation (CMMI) of the Centers for Medicare & Medicaid Services (CMS). The hope is better health care and better patient outcomes at a lower overall health care cost.

Medicare & Medicaid News

Obamacare funds battle against hospital-acquired conditions, readmissions

CMS awards $110 million to hospital associations and health systems

medical staff discusses patient's conditionSept. 25, 2015 – There are probably few senior citizens who do not know at least one person who has suffered and, maybe, died from a hospital-acquired infection or other dangerous condition. The CDC estimates two million a year in the U.S. are hit with hospital-acquired infections and 20,000 die. Tomorrow there will be an additional $110 million from the Affordable Care Act (Obamacare) fighting to end this nightmare.

Medicare & Medicaid News

Medicare news for seniors all good as open enrollment period nears

CMS now calling this annual period for changing plans the ‘Annual Election Period’

Sept. 22, 2015 - The Annual Election Period for Medicare health and drug plans – which up until now has been called the “Open Enrollment Period” - begins on October 15 and ends December 7, 2015. The Centers for Medicare & Medicaid released good news for senior citizens yesterday, with most of the focus on the success of the Medicare Advantage.

Medicare & Medicaid News

Medicare launches first ever plan to achieve health equity

Older black woman hears gets good news in mail as daughter watchesGoal is equity for minorities and other underserved populations

Sept. 9, 2015 - A new Medicare plan aimed at achieving equity for minority and other underserved populations and eliminating health disparities among Medicare beneficiaries was introduced yesterday by the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health (CMS OMH).

Medicare & Medicaid News

Medicare Advantage Plans to test more flexibility for seniors with chronic ills

Graphic reminder of Medicare Open Enrollment dates 2015Medicare Advantage Value-Based Insurance Design Model targets better cafe at less cost

Sept. 2, 2015 – Medicare will test the hypothesis that giving Medicare Advantage plans flexibility to offer targeted extra supplemental benefits or reduced cost sharing to enrollees who have specified chronic conditions can lead to higher-quality and more cost-efficient care, helping health plans and consumers have the tools they need to improve costs and spend dollars more wisely.

Medicare & Medicaid News

Nursing home care improvement is goal of CMS project

Funding would allow testing of new payment model for seniors in nursing facility care

Sept. 2, 2015 - A new funding opportunity designed to enhance the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents has been announced by the Centers for Medicare & Medicaid Services (CMS).

Medicare & Medicaid News

Medicare ACOs continue to improve quality of care and savings

Doctor smiles at elderly female patient in hospitalMedicare beneficiaries served by ACOs continues to increase; report on 2014

Sept. 2, 2015 - Medicare Accountable Care Organizations (ACOs) continue to improve the quality of care for Medicare beneficiaries, while generating financial savings, says the Centers for Medicare & Medicaid Services. The evidence is from the 2014 quality and financial performance results.

Medicare & Medicaid News

Medicare drug program premiums expected to stay about the same in 2016

Rates threatened by high cost of specialty drugs; growth in per-enrollee spending continues to be historically low

Aug. 19, 2015 - The monthly premium for a basic Medicare Part D prescription drug plan in 2016 is estimated to be $32.50, when Open Enrollment begins October 15. For the past five years – plan years 2011-2015 – the average monthly premium for a basic plan has been between $30 and $32.

Happy 50th Birthday to Medicare & Medicaid

President Lyndon B. Johnson signed bill creating Medicare and Medicaid on July 30, 1965. President Harry Truman became first member.

July 30, 2015

Medicare celebrates 50th anniversary with 55 million covered

State-by-state enrollment numbers

Medicare turns 50 but big challenges await

Medicare’s long-term future improved in Trustees Report

CMS sees modest growth in health care spending through 2014

Medicare & Medicaid News

depressed manNew Medicaid initiative improves access to substance use disorder treatment

The CMS Blog

July 30, 2015 - The Medicaid program plays an important role in providing access to treatment for individuals with a substance use disorder (SUD). Nearly 21 million Americans suffer from SUD, many of whom are low-income or uninsured.

Medicare & Medicaid News

Medicare has launched new star rating of home health services

Will help seniors stay in homes longer as need for care grows

July 20, 2015 - Medicare has taken another of several steps recently to help seniors stay in their homes longer. The latest is a new rating of home health care services. More...

Medicare & Medicaid News

Boomers with Obamacare health plans may face choices before joining Medicare

Some soon-to-be senior citizens may want to keep their marketplace subsidy

Cross roads signs Medicare and MarketplaceJuly 1, 2015 - Before the Affordable Care Act, older adults who couldn’t afford to buy their own health insurance would count the days until their 65th birthday, when Medicare would kick in. Now, 10,000 Americans hit that milestone every day, but for some who have coverage through the ACA’s insurance marketplaces, Medicare may not be the obvious next step. More...

97-year-old woman gazes into box

Google grants a 97-year-old's wish - "This is old fashioned stuff! Way before your time," she says. CNN Money

Your ad could be in the box above - today!

More Information on How

Medicare & Medicaid News

In-Home senior project achieves better care, lower cost for Medicare

Independence at Home practices introduced with Affordable Care Act  improving care, lowering costs for thousands of seniors

June 22, 2015 - For years, older Americans have expressed a strong desire to stay in their homes as they age, even if they need personal care. A major step in that direction was just announced by the Centers for Medicare and Medicaid Services. More...

Medicare & Medicaid News

Most Americans want government to negotiate lower drug prices for Medicare patients

They also say drug costs are ‘Unreasonable,’ although they can still afford them

June 17, 2015 - Americans expressed a strong preference for the government to begin negotiating with drug companies on behalf of Medicare patients for lower prices on medications, which most consider too high, according to a new poll from the Kaiser Family Foundation. More...

Medicare & Medicaid News

Prescription drug price battles show no sign of letting up - driving Medicare cost up billions

New drugs to fight heart disease projected to cost up to $12,000 a year; 10 new drugs could cost Medicare $31 billion

By Jordan Shapiro, The St. Louis Post-Dispatch

June 17, 2015 - The decision last week by experts at the Food and Drug Administration to endorse a pair of medicines aimed at combating heart disease brought on the latest round of hand-wringing over prescription drug costs. More...

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Medicare & Medicaid News

Medicare and Medicaid 50th Birthday Celebration Underway

Daily posts by CMS until party starts closer to July 30 date when bill signed by President Johnson

President Johnson signs Medicare-Medicaid bill on July 30, 1965June 16, 2015 – This summer will be the 50th anniversary of Medicare and Medicaid. On July 30, 1965, President Johnson signed legislation to establish Medicare for the elderly and Medicaid for low-income adults, children, pregnant women, and people with disabilities. More...

Medicare & Medicaid News

Some senior hospital patients charged 10 times rates paid by Medicare

Biggest problems are for-profit hospitals located in Florida

By Jenny Gold, Kaiser Health Nets

June 9, 2015 - Talk about sticker shock: Some U.S. hospitals charge patients more than 10 times the rates paid by Medicare. Of the 50 U.S. hospitals with the highest charges, 49 are for-profit institutions, 20 operate in Florida, and half are owned by a single chain, according to a study published in the journal Health Affairs Monday.

Medicare & Medicaid News

Medicare releases data on billion dollars in drugs bought through Part D

See what the docs are prescribing for senior citizens in the drug plan

April 30, 2015 - The Centers for Medicare & Medicaid Services today announced the availability of new, privacy-protected data on Medicare Part D prescription drugs prescribed by physicians and other health care professionals in 2013. This data shows which prescription drugs were prescribed to Medicare Part D beneficiaries by which practitioners. More...

Medicare & Medicaid News

Medicare accountable care medical groups cover almost two-thirds of U.S.

Now 424 ACOs dedicated to better care for seniors, others in Medicare fee for service

April 22, 2015 – Almost 70 percent of the U.S. population now lives in communities served by accountable care organizations (ACOs), which were created by Obamacare to provided Medicare patients with better coordinated and higher quality health care. A new analysis also shows that 44 percent live in areas served by two or more ACOs. More...

Medicare & Medicaid News

Medicare card will finally drop Social Security number

One of many provisions added to bill to increase pay for doctors in Medicare program

April 21, 2015 - One of the many - and probably better things - buried in the bill passed by Congress and signed by the President to increase the pay for doctors caring for Medicare patients is a provision that will finally remove a seniors Social Security number from their Medicare card. More...

Medicare & Medicaid News

Medicare's Hospital Compare adds star rating but fails to score with critics

Editor's note: New star rating system gets some hoarse criticism at Kaiser Health News

April 16, 2015 – Medicare’s Hospital Compare website may have added the star rating system today but the new service – well, even the earlier service – is not getting five stars from Jordan Rau of Kaiser Health News. His article published today is below. It is a “must read” for senior citizens planning on using the service to choose a hospital. More...

Medicare & Medicaid News

Medicare Hospital Compare adds star ratings system

Latest comparison ratings by CMS to help seniors, others compare and choose hospitals, other medical services

April 16, 2015 – How well does your hospital rate with Medicare? Today senior citizens and others can find out online. The famous “star rating” was added today to the Hospital Compare website provided by the Centers for Medicare & Medicaid Services (CMS). CMS says this will make it easier for consumers to choose a hospital and understand the quality of care they deliver. More...

Senior Citizen Politics

Wealthy seniors to pay more for Medicare under bill passed to fix doctor pay

Medicare’s troubled physician payment formula will soon be history, Congress passed bill and here is what it says

By Mary Agnes Carey, Kaiser Health News

April 15, 2015 - As expected, the Senate last night easily passed legislation to scrap the formula, accepting a bipartisan plan muscled through the House last month by Speaker John Boehner and Democratic leader Nancy Pelosi. The Senate vote came just hours before doctors faced a 21 percent Medicare pay cut. More...

Medicare & Medicaid News

Medicaid mental care for seniors, others may soon match care for physical health

Government had previously ordered parity by private managed care insurers, now want rule to activate in government programs

By Jenny Gold, Kaiser Health News

April 7, 2015 - A federal law that passed in 2008 was supposed to ensure that when patients had insurance benefits for mental health and addiction treatment, the coverage was on par with what they received for medical and surgical care. But until now, the government had only spelled out how the law applied to commercial plans. More...

Medicare & Medicaid News

Medicare Advantage, drug plan rates get surprise boost for 2016

CMS earlier indicated there would be little if any increase in cost for 2016 as it tries to reduce cost of private plans to match government insurance cost

 By staff

April 7, 2015 – Medicare Advantage and drug plan insurance providers got a nice surprise from Medicare this morning – a 1.25 percent rate increase for 2016. Earlier the Centers for Medicare & Medicaid Services (CMS) had announced it expected a slight decrease for next year. More...

Medicare & Medicaid News

Very poor, very sick elderly do worse in Medicare programs due to circumstances

Study by Medicare-Medicaid insurers say CMS cannot expect same healthcare results as for those from better environments

By Tucker Sutherland, editor

April 1, 2015 – If you are very, very poor and very, very sick – as are most Americans known as “dual eligibles” by the Centers for Medicare & Medicaid Services – you are likely to fair worse than others being treated with the same level of care by Medicare healthcare providers. This is the conclusion from a study funded by a healthcare technology company and the Special Needs Plan (SNP) Alliance, a group of companies that offer Medicare-Medicaid insurance plans. More

Medicare & Medicaid News

Medicare Doc pay bill passed in House blocks injured from suing physicians

Why did Senate leave town without finishing work on bill? Rubio says no cuts to Advantage

March 31, 2015 - The New York Times details some of the specifics of these protections for physicians inserted in House bill. Meanwhile, The Hill reports on why the Senate left town without finishing work on the Medicare physician payment overhaul - thereby leaving doctor payments in limbo. Marco Rubio wants to block any cuts to Medicare Advantage. More...

Medicare & Medicaid News

Some seniors to pay more for Medicare in House passed bill to hike doctor pay

This is a look at the details in this bill that will impact seniors on Medicare

March 27, 2015 - The House Thursday overwhelmingly passed legislation to scrap Medicare’s troubled physician payment formula, just days before a March 31 deadline when doctors who treat Medicare patients will see a 21 percent payment cut. More...

Political News for Senior Citizens

House Republican budget calls for privatizing Medicare, cutting Medicare

Senate Republicans expected to reject cutting benefits for senior citizens

March 18, 2015 - House Republicans are proposing to cut $5.5 trillion in U.S. government spending and balance the budget in nine years by cutting Medicaid and food stamps and partially privatizing Medicare. The House plan released Tuesday, straight from Representative Paul Ryan’s budgets of the past, is sure to run into opposition among Republicans who control the Senate. Almost half the Senate Republicans are up for re-election next year, and few senators are eager to run on a budget that would cut benefits for senior citizens. Bloomberg News

Medicare News from other media

Senate Democrats Threaten to Oppose Deal on Medicare Doc Pay

March 15, 2015 -Congress wants to avoid a 21 percent reduction in doctors' Medicare pay scheduled for April 1. Democrats want any agreement to finance the Children’s Health Insurance Program for four years. Associated Press on ABC News

Medicare News from other media

Two billion dollar trimming of Medicare to pay for physician pay increase

Bloomberg says congressional leaders in agreement to act by March 31

March 15, 2015 – Okay, it is still under wraps, but Bloomberg news says congressmen from both parties are about to make a run at trimming back Medicare by $200 billion to keep from cutting the reimbursement to physicians on March 31. Some of the cost would be offset with $35 billion worth of Medicare savings from beneficiaries, $35 billion from reducing or delaying higher payments to hospitals and other Medicare providers and the rest from $130 billion worth of adjustments in the budget resolution that would include government health programs. Bloomberg News, The News Tribune…

Medicare News from other media

Do you realize what a great deal you have with Medicare?

You will be surprised at what senior citizens get from Medicare

March 15, 2015 - As important as Medicare is for your long-term financial security, many retirees don't appreciate just how great a deal the program is until they see one shockingly large number: the difference between how much they've paid in Medicare taxes over the course of their lifetimes and how much they're likely to save on medical costs as a result of having Medicare coverage for the rest of their lives. Another interesting report by By Dan Caplinger for The Motley Fool

Medicare & Medicaid News

Hospitals working harder to make Medicare patients happy

Patient surveys more important since Medicare began requiring hospitals to report on satisfaction in 2007 - check your hospital's scores

By Jordan Rau, Kaiser Health News 

March 10, 2015 - Lillie Robinson came to Rowan Medical Center for surgery on her left foot. She expected to be in and out in a day, returning weeks later for her surgeon to operate on the other foot. But that’s not how things turned out. More...

Medicare & Medicaid News

Few senior citizens benefiting from Medicare obesity counseling

Affordable Care Act added Medicare benefit offering face-to-face weight-loss counseling to 13 million obese seniors in the U.S.

Sarah VarneyFebruary 23, 2015

Feb. 23, 2015 - In the farming town of Exeter, deep in California’s Central Valley, Anne Roberson walks a quarter mile down the road each day to her mailbox. Her walk and housekeeping chores are the 68-year-old’s only exercise, and her weight has remained stubbornly over 200 pounds for some time now. More...

Medicare & Medicaid News

Medicare makes Five Star Rating System for nursing homes even tougher

Climb gets even steeper for nursing homes to reach a five star rating

Feb. 23, 2015 - The Centers for Medicare & Medicaid Services (CMS) says it has strengthened the Five Star Quality Rating System for Nursing Homes on the Nursing Home Compare website to “give families more precise and meaningful information on quality when they consider facilities for themselves or a loved one.” More...

Medicare & Medicaid News

Patient deaths from hospital-acquired conditions reduced by 50,000

Medicare blog points to success of Affordable Care Act, Medicare’s stress on better care, HHS Partnership for Patients

By Patrick Conway, Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer (originally published February 11)

Feb. 19, 2015 - Recently, a Department of Health and Human Services report showed that an estimated 50,000 fewer patients died in hospitals and approximately $12 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013. More...

Medicare & Medicaid News

Medicare okays lung cancer screening with Low Dose Computed Tomography immediately

This is the first time that Medicare has covered lung cancer screening

Feb. 5, 2015 - Today the Centers for Medicare & Medicaid Services (CMS) issued a final national coverage determination that provides for Medicare coverage of Screening for Lung Cancer with Low Dose Computed Tomography (LDCT). The coverage - the first ever for lung cancer screening - is effective immediately. More...

Medicare & Medicaid News

Seniors with these medical conditions at high risk of falling into Medicare 'donut hole'

Researchers recommend counseling to manage drug regimens to avoid high drug cost

Feb. 2, 2015 - Among seniors, women and patients with diabetes and dementia are the most likely to fall into the Medicare Part D prescription drug plan "donut hole" - the gap occurring after beneficiaries reach their annual coverage limit and before catastrophic coverage kicks. More...

Medicare & Medicaid News

Obama Administration to move Medicare faster to payments based on quality care

To supplant fee-for-service medicine where medical providers are paid for service without regard for how the patient fares

Jan. 26, 2015 - The Obama administration Monday announced a goal of accelerating changes to Medicare so that within four years, half of the program’s traditional spending will go to doctors, hospitals and other providers that coordinate their patient care, stressing quality and frugality. More...

Medicare & Medicaid News

Moving forward on primary care transformation: The CMS Blog

Official blog for the Centers for Medicare & Medicaid Services, originally published January 23

By Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer 

Jan. 26, 2015 -Today, we at the Centers for Medicare & Medicaid Services (CMS) are excited to announce the promising findings from two large-scale tests of advanced primary care: the Comprehensive Primary Care (CPC) initiative and the Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration. More...

Medicare & Medicaid News

Medicare adds star ratings for dialysis facilities to growing list of compare sites

CMS plans adding Standardized Readmission Ratio (SRR) for dialysis facilities to reported quality outcome measures soon

Jan. 22, 2015 – Senior citizens needing the services of a dialysis facility have new help this morning in choosing the treatment that best meets their requirements. The Centers for Medicare & Medicaid Services (CMS) added star ratings to the Dialysis Facility Compare (DFC) website and updated the site with the most recent information. More...

Medicare & Medicaid News

Medicare, Medicaid leader Marilyn Tavenner resigns

Notifies her staff by email she is leaving as leader of Centers for Medicare and Medicaid Services

Jan. 19, 2015 – Marilyn Tavenner, head of the U.S. Centers for Medicare and Medicaid Services, plans to step down at the end of February, she told her staff in an e-mail, according to Bloomberg News. More...

Alzheimer's, Dementia & Mental Health

Most seniors with memory loss, dementia skip free testing from Medicare

Free dementia clinical testing now available to all senior citizens in Medicare

Dec. 17, 2014 – Alzheimer’s disease and the associated loss of memory and cognitive ability is usually found to be the top fear of senior citizens. Yet, despite clear evidence that memory and cognitive abilities are sliding down hill, the majority of seniors with these symptoms have not been to a doctor for evaluation. More...

Medicare-Medicaid News – Other Media

Half of Doctors Listed As Treating Medicaid Patients Are Unavailable, HHS Finds

U.S. health spending growth lowest since 1960, Medicare growth drops, too

Medicare spending grew 3.4% in 2013, down from 4% growth in 2012; due mostly to slower growth in enrollment, and spending changes included in Obamacare

By Mary Agnes Carey, Kaiser Health News

Dec. 3, 2014 - National health spending grew 3.6 percent in 2013, the lowest annual increase since the Centers for Medicare and Medicaid Services (CMS) began tracking the statistic in 1960, officials said Wednesday. More...

Medicare & Medicaid News

CMS Takes Another Big Step in Fighting Medicare Fraud, Abuse

CMS says new rules enhance Medicare provider oversight; strengthens beneficiary protections

Dec. 3, 2014 - New rules that strengthen oversight of Medicare providers and protect taxpayer dollars from bad actors were announced today by Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services. The new safeguards are designed to prevent physicians and other providers with unpaid debt from re-entering Medicare, remove providers with a pattern or practice of abusive billing and implement other provisions to help save more than $327 million annually. More...

Medicare & Medicaid News

Medicare Accountable Care Organizations may add emphasis on primary care services

Shared Savings Program Proposed Rule reflects focus on primary care and improved incentives for participation, quality, and efficiency

Dec. 2, 2014 – In response to suggestions from program participants, experts, consumer groups, and the stakeholder community at large, the Centers for Medicare & Medicaid Services (CMS) has proposed changes to improve the Shared Savings Program for Accountable Care Organizations (ACOs). CMS says this will put “greater emphasis on primary care services and promoting transitions to performance-based risk arrangements.” More...

Medicare & Medicaid News

Medicare wants seniors to get approval for non-emergency ambulance use

Anti-fraud program begins today in Pennsylvania, New Jersey and South Carolina

By Lisa Gillespie

Senior citizens living in three states will need prior approval from Medicare before they can get an ambulance to take them to cancer or dialysis treatments. The change, which begins today, is part of a three-year pilot to combat extraordinarily high rates of fraudulent billing by ambulance companies in Pennsylvania, New Jersey and South Carolina. More...

Medicare & Medicaid News

Senior Citizen Obesity Counseling Medicare Benefit Goes Largely Unused

Only about 120,000 seniors have participated, including about 50,000 last year

By Phil Galewitz, Kaiser Health News

Nov. 20, 2014 - Three years ago, the Obama administration offered hope to millions of overweight seniors when it announced Medicare would offer free weight-loss counseling. But less than 1 percent of Medicare’s 50 million beneficiaries have used the benefit so far. More...

Medicare & Medicaid News

Problems with Enrolling in Medicare Part B Clarified in New Report

Medicare Rights Center identifies problems, recommends ways to improve the system

Nov. 19, 2014 - The Medicare Rights Center, where staffers spend much of their time counseling senior citizens about Medicare, has released a report detailing common enrollment challenges facing people new to the Medicare program. And, the authors even contribute some thoughts on how the enrollment system can be improved. More...

Medicare & Medicaid News

Medicare Information Fails to Get Five-Star Rating from GAO

Government Accountability Office wants better consumer communications from Medicare and Health & Human Services

Nov. 19, 2014 – Before senior citizens put too much faith in the five-star ratings and tools provided by the Centers for Medicare & Medicaid Services, they should read a new report from the Government Accountability Office (GAO) that says Health & Human Services needs to see that CMS improves the information and ensures the tools address the needs of their consumers. More...

Medicare & Medicaid News

Helpful Guide to Choosing a Medicare Drug Plan May Help Meet Deadline

 Deadline for changing your Medicare plans is end of day December 7

Nov. 17, 2014 –Medicare Open Enrollment ends on December 7, 2014, and it is a safe bet that millions of senior citizens have not taken the time to carefully consider their Medicare health coverage to be sure it meets their needs at the lowest cost possible. Below is a very helpful guide provided by the Centers for Medicare & Medicaid Services that will make this challenge less difficult. More...

Medicare & Medicaid News

Medicare Enrollment Period Reminders of What You Need to Know

First, don’t get confused with open enrollment for Obamacare, which is also happening

By Mary Agnes Carey and Julie Rovner

Nov. 14, 2014 – Editor’s Note: Unfortunately, the “open enrollment” period for Obamacare – the Affordable Care Act, national health insurance program for most of those not eligible for Medicare – has been scheduled by Health and Human Services to overlap the Medicare open enrollment. Changes to Medicare advantage and the so-called Medicare prescription drug “doughnut hole” are taking center stage for senior citizens. More...

Medicare & Medicaid News

Hospice Care Achieving Its Goals with Medicare Patients: JAMA

Study finds Lower Rate of Hospitalization, ICU Admission, Invasive Procedures and Costs, plus patient and family satisfaction

Nov. 11, 2014 – Hospice care has not clearly carved out its role in healthcare, although a new study shows it is achieving the goals many envisioned - significantly lower rates of hospitalization, intensive care unit (ICU) admissions and invasive procedures at the end of life, along with significantly lower health care expenditures during the last year of life. More...

Medicare & Medicaid News

Medicare Lung Cancer Screening a Lifesaver for Seniors, Say Radiologists

CT lung cancer screening recommended for adults 55-80 with 30 pack a year smoking history, currently smoke or have quit within 15 years

Nov. 11, 2014 - New Medicare computed tomography (CT) lung cancer screening coverage provides high-risk seniors with access to care that can save more lives than any cancer screening test in history, says a news release from the American College of Radiology. More...

Medicare & Medicaid News

Medicare Dialysis Facility Compare Star Ratings Set to Debut in January

There are Star Ratings on Nursing Home Compare and Physician Compare; CMS plans applying Star Ratings to Home Health Compare and Hospital Compare in 2015

Nov. 10, 2014 - The latest addition to the “Medicare compare” websites – the Dialysis Facility Compare (DCF) Star Rating program - is expected to go live in January 2015. The Centers for Medicare & Medicaid Services (CMS) has finalized the methodology for the program and is releasing previews of ratings to individual Medicare-participating dialysis facilities for review. More...

Medicare & Medicaid News

Medicare May Need to Expand Options for Behavioral Weight Loss Counseling

Broader range of health professionals needed provide weight loss counseling for senior citizens, others in Medicare

Nov. 7, 2014 - An important addition to the “eat less, move more” strategy for weight loss lies in behavioral counseling to help achieve these goals. But research on how primary care practitioners can best provide behavioral weight loss counseling to obese Medicare patients in their practices - as encouraged by the Centers for Medicare and Medicaid Services (CMS) - remains slim. More...

Medicare & Medicaid News

Physicians, Others in Health Care Want Patients to Take More Responsibility for Their Care

‘…actions - or inaction - of patients should be considered in programs designed to improve care and patient outcomes’

By Tucker Sutherland, editor & publisher,

Nov. 3, 2014 –An interesting twist has just been made in the national effort to improve healthcare – the doctors want the patients to step up and share some the responsibility. Keep in mind that when we talk about "patients," we are primarily talking about senior citizens. And, the health care world is not just composed to health care providers and patients. The Centers for Medicare & Medicaid Services is the big kid on the block. More...

Medicare & Medicaid News

Money Retired Seniors Need to Pay for Health Care is Going Down

Medicare was not designed to cover all health care expenses; seniors have to pay deductibles for services, uninsured costs of prescription drugs

Nov. 3, 2014 – The amount of money senior citizens need to have available in retirement, just to cover health care costs, is in decline, says a new study by the nonpartisan Employee Benefit Research Institute (EBRI). The reason they found is the enhanced prescription drug coverage provided by the Patient Protection and Affordable Care Act (PPACA), often called “Obamacare.” More...

Medicare & Medicaid News

Medicare Penalty for COPD Readmissions May Penalize Teaching Hospitals

Michigan U. study hypothesizes teaching hospitals may get most penalties for treating poor and worst cases

Nov. 2, 1024 - Last month, the federal government revealed that it will fine more than 2,600 hospitals in the coming year, because too many Medicare patients treated at these hospitals are ending up back in the hospital within 30 days of going home. Two new conditions have been added in this round of penalties: elective hip and knee replacement and chronic lung disease. More...

Medicare & Medicaid News

Reduction in Medicare Payments to Home Health Agencies Proposed for 2015

CMS explains details that will save $60 million in program that cost $18 billion in 2013

Oct. 30, 2014 - The Centers for Medicare & Medicaid Services (CMS) today announced changes to the Medicare home health care prospective payment system (HH PPS) for calendar year 2015 that are expected to reduce payments to home health agencies next year by 0.30 percent, or $60 million. The program cost Medicare $18 billion in 2013. More...

Medicare & Medicaid News

Disabled Senior Citizen Wins Again Over Medicare Lawyers

She wins fight against controversial effort by Medicare to refuse care if you are not improving

Original report by Susan Jaffe, Kaiser Health News

Oct. 30, 2014 – I’ll bet lawyers for Medicare hate to walk into a courtroom and see Glenda Jimmo, 78, sitting at the plaintiff’s table. The disabled senior with serious health problems, who successfully challenged Medicare for denying her home health care coverage, has racked up another win against the government. In the latest case, Medicare refused to pay for her care because she was not improving - the same issue she won in the first lawsuit. More...

Medicare & Medicaid News

Low-Income Seniors in Medicare to See More Help in Finding Help

National Council on Aging gets funding from MIPPA Resource Center to continue assistance to low-income people

Oct. 27, 2014 – The National Council on Aging (NCOA) has been awarded a grant from the Administration for Community Living (ACL) to continue its efforts to help thousands of low-income people with Medicare to get help enrolling in programs that make their health care more affordable. More...

Senior Citizen Politics

Leading Medical Groups Urge Congress to Stop Steep Medicaid Cuts

Doctors treating Medicaid patients face big pay cut in 2015, way below pay for treating Medicare patients

Oct. 27, 2014 - Doctors representing four major physician organizations are knocking on doors in Washington today to try and preserve the current law of payment parity for primary care and immunization services under Medicaid for at least two years. The law, set to expire at the end of this year, mandates that doctors treating Medicaid patients – the poorest patients – be paid the same as what is paid doctors treating Medicare patients with the same procedure. More...

Medicare & Medicaid News

Disabled Senior Who Led Suit Against Medicare Must Try Again

Can Medicare deny coverage because you are not getting better? Even if they say they won’t? A story every senior should read

By Susan Jaffe, Kaiser Health News - This KHN story also ran in NPR’s Shots blog.

Oct. 27, 2014 - A 78-year-old Vermont mother of four who helped change Medicare coverage for millions of other seniors is still fighting to persuade the government to pay for her own care. Glenda Jimmo, who is legally blind and has a partially amputated leg due to complications from diabetes, was the lead plaintiff in a 2011 class-action lawsuit seeking to broaden Medicare’s criteria for covering physical therapy and other care delivered by skilled professionals. More...

Medicare & Medicaid News

Problems Seniors Have with Medicare Advantage Plans Highlighted

Medicare Rights Center highlights Advantage Plan denials of coverage and appeals

Oct. 21, 2014 - The Medicare Rights Center has released its first Medicare Snapshot: Stories from the Helpline, spotlighting Medicare Advantage (MA) plan denials of coverage and appeals issues as experienced by a typical caller to Medicare Rights’ national helpline. Over one-third of all callers to the helpline express difficulty managing coverage denials and appeals. More...

Medicare & Medicaid News

How to Pick a Medicare Advantage Plan: Consumer Reports

CR’s October issue has lots of tools to help with your decision and ranking of  MA plans

Oct. 21, 2014 - In the months leading up to the fall Medicare open enrollment season, your mailbox may be overflowing with sales brochures from Medicare Advantage plans. Our advice is to ignore them. There are better, unbiased ways to pick the right plan for you, according to a Consumer Reports. More...

Medicare & Medicaid News

Five Costly Mistakes Boomers Make When Enrolling in Medicare

NCOA's My Medicare Matters is designed to help seniors make smart choices; also offers help on Open Enrollment

Oct. 16, 2014 – Signing up for Medicare probably presents more options than most Baby Boomers assume before they reach age 65. With hundreds of policies to choose from, and so much information to understand, many seniors guess when choosing a policy and end up paying too much for a plan that doesn't cover what they need, according to the National Council on Aging (NCOA), which created a website to help senior citizens. More...

Medicare & Medicaid News

Seniors to Find Medicare Advantage, Drug Plans Improving as Enrollment Opens

CMS touts better quality and more variety and steady prices as Open Enrollment period begins today, runs through December 7 (Links to more news on Open Enrollment below news report)

Oct. 15, 2014 - For 2015, steadily increasing quality of plans should give seniors confidence that they have an array of quality choices at competitive prices, according to a news release today from The Centers for Medicare & Medicaid Services (CMS) reminding seniors that Medicare Open Enrollment begins today. More...

Medicare & Medicaid News

Medicare Help to Guide Your Open Enrollment Challenge

Medicare Open Enrollment – the time to make changes in your Medicare services – opens tomorrow and closes on December 7

By Tucker Sutherland, editor,


Medicare videos may help you with Open Enrollment - see links

Oct. 14, 2015 – Medicare Open Enrollment – it begins tomorrow, but for many senior citizens it is not something they eagerly anticipate each year. Not liking change just seems to be something that develops in our DNA as we become a senior. And, it is made even more distasteful knowing the whole system of choosing the right health and drug plans is designed for using a computer to go online. More...

Medicare & You Available Online or for E-Readers as Help for Open Enrollment

Printed books have been mailed but if you have not received it, or prefer electronic data convenience it is online to help seniors with Open Enrollment, which starts Wednesday

See in story what you can do during open enrollment, link to Plan Finder

Oct. 13, 2015 - As senior citizens do their research in preparation for Medicare Open Enrollment that begins on Wednesday, an important reference to use is the Medicare & You 2015 handbook, which provides information on Medicare provisions for the new year. The paper edition was mailed to all Medicare enrollees in October but if you have not received it, it is available online or as a download to your eReader or other digital devices. More...

Medicare & Medicaid News

Medicare to Cover First Stool DNA Test for Detection of Colorectal Cancer

Cologuard the first and only FDA-approved noninvasive stool DNA screening test for colorectal cancer

Oct. 10, 2014 – Exact Sciences Corp. announced yesterday that Centers for Medicare & Medicaid Services issued its final National Coverage Determination (NCD) for Cologuard, making it the first and only Food and Drug Administration (FDA) approved stool DNA test for the detection of colorectal cancer and precancer covered by Medicare. Coverage will go into effect immediately. More...

Medicare & Medicaid News

Many Medicare Outpatients Pay More at Rural Hospitals, Report Says

Medicare pays country hospitals more generously so they won’t go out of business

By Jordan Rau KHN Staff Writer

Oct. 9, 2014 - Many Medicare beneficiaries treated at primarily rural “critical access” hospitals end up paying between two and six times more for outpatient services than do patients at other hospitals, according to a report released Wednesday by the inspector general at the Department of Health and Human Services. More...

Medicare & Medicaid News

Medicare 2015 Part B Charges Remain Unchanged, Part A Deductible Up Some

Premiums, copays and deductibles for other Medicare programs for 2015 also announced

Oct. 9, 2014 – There is good news for senior citizens today – the Medicare Part B monthly premium and deductible will remain the same for 2015 as the last two years: $104.90 and $147 respectively. Most other Medicare charges will also remain stable with the exception of The Medicare Part A deductible, that beneficiaries pay when admitted to the hospital, will be $1,260 in 2015, an increase of $44 from this year's $1,216 deductible. More...

Medicare & Medicaid News

Hospice Providers Cheer New IMPACT Act Signed by President Obama

‘This new law strengthens oversight and transparency throughout the entire hospice community’

Oct. 9, 2014 - A new law, the “Improving Medicare Post-Acute Care Transformation Act of 2014” (IMPACT Act), that includes provisions creating greater oversight and increased transparency within the hospice community was signed and made official yesterday by President Obama. The National Hospice and Palliative Care Organization push for passage of this legislation and cheered the President’s final approval. More...

Medicare & Medicaid News

Physical Therapy Before Hip, Knee Replacements May Save Medicare Mega-Millions

Also good news for senior citizens, who undergo most knee, hip replacements, to endure less stress following surgery

By Tucker Sutherland, editor,

Oct. 7, 2014 – New research released today finds that postoperative care and costs could be reduced by about 30% for patients having total hip (THR) or total knee (TKR) replacement surgery, if physical therapy is administered before joint replacement surgery. It is good news for senior citizens, who have the majority of these procedures, and it makes sense considering the increasing abilities of seniors to tolerate physical exercise at increasing age levels. More...

Medicare & Medicaid News

Nine Tips for the Daunting Task of Signing Up For Medicare

Enrolling in Medicare is a ‘daunting task’ even for a consumer reporter who has written about health-insurance

By Caroline Mayer, Kaiser Health News

Oct. 7, 2015 - “Welcome to America's hottest talk line. Ladies, to talk to interesting and exciting guys free, press 1 now. Guys, hot ladies are waiting to talk to you…" Wait! I thought I was calling Social Security to ask a question about enrolling in Medicare. More...

Medicare & Medicaid News

Medicare Introduces Innovations to Improve Post-Acute Care

Nursing Home Five-Star rating expands, conditions for participation by home health agencies strengthened

Oct. 7, 2014 – Two new initiatives to improve the quality of post-acute care in Medicare were announced yesterday by the Centers for Medicare & Medicaid Services (CMS). First, the agency’s widely-used Five Star Quality Rating System for Nursing Homes will be expanded to improve consumer information about individual nursing homes’ quality. Secondly, proposed new conditions for home health agencies will modernize Medicare’s Home Health Agency Conditions of Participation to ensure safe delivery of quality care. More...

Medicare & Medicaid News

Telemarketing Scheme of Fake Medicare Callers Took Millions from Senior Citizens

Federal Trade Commission gets court to shut it down, seeks permanent shutdown, return of money

Oct. 3, 2014 – A massive fake Medicare scheme that stole millions of dollars from the bank accounts of senior citizens has been stopped by a federal court at the request of the Federal Trade Commission. The telemarketing crooks pretended to be part of Medicare to gain the confidence of the seniors. More...

Medicare & Medicaid News

Medicare Serious About Cutting Readmissions, Fines 2,610 Hospitals

Federal government’s penalties begin their third year this month

By Jordan Rau, KHN Staff Writer

Oct. 3, 2014 - Medicare is fining a record number of hospitals – 2,610 – for having too many patients return within a month for additional treatments, federal records released Wednesday show. Even though the nation’s readmission rate is dropping, Medicare’s average fines will be higher, with 39 hospitals receiving the largest penalty allowed, including the nation’s oldest hospital, Pennsylvania Hospital in Philadelphia. More..

Medicare & Medicaid News

Medicare Open Enrollment Starts October 15, Here is What We Know So Far

Premiums not expected to rise overall in 2015 - some may decline - but some plans have signaled significantly higher rates

By Michelle Andrews, Kaiser Health News

Oct. 1, 2014 - Medicare beneficiaries who want to make changes to their prescription drug plans or Medicare Advantage coverage can do so starting Oct. 15 during the Medicare's program’s annual open enrollment period. There will be somewhat fewer plans to pick from this year, but in general people will have plenty of options, experts say.

Medicare & Medicaid News

What Doctors, Hospitals Provided Free by Drug Firms, Suppliers Released by CMS

Information promotes transparency in financial relationships between health care industry, doctors and teaching hospitals

Oct. 1, 2014 – For the first time, consumers have information on consulting fees, research grants, travel reimbursements, and other gifts the health care industry – such as medical device manufacturers and pharmaceutical companies – provided to physicians and teaching hospitals. The information was released yesterday by the Centers for Medicare & Medicaid Services (CMS) for the last five months of 2013. It meets a requirement of the Affordable Care Act (Obamacare) to help consumers understand the financial relationships between the health care industry, and physicians and teaching hospitals.

Seniors are 90% of Flu Deaths; Just 65% Get Free Medicare Vaccinations

Actions those senior citizens 65 and older need to take this flu season with links to lots of information - CDC says get shot by October

Sept. 28, 2014 – There is a reason that senior citizens are the focus of attention when flu season approaches - 90 percent of seasonal flu-related deaths and between 50 and 60 percent of seasonal flu-related hospitalizations in the U.S. occur in people 65 years and older, according to government estimates. Knowing these numbers and that Medicare provides free flu shots, it should be easy to convince seniors to get vaccinated.

Medicare & Medicaid News

Several Doctors, Others Indicted in $56 Million Medicare Fraud

Operated companies in New Orleans area that purported to offer home health services and durable medical equipment to Medicare beneficiaries

Sept. 26, 2014 - A New Orleans grand jury yesterday indicted seven defendants, including three doctors for their roles in a $56 million Medicare fraud scheme that operated home health services and durable medical equipment services in New Orleans and surrounding communities.  Thirteen defendants have now been charged in this case, three of whom pleaded guilty to their conduct Wednesday. 

Medicare & Medicaid News

Better Understand the Criminal Risk of Using Copay Coupons in Medicare

Health and Human Services officials provide a layman’s view of how anti-kick-back law impacts senior citizens, Medicare and taxpayers

Sept. 24, 2014 – The news yesterday that senior citizens run the risk of criminal prosecution for using copay coupons to purchase brand name prescription drugs in the Medicare Part D drug program is a unique occurrence that caused concern among seniors, who most often are the least likely U.S. citizens to break the law. A better understanding of this situation and the reason for this kick-back law has been provided by the Office of Inspector General of Department of Health and Human Services and its Office of Evaluation and Inspections.

Medicare & Medicaid News

Most Want a Year of Nursing Home and Dental Coverage Added to Medicare

How to fix Medicare? Kaiser Health News asked the public

Sept. 23, 2014 – A mini-survey by Mary Agnes Carey of Capsules, the Kaiser Health News Blog, indicates that a vast majority of Americans, when asked about changes they would like to see in Medicare, want the program to add dental coverage and, secondly, a year of nursing home care.

Medicare & Medicaid News

Think Medicare Pay Rate for Doctors Favors Surgeons?

Surprising study still does not explain why proceduralists and surgeons earn much more money than primary doctors

Sept. 22, 2014 - A surprising new study pulls back the curtain on one of the most contentious issues in health care: differences in payment by Medicare and income between physicians who perform operations, procedures or tests, and those who don't.

Senior Citizen Alerts

Senior Citizens May Break Federal Law Using Drug Copay Coupons in Medicare

These discount coupons used in drug program for a specific brand name drug are considered kick-back and federal crime

By Tucker Sutherland, editor, SeniorJournal

Sept. 22, 2014 – Maybe it is much-to-do-about-nothing, but a warning – actually a “Special Advisory Bulletin” – has been issued by the Office of the Inspector General for Health and Human Services warning senior citizens not to use discount coupons from pharmaceutical manufacturers for a specific brand name drug in the Medicare Part D drug program. It is considered a kick-back and a federal offense.

Medicare & Medicaid News

Drug Manufacturers Must Reform Marketing to Avoid Hurting Medicare

Current practice of ‘copay coupon’ damages Medicare Part D, can make seniors criminals

Sept. 22, 2014 – In response to the warning for senior citizens not to use brand name drug discount coupons in the Medicare Part D program, the president of the association for pharmacy benefit managers said the pharmacy manufacturers must “assure regulators that copay coupons don't induce demand for brand drugs and increase costs in public programs like Medicare.”

Caregiver & Elder Care News

National Group Reduces Antipsychotic Drug Use in Nursing Homes, Sets New Goals

National Partnership, including CMS, seeks to optimize the quality of life in America’s nursing homes by improving care for all residents, especially those with dementia

September 19, 2014 – After two years of success in reducing the use of antipsychotic medications by patients in long-stay nursing home care, the National Partnership to Improve Dementia Care today established a new national goal of reducing the use by 25 percent by the end of 2015, and 30 percent by the end of 2016. The public-private coalition includes the Centers for Medicare & Medicaid Services (CMS), consumers, advocacy organizations, providers and professional associations.

Medicare & Medicaid News

Most and Least Expensive Medicare Drug, Advantage Plans Identified for 2015

With Medicare Open Enrollment beginning on October 15, free website presents an analysis of advantage and drug plans

September 19, 2014 - HealthPocket, a website that compares and ranks all health insurance plans analyzed the release of 2015 Medicare insurance data and has a slightly different conclusion on the cost of Medicare Advantage plans than does the Centers for Medicare and Medicaid Services. CMS sees the average premium for 2015 as $32.26, while HealthPocket sees $62.69. They may both be right. They do agree the increase in cost for the 2015 plans is very small.

Medicare & Medicaid News

Medicare Advantage Plans Growing, Small Premium Increases for 2015

Seniors will see wide range of Medicare health, drug plans when enrollment opens October 15, says CMS

September 19, 2014 - More people with Medicare will have access to higher quality Medicare Advantage (MA) plans, and for the fifth straight year, enrollment is projected to increase to a new all-time high, while premiums remain “affordable,” according to the Centers for Medicare & Medicaid Services (CMS). Open enrollment begins October 15.

Other Media Reports

Generic Drugs Produce Better Health Results for Senior Citizens

September 18, 2014 - Researchers studied the health records of more than 90,000 Medicare patients and found the lower out of pocket cost for generic drugs improve therapy and clinical outcomes. The mean co-pay was $10 for generic statins and $48 for the brand names. See video at MedlinePlus

Keeping Seniors on Medicare Out of Emergency Room Goal of New Program

September 18, 2014 - An emergency room decision-support program can significantly reduce emergency room visits and hospital admissions among senior citizens on Medicare. This could have important economic implications, helping to reduce the nearly 33 percent of avoidable emergency room visits that contribute to about $18 billion in unnecessary healthcare costs each year.

CMS Prepares for Open Enrollment for Marketplace Consumers

Trying to clarify data matching issues – This does not apply to Medicare

Sept. 16, 2014 -This announcement by the Centers for Medicare & Medicaid Services (CMS) does not apply to those on Medicare. It is for those enrolled in health plans through the Marketplace. It is part of the preparation for their “Open Enrollment,” which begins November. Seniors should not confuse it with the “Open Enrollment for Medicare, which begins October 15. More information at CMS.

Medicare & Medicaid News

Confusion about Medicare and Marketplace Cleared up by CMS Q&A

Many seniors will be surprised by this Q&A about Medicare and the Marketplace of the Affordable Care Art

Aug. 26, 2014 - There has often been confusion for many senior citizens between Medicare and the Health Insurance Marketplace - the health insurance program for U.S. citizens who have not reached the age of Medicare eligibility, which is normally age 65. Now, the Centers for Medicare & Medicaid Services, which also runs the Marketplace, is offering some help. It has issued a Q&A on the most frequent questions asked about Medicare and the Marketplace. More...

Medicare & Medicaid News

New Executives Named as CMS Prepares for 2015 Open Enrollment for Marketplace

Open Enrollment for Health Insurance Market place will be November 15, 2014 to February 15, 2015; coverage can start as early as January 1, 2015

Aug. 26, 2014 – A new Marketplace Chief Executive Officer (CEO), Kevin Counihan, will join the Centers for Medicare & Medicaid Services (CMS), and Lori Lodes has been named the new Director of Communications for CMS. The announcement was made by Health and Human Services Secretary Syliva M. Burwell, who is about have her first turn at steering the Health Insurance Marketplace through an open enrollment period. More...

Medicare & Medicaid News

Government Streamlining Medicare Coverage For Cancer Test

In a clinical trial, Colorguard detected 92 percent of colorectal cancers and 42 percent of advanced adenomas, large polyps that are more likely than small polyps to lead to cancer.

By Michelle Andrews, Insuring Your Health

Aug. 19, 2014 - Medicare beneficiaries may get speedier coverage for a newly approved screening test for colorectal cancer under a pilot project in which two federal agencies reviewed the product at the same time instead of one after the other. More...

Medicare & Medicaid

FDA Approves First Non-Invasive DNA Screening Test for Colorectal Cancer

Collaboration with Centers for Medicare & Medicaid Services contributed to proposed Medicare coverage for Cologuard

Cologuard vs Fecal Immunochemical Test (FIT)

Cologuard detected 92% of colorectal cancers, 42% of advanced adenomas.

FIT screening  detected 74% of cancers, 24% of advanced adenomas.

Aug. 19, 2014 - The U.S. Food and Drug Administration on August 11 approved Cologuard, the first stool-based colorectal screening test that detects the presence of red blood cells and DNA mutations that may indicate the presence of certain kinds of abnormal growths that may be cancers such as colon cancer or precursors to cancer. More...

Medicare & Medicaid News

Some States, Seniors Bristle at Lack of Authority Over Medicare Advantage Plans

Medicare pays private health plans - an alternative to traditional Medicare - set monthly rate per patient: about 16 million have signed up, almost one third of elderly, disabled eligible for Medicare

By Fred Schulte, The Center for Public Integrity

Humana hit him with a bill for $6,461.66, claiming the surgery was not covered because the hospital was “out of network.”

Aug. 19, 2014 - When Minnesota retiree Doug Morphew needed surgery last year, he expected his Humana Medicare Advantage plan to step up and pay the lion’s share of the bill. Morphew said the health plan had told him over the phone he would owe just $450 for the two days he spent in a St. Paul hospital recovering from the operation to repair an aortic aneurysm. Less than a month later, however, Humana hit him with a bill for $6,461.66... More...

Caregiver & Elder Care News

One of Five Medicare Hospice Patients Discharged Alive – Is It to Save Money

Live discharge rates differ between hospice programs; when should those rates raise red flags among issues explored

Aug. 13, 2014 - About 1 in 5 Medicare patients is discharged from hospice care alive, whether due to patients' informed choice, a change in their condition, or inappropriate actions by the hospice to save on hospitalization costs related to terminal illness. More...

Medicare & Medicaid News

Medicare Advantage Plans Exaggerate Diseases of Senior Citizens to Make More Money

Suspect billing practices have been common across much of the Medicare Advantage industry and are likely to get worse unless officials crack down

By Fred Schulte, The Center for Public Integrity

Aug. 8, 2014 - Many Medicare Advantage health plans routinely overbill the government for treating elderly patients - and have done it for years, a federal study shows. More...

Medicare & Medicaid News

Medicare Spending Cuts Also Reducing Healthcare Spending for Younger People

Medicare by far the largest payer of hospital bills in U.S., accounting for about 30% of total hospital revenues

Aug. 6, 2114 – The increased efforts by Medicare to reduce costs and improve the medical care for senior citizens and the disabled, mandated by prices under the Obamacare, appears to be reducing the total overall hospital spending. Even younger patients and insurance companies are gaining the benefits. More...

Medicare & Medicaid News

More Inspections of Medicare Hospice Programs Demanded by New House Bill

National Hospice and Palliative Care Organization backs bi-partisan bill

Aug. 5, 2014 – Just before the House of Representatives slammed the door shut to go on their August recess, a bi-partisan bill was introduced that will require “more timely” surveys of Medicare-certified hospice care programs, according to the National Hospice and Palliative Care Organization (NHPCO). More...

Medicare & Medicaid News

Medicare Rule on Hospital Pay Wants Charges Public, Emphasis on Better Care

Rule updates Medicare payment policies and rates for inpatient stays at general acute care, long-term care hospitals

Aug. 4, 2014 – A final rule that updates Medicare payment policies and rates for inpatient stays at general acute and long-term care hospitals (LTCHs) for FY 2015 was issued today. The provision that will grab the attention of seniors supports price transparency by emphasizing the Obamacare requirement that hospitals most make their charges available to patients and the public. Hospital administrators may pay more attention, however, to mandated improvements in the quality of care that limit payment for hospital acquired conditions (HACs) and readmissions. More...

Medicare & Medicaid News

Patient-Centered Medical Homes Reduce Costs for Medicare Patients

Medicare costs for patients receiving care from PCMHs grew slower than for other Medicare patients, rates for emergency room visits, acute care hospitalizations lower, too

By Stephanie Stephens, HBNS Contributing Writer

Learn more about PCMH care below news report. See video, too.

Aug. 1, 2014 - The patient-centered medical home (PCMH), introduced in 2007, is a model of health care that emphasizes personal relationships, team delivery of care, coordination across specialties and care settings, quality and safety improvement, and open access. As the number of PCMHs has increased, a new report in the journal Health Services Research finds the model offers a promising option to reduce health care costs and utilization of some health care services. More...

Medicare & Medicaid News

Medicare Drug Plan Premiums Up $1 Next Year, More Reports on Low Medicare Costs

Unprecedented low levels of growth in Medicare spending, continued savings for seniors citizens

Aug. 1, 2014 - The average premium for a basic Medicare Part D prescription drug plan in 2015 will increase by about $1, to an estimated $32 per month, continuing its historically low growth rate. This projection by the Centers for Medicare & Medicaid Services (CMS) comes on the heels of the 49th anniversary of the signing of Medicare and Medicaid into law. More...

Medicare & Medicaid News

Medicare Celebrates 49th Birthday Today

Links below the news report to information, images, recordings on history of the program that are kept by Social Security and Medicare

July 30, 2014 - It was forty-nine years ago that President Lyndon B. Johnson went to the Truman Library in Independence, Missouri to have the former president, Harry Truman, join him for the signing of the bill establishing Medicare, or as the record shows then, the “Supplementary Medical Insurance Program Under the Social Security Act.” The information and downloads below report or from Social Security and Medicare. More...

Caregiver & Elder Care News

Medicare Experiment Could Signal Sea Change for Hospice Care

What is hospice care? How does it differ from palliative care? And. curative care? Being changes in care for oldest and sickest Americans

By Michelle Andrews, KHN Writer

July 30, 2014 - Diane Meier is the director of the Center to Advance Palliative Care, a national organization that aims to increase the number of palliative care programs in hospitals and elsewhere for patients with serious illnesses. Meier is also a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City. We spoke about a recently launched pilot program under the health law that allows hospice patients participating in the pilot to continue to receive life-prolonging treatment. More...

Medicare & Medicaid News

Obamacare Helping Medicare Fight Fraud in Several States

CMS extends moratoria for enrolling ground ambulance suppliers, home health agencies in targeted high risk areas; regular service uninterrupted

July 30, 2014 – Obamacare is coming in handy for the Centers for Medicare & Medicaid Services (CMS) again, but this time it is in the unusual area of helping the agency fight fraud, waste, or abuse. CMS announced yesterday it is extending its enrollment moratoria on new grand ambulances in the Houston and Philadelphia metropolitan areas and new home health agencies in the metropolitan areas of Chicago, Fort Lauderdale, Detroit, Dallas, Houston, and Miami. More...

Medicare & Medicaid News

Senior Citizens, Medicare Reaping Big Benefits from Obamacare, $11.5 Billion Saved on Drugs

New report says per capita Medicare spending growth averaged 2% over 2009 – 2012, and nearly 0% in 2013

July 29, 2014 - More than 8.2 senior citizens and people with disabilities covered by Medicare have saved $11.5 billion since 2010 as a result of the Affordable Care Act, according to data released by the Department of Health and Human Services. Obamacare was just yesterday credited with extending the life of Medicare benefits. This news also comes on the heels of continued historic low levels of growth in Medicare spending. More...

Medicare & Medicaid News

Medicare’s Hospital Trust Fund Flush Until 2030: Good News for Boomers, Seniors

News not so good on Social Security: projected to run out of disability benefit money in 2016, just two years from now, unless Congress intervenes

By Julie Rovner, KNH Staff Writer

July 28, 2014 - Medicare’s Hospital Insurance Trust Fund, which finances about half the health program for seniors and the disabled, won’t run out of money until 2030, the program’s trustees said Monday. That’s four years later than projected last year and 13 years later than projected the year before the passage of the Affordable Care Act. More...

Medicare & Medicaid News

HHS Funds to Enhance Ability of States to Improve Medicaid Reform

HHS also announces $11 Million to integrate HIV services in Community Health Centers

July 15, 2014 - A new collaboration with states to improve care for Medicaid beneficiaries by accelerating efforts in reforming their health care systems to improve health and care, while also reducing costs, was announced yesterday by Health and Human Services Secretary Sylvia M. Burwell, who called the program “innovative.” More...

Medicare & Medicaid News

New Health Care Innovation Awards Announced for Better Health Care, Lower Costs

Centers for Medicare & Medicaid Innovation Center to invest $360 million

July 10, 2014 – Health Care Innovation Awards expected to total as much as $360 million to deliver better health care at lower costs were announced yesterday by Health and Human Services Secretary Sylvia Mathews Burwell. Seven awards from the Centers of Medicare and Medicaid Services’ Innovation Center will focus on improving care for frail elderly patients or providing support for aging in the community and most of the other endeavors will also benefit seniors. More...

Medicare & Medicaid News

HHS to Add 150 New Health Centers for High Need Communities Across U.S.

Affordable Care Act funds $100 million to expand primary care in 2015 in health centers

July 8, 2014 – An estimated 150 new health centers serving communities in need will be built across the country in 2015, thanks to a $100 million in funding from the Affordable Care Act. The new health center sites will increase access to comprehensive, affordable, high quality primary health care services in the communities that need it most, according an announcement today by HHS Secretary Sylvia Mathews Burwell. More...

Medicare & Medicaid News

Medicare Costs for Breast Cancer Screenings Skyrocket, But Do Patients Benefit?

While U.S. Preventive Services does not recommend breast cancer screening for senior women 75 and older, Medicare still spent an increasing amount on this age group

By Karen N. Peart, Yale University

July 3, 2014 - Breast cancer screening costs for Medicare patients skyrocketed between 2001 and 2009, while the number of screening mammograms performed remained stable. What makes this even worse is that the increased cost did not lead to earlier detection of new breast cancer cases, says a new study by Yale School of Medicine researchers. More...

Medicare & Medicaid News

Medicare to Help Seniors Choose Health Care Providers with Five-Star Ratings on ‘Compare’ Sites

5-Star grade being added to Hospital Compare, Dialysis Facility Compare, Home Health Compare says Medicare Blog, says Medicare Blog

By Dr. Patrick Conway,
CMS Deputy Administrator for Innovation and Quality,  Chief Medical Officer

June 27, 2014 - When buying a product or service, looking at ratings can often help narrow down the choices. Some websites offer “star” ratings that give information about the quality of the products and services they offer. Wouldn’t it be helpful to have the same kind of ratings when choosing a health care provider?

Medicare & Medicaid News

Kentucky Clinic Charged with Selling Improper Chemo Drugs, False Medicare Claims

Charged with false claims to Medicare program for misbranded, unapproved chemotherapy drugs; drugs came from Turkey and India through Canada

June 26, 2014 – The FDA’s Office of Criminal Investigations announced today that an oncology center in Kentucky has pleaded guilty to selling unapproved and improperly labeled chemotherapy drugs. The charges included submitting false claims to the Medicare program for misbranded, unapproved chemotherapy drugs administered through the clinic. The successful investigation also serves as a warning to seniors – the most frequent patients at oncology centers...

Medicare & Medicaid News

Medicare Fraud Prevention System Finds $210 Million in Improper Payments in Second Year

CMS took action against 938 providers and suppliers, says report sent to Congress today; anti-fraud strategy recovered $19.2 billion in last five years

June 25, 2014 – The Centers for Medicare & Medicaid Services announced today that its “state state-of-the-art Fraud Prevention System” discovered or prevented more than $210 million in improper Medicare fee-for-service payments, nearly double the identified savings of $115.4 million achieved during the first year of the program. It also resulted in CMS taking action against 938 providers and suppliers, according to a report sent to Congress today.

Medicare & Medicaid News

Over 750 Hospitals Face Medicare Crackdown on Patient Injuries

The biggest impact may be on the nation’s major teaching hospitals: 54 percent were marked for preliminary penalties; CDC estimates 75.000 died in 2011 from infections picked up in hospitals

By Jordan Rau, KHN Staff Writer

June 24, 2014 - During a hernia operation, Dorothea Handron’s surgeon unknowingly pierced her bowel. It took five days for doctors to determine she had an infection. By the time they operated on her again, she was so weakened that she was placed in a medically induced coma at Vidant Medical Center in Greenville, North Carolina.

Medicare & Medicaid News

Insurance Industry, Consumers Join Forces to Fight High Prices of Specialty Drugs

Crisis makes for strange bed fellows – insurance companies, consumer advocates; cost sharing for some with chronic diseases like cancer is over 40 percent in exchange plans, puts pressure on Medicare drug plans

By Lisa Gillespie, Kaiser Health News

June 13, 2014 - Here’s the next salvo in the back and forth between insurers and the drug industry over drug prices: the Pharmaceutical Research and Manufacturers of America are pushing the Department of Health and Human Services to take action to protect consumers who have gained insurance via the health law’s online marketplaces from high, out-of-pocket costs for specialty drugs. Read more...

Medicare & Medicaid News

CMS Announces $60 Million Budget to Hire Health Care Navigators for 2015

Navigator program will continue to help consumers understand health coverage options as they enroll in coverage

June 10, 2014 – The Centers for Medicare and Medicaid Services is looking for Navigators to provide unbiased information to consumers about health insurance and public programs and it has $60 million in funding to attract them. The primary program involved in the Navigator program that effects seniors is Medicaid. Read more...

Medicare & Medicaid News

Medicare Releases First Update of Hospital Charge Data; FDA Makes Health Datasets Available

Data can help improve care coordination and health outcomes for Medicare patients; the Food and Drug Administration will also introduce a new open data initiative at Datapalooza

June 3, 2014 – The first annual update to the Medicare hospital charge data - information comparing the average amount a hospital bills for services that may be provided in connection with a similar inpatient stay or outpatient visit – is being released today by the Centers for Medicare & Medicaid Services. CMS is also releasing a suite of other data products and tools aimed to increase transparency about Medicare payments. Read more...

Medicare and Medicaid News

Medicare Can Save Quick $5 Billion by Better Part D Choice for Low-Income Seniors

Researchers find simple way to strengthen Medicare drug program for low-income seniors and save government billions of dollars

June 3, 2014 – A $5 billion dollar savings for Medicare in the first year of making a simple and logical policy change sounds great to most seniors who worry about the financial pressure on their health care insurance program. Well, it’s possible, according to a new study that suggests changing the way Part D plans are selected for low-income beneficiaries eligible for a government subsidy. Read more...

Medicare and Medicaid News

Shopping for Long-Term Care Insurance - Tough Money Decision for Seniors

Many seniors don't realize long-term care is not a regular service of Medicare

By Steve Tripoli, NPR News, NPR’s Shots blog.

May 29, 2014 - One of the toughest money decisions Americans face as they age is whether to buy long-term care insurance. Many people don't realize that Medicare usually doesn't cover long-term care, yet lengthy assisted-living or nursing home stays can decimate even the best-laid retirement plan. Read more...

New Regulations for Medicare Advantage, Prescription Drug Plan Target Fraud and Abuse

Tightens up drug prescribing, clears release of more Part D data, expands health improvement incentives

May 20, 2014 – New regulations for Medicare Advantage and the Part D prescription drug benefit were issue yesterday by the Centers for Medicare & Medicaid Services (CMS) that the agency says will continue efforts to curb fraud and abuse and improve benefits and the quality of care for seniors and the disabled enrolled in these programs. CMS also noted it is projected to save an estimated $1.615 billion over the next ten years 2015 – 2024. Read more...

Health & Medicine for Senior Citizens

Brief 15-Minute Visits Take a Toll on the Doctor-Patient Relationship

Patients and physicians say they feel the time crunch as never before as doctors rush through appointments as if on roller skates

By Roni Caryn Rabin, KHN
This KHN story was produced in collaboration with USA TODAY

April 21, 2014 - Joan Eisenstodt didn’t have a stopwatch when she went to see an ear-nose-and-throat specialist recently, but she is certain the physician was not in the exam room with her for more than three or four minutes. Read more...

Medicare & Medicaid News

Quality Data on Inpatient Psychiatric Facilities Now Available to Seniors on Hospital Compare

Centers for Medicare & Medicaid Services continues to expand more information for seniors to help choose best medical care

April 18, 2014 – Quality measures from inpatient psychiatric facilities will be publicly reported on Hospital Compare, a consumer-oriented website that provides information on the quality of care hospitals are providing to their patients, according to a news release yesterday by the Centers for Medicare & Medicaid Services (CMS). Read more...

Senior Citizen Politics

Kansas Governor Asked to Veto Bill Putting State in Charge of Medicare, Medicaid, Their Federal Funds

Wichita Eagle tries to stop this effort it calls a “real and present danger”

April 10, 2014 – Many of America’s senior citizens may not be aware of the threat posed to Medicare and senior health benefits covered by Medicaid and the Affordable Care Are. Much of the attack is happening in states and is below the radar of national media. Actions by Republicans in Kansas provide a clear picture of the danger, as explained in an editorial that appeared this week in the Wichita Eagle. Read more...

Medicare & Medicaid News

Medicare Records on 880,000 Health Care Providers Now Available for Online Download

Gives consumers unprecedented transparency on the medical services physicians provide and how much they are paid

April 9, 2014 – There is a lot more – a whole lot more, actually – information available today to Medicare beneficiaries who want detailed information on 880,000 distinct health care providers who received $77 billion in Medicare payments in 2012, under the Medicare Part B Fee-For-Service program. Read

Medicare & Medicaid News

Anticipated Cut in Medicare Advantage Plan Payments Becomes Marginal Increase by CMS

Health insurance lobby had fought hard to avoid the cut, wanted payments to remain the same

April 7, 2014 - The highly anticipated change for 2015 to the rate paid to private Medicare Advantage Plans was announced today and it has to be viewed as a win for the health insurance lobby. The proposed rate reduction of 1.9 percent proposed in February by the Centers for Medicare and Medicaid Services became a marginal increase of .04 percent for next year. Read more...

Medicare and Medicaid News

Decoding the High-Stakes Debate Over Medicare Advantage Cuts

Final 2015 Medicare Advantage rates are expected to be released Monday

By Jay Hancock, KHN Staff Writer

April 7, 2014 - Health insurers often try to influence Washington through quiet persuasion in plush offices. To fight potential government cuts for private Medicare plans, however, they’ve hit the streets. The Obama administration has proposed reducing what insurers collect for Medicare Advantage plans - HMOs and PPOs, mainly - that cover about 15 million seniors. (Regular Medicare, which still covers most seniors, pays doctors and hospitals directly.) Read more...

Medicare & Medicaid News

Medicare Physician Quality Reporting, Use of Electronic Prescribing Show Increases

New report issued today compares participation in 2011 and 2012

April 3, 2014 – Two key programs aimed at improving service to seniors and the disabled in Medicare have shown significant increases, according to the Centers for Medicare & Medicaid Services (CMS). This report, however, just includes data on the increase from 2011 to 2012 in the systems – the Physician Quality Reporting System and Electronic Prescribing (eRx). Read more...

Senior Citizen Politics

Congress Retreats to Temporary Fix to Medicare Doc Payments for 17th Time

"The American Medical Association is extremely disappointed in today's House action to give up on SGR repeal...

Mary Agnes Carey, KHN, and Emily Ehtridge, CQ Roll Call, explain the drama in Health on the Hill

March 28, 2014 - For the 17th time, Congress is on the verge of approving yet another temporary fix to the Medicare physician payment formula, according to Mary Agnes Carey, Kaiser Health News. “Known as the Sustainable Growth Rate, or the SGR, the formula has repeatedly called for cuts in Medicare physician payments, but every time that deadline comes up, Congress comes through with yet another sort term patch,” she says. Read more...

Medicare and Medicaid News

CMS Rules Would Help Protect Seniors When Medicare Advantage Plans Drop Doctors

Proposals follow UnitedHealthcare's decision to drop thousands of doctors from its Medicare Advantage plans

By Susan Jaffe, KHN

This KHN story was produced in collaboration with The Washington Post

March 24, 2014 - Federal officials are considering new Medicare Advantage rules to help protect seniors when insurers make significant reductions to their networks of doctors and other health care providers. The proposals follow UnitedHealthcare's decision to drop thousands of doctors from its Medicare Advantage plans in at least 10 states last fall. Read more...

Medicare & Medicaid News

Hospital Compare Has Lots of Info, Too Similar to Make Easy Decisions

Hospitals nationwide have achieved 98% compliance with reporting data, likely represents a substantial improvement in systems and safety

By Stephanie Stephens, HBNS Contributing Writer

March 22, 2014 - There is good news and not-so-good news about Medicare’s Hospital Compare website, designed to help patients choose hospitals with the best quality rating matching their need. The good news is that an amazing 98 percent of hospitals are participating. On the downside, however, patients can’t distinguish the quality of performance of one hospital from another. Read more...

Medicare & Medicaid News

Medicare, Medicaid Patients Can Receive Palliative Care While Still in Treatment as Test Program

Test program authorized by Obamacare to measure if seniors with deadly illness will choose hospice and curative care

March 20, 2014 - Medicare and Medicaid patients will be allowed to continue receiving medical care for their ailment, while at the same time receiving access to palliative care, in a new initiative that began Tuesday. The Medicare Care Choices Model will test improvements to certain beneficiaries’ quality of life while they are receiving both curative and palliative care, according to information from the Centers for Medicare & Medicaid Services. Read more...

Health & Medicine for Senior Citizens

Colon Cancer Rate Takes Big Drop, Particularly for Senior Citizens

Larger declines among Medicare-eligible seniors likely reflect higher rates of screening because of universal insurance coverage

March 17, 2014–Colon cancer incidence rates have dropped 30 percent in the U.S. in the last 10 years among adults 50 and older due to the widespread uptake of colonoscopy, with the largest decrease being in senior citizens over age 65. Colonoscopy use has almost tripled among adults ages 50 to 75, from 19 percent in 2000 to 55 percent in 2010. Read more...

Medicare and Medicaid News

Can Congress Put an End to Annual Medicare Physician Payment Ritual?

“What isn’t fair, given that we have been dealing with this for more than a decade, is the constant uncertainty and wrangling,” AARP spokesman

By Susan Jaffe, Capsules, The KHN Blog
This story comes from our partner NPR's Shots blog.

March 17, 2014 - Congress is still searching for money to avoid a 24 percent cut in pay for doctors who treat Medicare patients. But seniors are already paying their share of the cost in premiums, as if the pay cut — scheduled to kick in on April 1 — won’t happen. Read more...

Medicare & Medicaid News

Medical and Patient Groups Call for Medicare Coverage of CT Lung Cancer Screening

Lung cancer kills more people each year than breast, colon and prostate cancers combined

March 13, 2014 - Last December, the United States Preventive Services Task Force (USPSTF) recommended screening of adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Today a large number of medical and patient groups called on the Centers for Medicare & Medicaid Services (CMS) to provide Medicare coverage of low-dose computed tomography (LDCT) screening for patients defined in the USPSTF recommendations and others found to be at high-risk of lung cancer. Read more...

Medicare and Medicaid News

Medicare Officials Back Away From Changes to Prescription Drug Plan

By Mary Agnes Carey, Kaiser Health News,
Capsules: The KHN Blog

March 10, 2014 - Facing heavy bipartisan opposition on Capitol Hill as well as from patient groups, businesses, insurers and others, the Centers for Medicare & Medicaid Services said Monday it did not plan to move ahead “at this time” with several proposed changes to the Medicare prescription drug program. Read more...

Medicare and Medicaid News

How Proposed Medicare Part D Changes Are Playing On Capitol Hill

Many considered this a program that didn’t need fixing, Medicare says they want to make it better but there is opposition – see video in story

March 7, 2014 - Officials at the Centers for Medicare & Medicaid Services are proposing to remove some drugs from Medicare’s prescription drug plans and limit how many plans insurers can offer. Mary Agnes Carey, Kaiser Health News, and CQ Roll Call’s Emily Ethridge discuss on this video. Text and an audio link are below. Read more...

Medicare and Medicaid News

Administration Faces Opposition To Changes In Medicare Prescription Drug Program

Officials say they want to help beneficiaries make good choices and save taxpayers money

By Mary Agnes Carey, KHN Staff Writer

March 7, 2014 - Medicare’s prescription drug program was controversial when it arrived, but a decade later it is widely considered to be a Washington success story. Now, though, the Obama administration is proposing a series of significant changes to fix what critics say isn’t broken. Read more...

Medicare & Medicaid News

Medicare Reports One Third of Skilled Nursing Patients Harmed in Treatment; Most Preventable

Medicare’s inspector general of skilled nursing facilities reports nearly 22,000 patients were injured and more than 1,500 died in a single month - a higher rate of medical errors than hospitals.

By Marshall Allen, ProPublica

March 4, 2014 - One-in-three patients in skilled nursing facilities suffered a medication error, infection or some other type of harm related to their treatment, according to a government report released today that underscores the widespread nature of the country’s patient harm problem. Read more...

Medicare and Medicaid News

Impact Of Medicare Advantage Cuts On Seniors Sharply Disputed

Several changes in Medicare for 2015 were announced on Friday by Centers for Medicare & Medicaid Services but headlights are on cuts in funding to MA plans

By Phil Galewitz, KHN Staff Writer

Feb. 24, 2014 - Seniors enrolled in Aetna’s Medicare Advantage plan In Baltimore County, Md., saw their monthly premiums rise from $33 to $51 this year. Enrollees in HealthNow New York, a Medicare HMO in upstate Erie County, saw their premiums jump from zero to $28 a month. The health insurance industry points to these examples as some of the more extreme cases of beneficiaries feeling the sting of federal funding cuts to Medicare Advantage plans that cover nearly 16 million senior citizens. Read more...

Medicare and Medicaid News

Obama Administration Proposes 1.9 Percent Cut in Medicare Advantage Payments

News release by Centers for Medicare & Medicaid Services on several changes for 2015 is published below this news report

By Mary Agnes Carey, KHN Staff Writer

Feb. 24, 2014 - An Obama administration announcement about payment rates for Medicare Advantage plans in 2015 has set off a dispute about how large – or small – the changes really are. Late Friday, the Centers for Medicare & Medicaid Services announced proposed rates that officials said could mean payment reductions of 1.9 percent for the private plans in the program. Read more...

Medicare & Medicaid News

Quality Ratings Added to Physician Compare Website for Medicare, Medicaid Patients

Diabetes and heart disease measures among new quality ratings

Feb. 24, 2014 - The Physician Compare website designed to help Medicare and Medicaid patients make informed choices in finding physicians and other health are professionals, has been enhanced by the addition of quality measures to indicate the performance achieved by hundreds of thousands of these care providers in treating specific conditions. Read more...

Medicare & Medicaid: Marci's Q&A

Medicare Adds New Mental Health Coverage in 2014, Explains Marci’s Medicare Answers

Marci’s February Q&A also has solutions for seniors with new Medicare drug plans in 2014

Feb. 13, 2014 – There is new coverage from Medicare in 2014 for outpatient mental health visits that Marci explains in this February issue of Marci’s Medicare Answers.  Another senior writes in who joined a new Medicare prescription drug plan, only to find a prescription he needs is not covered. Marci has good news on this one, too. Read more...

Medicare & Medicaid News

Last Chance to Disenroll from Medicare Advantage Plan is Valentine’s Day

Special disenrollment period ends but seniors should have details before they cancel

Feb. 13, 2014 - Medicare beneficiaries who are dissatisfied with their Medicare Advantage (Medicare private health) plans, have until Friday, February 14, to disenroll. Beneficiaries have had the opportunity to drop their private plan and enroll in Original Medicare since January 1, when the Medicare Advantage Disenrollment Period (MADP) began, according to the Medicare Rights Center. Read more...

Caregiver & Elder Care News

Seniors Moved from Nursing Homes to Home, Community Care Suffer More Hospitalizations

Long-term care at home meets desires of older patients and can save Medicaid money

Feb. 12, 2014 – What looks like a “win-win” for everyone – senior citizens and the Centers for Medicare & Medicaid Services – is not turning out that way, according to a new study in the online Journal of the American Geriatrics Society. The seniors want to age at home, rather than in nursing homes, which can save money for Medicaid. The problem the study found was that as these older people eligible for Medicaid and Medicare were moved  into community care there was a 40 percent greater risk of "potentially preventable" hospitalizations. Read more...

Medicare & Medicaid News

Readmission Rates Lowest for Medicare Rehab Patients With Lower Joints Replaced

Most likely to be back into rehab within 30 days are those being treated for being weak or feeble says JAMA report that takes look at new CMS quality measure

Feb. 11, 2014 - As part of its effort to emphasize quality care, the Centers for Medicare & Medicaid Services has established readmission rates as a way to measure performance for inpatient rehabilitation facilities. A new study of such readmissions for Medicare fee-for-service patients has found the rate of return to the facility within 30 days is the lowest – 6 percent - for those who had joints replaced in their lower extremities and highest – 20 percent - for those treated for debility (weakness or feebleness). Read more...

Medicare & Medicaid News

Bipartisan Plan Would Shift Medicare’s Doctor Payment System To Reward Quality

Long battle over how Medicare compensates physicians takes a new turn; AMA offers support

By Mary Agnes Carey, KHN Staff Writer

Feb. 6, 2014 - The bipartisan leadership of three Senate and House committees introduced legislation Thursday to overhaul the way Medicare pays physicians. Read more...

Health & Medicine for Senior Citizens

Patients, Caregivers Will Have Direct Access to Lab Test Results Due to New Rule by HHS Agencies

Now patients and their designated care-givers can not only get info from physicians, but also directly from laboratories

Feb. 3, 2014 - Patients or someone they designate will soon have direct access to completed laboratory test reports from the lab performing the test. As part of an ongoing effort to empower patients to be informed partners with their health care providers, the Centers for Medicare & Medicaid Services (CMS) and two other agencies in the Department of Health and Human Services (HHS) joined forces to issue the new rule. Read more...

Medicare & Medicaid News

CMS Slams Door on New Home Health, Ambulance Suppliers in Some Areas to Fight Fraud, Abuse

"...the moratoria put fraudsters on notice that we are using all available tools, including these moratoria, to combat fraud, waste and abuse in our health care programs."

Marilyn Tavenner, CMS Administrator

Patient access uninterrupted in current and new counties in agency’s fraud fighting efforts

Jan. 31, 2014 – The Centers for Medicare & Medicaid Services slammed the door yesterday on the enrollment of new home health agencies or ground ambulance suppliers in several cities and extended for six months the current enrollment moratoria in others as part of its fraud fighting efforts. The moratoria extension and imposition of the new moratoria were announced in a notice issued yesterday in the Federal Register. Read more...

Medicare & Medicaid News

Medicare Achieves Significant Savings, Quality Improvements from Delivery System Initiatives

Medicare Accountable Care Organizations, Pioneer ACOs save $380 million

Jan. 30, 2014 - Today, the Centers for Medicare & Medicaid Services (CMS) released findings on a number of its initiatives to reform the health care delivery system.  These include interim financial results for select Medicare Accountable Care Organization (ACO) initiatives, an in-depth savings analysis for Pioneer ACOs, results from the Physician Group Practice demonstration, and expanded participation in the Bundled Payments for Care Improvement Initiative. Savings from both the Medicare ACOs and Pioneer ACOs exceed $380 million, CMS says. Read more...

Medicare & Medicaid News

Medicare Rights University Launched by Medicare Rights Center

A 'one-of-a-kind' online curriculum for health care and insurance professionals

Jan. 29, 2014 - The Medicare Rights Center today announced the launch of Medicare Rights University (MRU), a web-based curriculum designed to empower any professional to better help their own clients, patients, employees, retirees, and others navigate a multitude of Medicare questions. Read more...

Senior Citizen Politics

Medicare Kept 25 Percent of Part D Contracts Out of Plan Finder Due to Pricing Inaccuracy: GAO Report

Senate Special Committee on Aging requested GAO study the shows Medicare’s watchdog actions

Jan. 17, 2014 - A new Government Accountability Office (GAO) report released last week found that during the first seven months of 2013, 25 percent of Medicare Part D contracts had one or more plans suppressed from Plan Finder, the Medicare website seniors use to choose their drug plans, due to pricing inaccuracy, according to a news release from the Senate Special Committee on Aging. Read more...

Medicare & Medicaid News

Still Crazy After All These Years: Preventive Services Open Door to Healthy Aging for Seniors

Ron Pollack, Executive Director, Families USA

Affordable Care Act (Obamacare) makes getting preventive services easier and easier to afford, yet, less than 50% of seniors are up-to-date

Jan. 17, 2014 - A fun-loving, active couple I know, both of whom are older than 85, recently performed in an hour-long musical production. And they were pretty darn good! They are clearly in love and enjoying life. What are they doing right? They told me that they “take care of themselves.” Nothing magical, and no miracle treatments have extended their golden years. Read more...

Health & Medicine for Senior Citizens

What Does Team-Based Care Mean for Patients? Expanding Rapidly with Push by Medicare

Editor’s Note: There are over 360 Accountable Care Organizations working with Medicare to provide higher-quality coordinated care for seniors. Doctors, hospitals and health care providers establish ACOs to work together to provide better health care, while working to slow the growth of health care cost.

By Jessie Gruman, President, Center for Advancing Health

Jan. 16, 2014 - Have you heard that soon most primary care in the U.S. will be delivered by teams? Yep. Team-based care is one of the characteristics of the patient-centered medical home, a way of organizing the care of patients that allows primary care clinicians to see more patients in a day while at the same time delivering better care. Read more...

Medicare and Medicaid News

Congress About to Change Medicare Payment for Physicians; What It Means for Patients, Docs

After years of yearly political battles over what Medicare should pay doctors, a somewhat permanent fix seems about to win passage in Congress.

By Mary Agnes Carey, KHN Staff Writer

Jan. 16, 2014 - After years of legislative wrangling and last-minute patches, expectations are high among physician groups, lawmakers and Medicare beneficiaries that Congress could act this year to permanently replace the current Medicare physician payment formula. While committees in both chambers have approved their own "doc fix" proposals, the approaches have yet to be reconciled, and none have identified how they would pay for a repeal. Read more...

Senior Citizen Politics

Seniors with Multiple Chronic Conditions to Benefit from Medicare Changes in Bi-Partisan Bill

U.S. Senators, Representatives from both parties introduced today the Better Care, Lower Cost Act - video of news conference in story

Jan. 15, 2014 – Millions of senior citizens in Medicare may the among those to benefit from unusual cooperation between Democrats and Republicans to pass legislation that will, according to the sponsors, provide better care and lower cost for seniors and others covered by Medicare that have multiple chronic conditions. Two U.S. Senators from opposite political parties (Ron Wyden, D-Ore., and Johnny Isakson, R-Ga.) and two House members representing both parties (Erik Paulsen, R-Minn., and Peter Welch, D-Vt.) have joined forces to introduce the Better Care, Lower Cost Act today. Read more...

Health & Medicine for Senior Citizens

Millions of Senior Women at High Risk of Breast Cancer May Get Preventive Drugs Free

Estimates are that over 10 million women in U.S.age  35 to 79 could be eligible for tamoxifen chemoprevention on the basis of their risk factors; Obamacare

By Phil Galewitz, Capsules, Kaiser Health News

Jan. 12, 2014 - Starting next September, women at increased risk for breast cancer will be able to get some drugs shown to help prevent the disease without a co-pay, the Obama administration said Thursday. Read more...

Medicare & Medicaid News

CMS Declares War on Prescription Drug Abuse in Medicare, Focus on Opioid, Acetaminophen Users

Begins with validation and analysis of Part D claims data it receives from Part D sponsors

Jan. 9, 2014 – Prescription drug abuse, even in the Medicare Part D drug program, is a nationwide epidemic, according to the Centers for Medicare and Medicaid Services, which has committed to take the problem seriously and begin actions to protect Medicare beneficiaries and the Medicare Trust fund. Targets include Part D enrollees who use opioid or acetaminophen, to see if they have overutilization issues, and physicians who may over-prescribe. Read more...

Medicare & Medicaid News

Program Changes to Improve Medicare Drug Plans, Advantage Program Proposed by CMS

Wide range of programs will be for next year’s programs; seeks public comment

Jan. 8, 2014 – The Centers for Medicare and Medicaid Services is proposing a new way to identify protected classes of drugs and other changes it says will strengthen protections, improve health care quality and reduce costs for Medicare beneficiaries with private Medicare Advantage (MA) and Part D prescription drug plans in Contract Year (CY) 2015. Read more...

Medicare & Medicaid News

Hospitals Serving Elderly Poor More Likely Penalized by Medicare for Readmissions

Medicare reduces payments to penalizes hospitals with high rates of readmissions for pneumonia, heart attack and heart failure; those serving poorest seniors have higher readmission rates

By Valerie DeBenedette, HBNS Contributing Writer

Jan. 7, 2014 - Hospitals that treat more poor seniors who are on both Medicaid and Medicare tend to have higher rates of readmissions, triggering costly penalties from the Centers for Medicare and Medicaid Services (CMS), finds a new study in Health Services Research. Read more...

Medicare & Medicaid News

New Medicare Data Show 364 Hospitals Have High Rates Of Overall Readmissions

List of hospitals by state with the best and worst readmission rates reported by Medicare

By Jordan Rau, Capsules, Kaiser Health News

Jan. 6, 2014 - Medicare’s new comprehensive measure of hospital readmissions shows that at least 20 percent of the hospitals in Illinois, Maryland, Massachusetts, New Jersey, New York and Rhode Island have higher rates of patients returning than the national average. Read more...

Medicare & Medicaid News

Senior Citizens on Medicare Greatly Affected by Obamacare but Not the Insurance Coverage

Answer to question by Social Security representative not exactly accurate saying people in Medicare ‘not affected by Affordable Care Act’

By Tucker Sutherland, editor,

Jan. 6, 2014 – In this week’s Social Security Q&A by Oscar Garcia, Public Affairs Specialist with the Social Security Administration may leave the wrong impression about the Affordable Care Act (Obamacare) and its impact on seniors and others covered by Medicare. He states, “People who have Medicare coverage are not affected by the Affordable Care Act.” He probably meant to explain they do not get health insurance through the program’s Health Insurance Market Place. This is true but many provisions of the health care program do greatly affect senior citizens in Medicare. Read more...

Health & Medicine for Senior Citizens

Seniors Should Heed Study Showing Electronic Health Records Benefit Patients and Physicians

Majority of physicians said they were alerted to a potential medication error or critical lab value by an electronic health record; one-third say they help spot needed tests; Medicare offers physicians incentive

By Sharyn Alden, HBNS Contributing Writer

Jan. 2, 2014 – Senior citizens – the age group most in need of medical care, often from chronic problems – should check to see if their doctors are using electronic health records (EHRs). It may save their life. A new study in Health Services Research finds nearly three-quarters of physicians using EHRs  in 2011 said there were clinical benefits when patients’ medical histories were kept in digital files. Read more...

Caregiver & Elder Care News

Palliative Care Helps with One Family’s Journey: Medicare Program to Improve Care, Reduce Costs

Palliative care focuses on improving the quality of life for patients with serious illnesses, relieving symptoms, pain and stress - It’s not hospice

By Jenny Gold, KHN Staff Writer

Jan. 2, 2014 - When palliative care specialist Dr. Tim Ihrig crosses the threshold of the Avelleyras home, he steps over a doormat that says, "One nice person and one old grouch live here." It doesn’t take long to figure out who the nice person is. Read more...

Medicare & Medicaid: Marci's Q&A

Medicare to Open Advantage Plan Disenrollment; Other Key Information in Marci’s Medicare Answers

Marci’s Q&A has information about Medicare in the new year that may be critical to some senior citizens: changing back to original Medicare, changes in 2014, getting Extra Help

Dec. 27, 2013 – Although Medicare just closed “Open Enrollment” earlier this month, there is a new “Disenrollment” period about to open, when seniors enrolled in Medicare Advantage can switch to Original Medicare. This and other important information about Medicare in 2014 are explained below in the “Dear Marci” Q&A from the Medicare Rights Center. Read more...

Medicare & Medicaid News

Senators Press Medicare for Answers on Failure to Monitor Doctor Waste in Drug Program

Earlier ProPublica report detailed wasteful practices by doctors who routinely give patients pricey name-brand drugs when cheaper generic alternatives are available

by Charles Ornstein and Tracy Weber, ProPublica

Dec. 26, 2013 - A Senate committee chairman said he is concerned about the “serious vulnerabilities” detailed in a ProPublica report  about scams that target Medicare’s popular prescription drug program. Read more...

Medicare & Medicaid News

Medicare, Other Health Care Spending Slowing but Cost Controls Must Be Implemented

New England Journal of Medicine study finds health spending rose just 0.8% per person in 2012, Affordable Care Act measures to control costs may be contributing to biggest slowdown in decades

Dec. 26, 2013 – The growth of health care cost is slowing and at least a portion is due to actions stemming from Obamacare (Affordable Care Act), but regardless of the causes, the U.S. needs to try to control health spending. An analysis, published today in the New England Journal of Medicine, also finds that a broad, bipartisan consensus about strategies that will be effective in controlling costs has emerged. Read more...

Medicare & Medicaid News

Does Cataract Surgery Need Preoperative Consultation? It is Increasing for Medicare Patients

Older patients (75 to 84) were more likely to have a consultation than patients age 66 to 74

Dec. 23, 2013 – Cataract surgery – a low-risk surgery that has almost become routine for senior citizens – has increasingly involved a preoperative consultation for Medicare patients, despite no clear guidelines about when to require such a service. A new study suggests in may be unnecessary use of Medicare health care resources. Read more...

Medicare & Medicaid News

Medicare’s Accountable Care Organizations Continue Growth as Health Care Spending Slows

123 new ACOs join program; Congressional Budget Office estimates Medicare spending per beneficiary will grow at approximately the rate of growth of the economy for the next decade

Dec. 23, 2013 – There are now more than 360 Accountable Care Organizations working with Medicare to provide higher-quality coordinated care to 5.3 million seniors and other beneficiaries, while reducing the cost of health care, according to an announcement today by HHS Secretary Kathleen Sebelius. And, she added that Medicare is expected to break a decades old pattern of spending growth outstripping economic growth. Read more...

Medicare & Medicaid News

Free Preventive Services Draws Over 25 Million Seniors, Others in Original Medicare

CMS credits Affordable Care Act for accomplishment in first 11 months of 2013; 3.5 million received free Annual Wellness Visit

Dec. 17, 2013 - More than 25.4 million senior citizens and othrs covered by Original Medicare received at least one preventive service at no cost to them during the first eleven months of 2013, because of the Affordable Care Act. Today’s news from the Centers for Medicare & Medicaid Services comes after last month’s announcement showing that the health care law also saved seniors $8.9 billion on their prescription drugs since the law’s enactment. Read more...

Medicare and Medicaid News

Medicare Identifies 97 Best and 95 Worst Hospitals for Hip And Knee Replacements

Latest part of the government’s push to improve quality at the nation’s hospitals instead of simply paying Medicare patients’ bills

By Jordan Rau, KHN Staff Writer

Dec. 17, 2013 - Medicare has begun tracking the outcomes of hip and knee replacement surgeries, identifying 95 hospitals where elderly patients were more likely to suffer significant setbacks. The government also named 97 hospitals where patients tended to have the smoothest recoveries. Read more...

Medicare & Medicaid News

What Senior Citizens Need to Know About Medicare in 2014

Families USA presents a Q&A on information seniors need to know about Medicare in 2014

Dec. 16, 2013 - Many seniors are now looking to Medicare decisions and options for 2014, since open enrollment has closed. Families USA has provided answers to questions they anticipate will be on the minds of senior citizens in the new year. It also has advice for newcomers to the program in the column below. Read more...

Medicare & Medicaid News

Medicare's Hospital Compare Introduces Information on Deadly Hospital Infections

CDC, CMS collaborate to advance public reporting of important hospital quality indicators deadly diarrhea and MRSA - see guide for finding info

Dec. 13, 2013 - Senior citizens, the most regular hospital patients, have long wanted more information about deadly infections that have been occurring to frequently in hospitals. Yesterday, the Medicare website Hospital Compare provided the first look at how their local hospitals are doing at preventing Clostridium difficile infections (deadly diarrhea) and methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections. Read more...

Senior Citizen Politics

Congress Moves Closer To Changing How Medicare Pays Doctors

Annual battle over how much physicians will be paid for treating Medicare patients may be coming to and end, as well as worry by seniors if their doctor will still take Medicare patients

Dec. 13, 2013 – Almost as regular as Christmas in December of the last few years has been the congressional battle over how much physicians will be paid by Medicare. Long-standing legislation cut the pay each year and the doctors would have to spend heavily to convince Congress to give them a slight increase. But key House and Senate committees approved legislation Thursday to repeal the Sustainable Growth Rate, the formula officials use to pay doctors who treat Medicare patients. KHN’s Mary Agnes Carey and Politico Pro’s Jennifer Haberkorn discuss below. Read more...

Medicare and Medicaid News

Fewer Medicare Patients Return to Hospital in First Year of Medicare Penalties

Medicare targeting rehospitalizations as a significant indicator of gaps in medical quality in the nation’s hospitals

By Jordan Rau, Kaiser Health News Blog

Dec. 9, 2013 - During the first eight months of this year, fewer than 18 percent of Medicare patients ended up back in the hospital within a month of discharge, the lowest rate in years, the government reported Friday. This drop occurred during the first year that Medicare financially penalized hospitals for their readmission rates, and the government seized on the decrease as evidence the incentives are having an effect. Read more...

Senior Citizen Politics

Protect Low-Income People with Medicare Urged by Aging, Disability, Faith-Based Groups

60 organizations call for Congress to make Medicare QI Program permanent

Dec. 9, 2013The National Council on Aging (NCOA) and 59 other diverse national organizations are urging Congress to make the low-income Medicare Qualified Individual (QI) program permanent as part of the Medicare physician payment (SGR) bill, scheduled to be considered by the Senate Finance and House Ways and Means Committees this week. Read more...

Medicare and Medicaid News

Judge Stops UnitedHealthcare from Dropping Physicians from Medicare Advantage Plan

Judge's order stopping last minute changes by Medicare Advantage plan in Connecticut could have national impact

By Susan Jaffe, Kaiser Health News

Dec. 6, 2013 - In a decision that could have national implications, a federal judge in Connecticut blocked UnitedHealthcare late Thursday from dropping an estimated 2,200 physicians from its Medicare Advantage plan in that state. The Medicare deadline for enrolling in new plans ends tomorrow, leaving little time for seniors to find plans which include their preferred physicians or switch to traditional Medicare. Read more...

Medicare and Medicaid News

Medicare Seeks To Curb Spending On Post-Hospital Care That Varies Widely

Study shows cost of care after leaving the hospital varies widely; Over 25% of Medicare spending in Louisiana, Texas, Mississippi, Oklahoma and Massachusetts for post-acute care – check your state

By Jordan Rau, KHN Staff Writer

Dec. 2, 2013 - After years of trying to clamp down on hospital spending, the federal government wants to get control over what Medicare spends on nursing homes, home health services and other medical care typically provided to patients after they have left the hospital. Read more...

Medicare & Medicaid News

Medicare Saving Big Bucks for Seniors and Taxpayers, Says CMS

News on Obamacare savings on prescription drugs for seniors; new information shows historically low growth in Medicare spending; open enrollment almost over

Nov. 26, 2013 – The Affordable Care Act (Obamacare) may be having problems kicking off the health care exchanges for younger Americans, but for seniors it has saved billions of dollars, according to news today from the Centers for Medicare & Medicaid Services. And, the agency adds, it has reached historically low levels of growth in Medicare spending. Read

Senior Citizen Alerts

Tips for Senior Citizens to Protect Against Health Care Scams

Scammers are trying to con seniors into giving out sensitive information while signing them up for plans they do not need

Nov. 21, 2013 - Fraudsters are capitalizing on the rollout of the Affordable Care Act (ACA) and Medicare’s Open Enrollment. The shifts in the healthcare landscape have prompted some criminals to carry out health care scams targeting seniors, according to the Senate Special Committee on Aging. Read more...

Medicare & Medicaid News

Medicare's Failure to Track Doctors Wastes Billions on Name-Brand Drugs

Investigative reporters with ProPublica found over $300 million was paid in 2011 due to only 913 doctors choosing name brand drugs - see video

by Charles Ornstein, Tracy Weber and Jennifer LaFleur, ProPublica

Nov. 20, 2013 - Medicare is wasting hundreds of millions of dollars a year by failing to rein in doctors who routinely give patients pricey name-brand drugs when cheaper generic alternatives are available. ProPublica analyzed the prescribing habits of 1.6 million practitioners nationwide and found that a tiny fraction of them are having an outsized impact on spending in Medicare's massive drug program. Read more...

Medicare & Medicaid News

Report Finds Rapid Growth in Medicare Observation Services that Can Cost Seniors

Raises concerns about clinical benefit and out-of-pocket costs for seniors, quality of care

Nov. 14, 2013 – AARP Public Policy Institute released a new report today examining the use of hospital "observation status" for Medicare patients. Hospital emergency rooms sometimes hold patients for observation before admitting them or sending them home. This observation status has grown rapidly and for Medicare patients the distinction is important because it can affect out-of-pocket costs. Use of observation status as a substitute for admission also raises concerns about quality of care. Read more...

Medicare and Medicaid News

Obamacare Enrolls About 91,000 in Medicaid As Result of ‘Woodwork’ Effect

Medicaid popular even in states hostile to the Affordable Care Act, like Florida and Texas

By Phil Galewitz, The KHN Blog

Nov. 14, 2013 - Supporters and opponents of the federal health law still can’t decide whether to call it the “woodwork” or “welcome mat” effect — the millions of people currently eligible for Medicaid who are not enrolled and who are expected to sign up as a result of the Affordable Care Act. Read more...

Medicare News

Strange Pricing Details Can Bedevil Medicare Beneficiaries Choosing Drug Plans

Medicare advocates urge seniors to compare plans each year to find a way to save money, but many find the process so complex that they don’t switch

By Susan Jaffe, The KHN Blog

Nov. 13, 2013 - Pharmacist Gina Upchurch knows all the ins and outs of the Medicare prescription drug benefit and was sure she discovered something very wrong:  using the government’s online plan finder tool to help seniors compare dozens of 2014 drug policies, she noticed that some insurers charge higher prices for a prescription filled every two or three months compared to the same drug bought every month. Read more...

Features for Senior Citizens

Where Senior Veterans Get Health Care and More About U.S. Military Veterans on Their Day in 2013

Military veterans honored today with parades and speeches across the nation, national ceremony at the Tomb of the Unknowns at Arlington National Cemetery in Virginia

Nov. 11, 2013 - A hot topic on this Veterans Day is health care. Where to vets who are senior citizens get their health care? The number of veterans age 65 and over covered by Medicare; 4.1 million covered by employer-sponsored health insurance; 3.1 million covered by VA health care; 3.1 million covered by direct-purchase insurance; 1.3 million covered by TRICARE; and 878,00 covered by Medicaid. These numbers are not mutually exclusive. Individuals can have more than one type of health insurance coverage. Read more...

Medicare & Medicaid News

Fighting Medicaid Fraud, Waste, and Abuse Through Education - Medicare Blog

By Ted Doolittle, CMS Deputy Director, Center for Program Integrity

Nov. 7, 2013 - The Centers for Medicare & Medicaid Services (CMS) wants everyone to join in the fight against fraud, waste, and abuse as part of our comprehensive strategy to protect federal health care programs and taxpayer dollars.  We are now making it easier than ever before for health care providers, managed care plans, and individuals and families with Medicaid benefits to use the education and training materials on the new Medicaid Program Integrity website. Read more...

Medicaid News

Medicaid Enrollment is Soaring with Obamacare

Biggest reason for initial jump in Medicaid enrollment is that hundreds of thousands in expansion states have been pre-qualified for expanded Medicaid - see state-by-state report

By Christine Vestal, Stateline

Nov. 7, 2013 - States are reporting far higher enrollment in Medicaid than in private insurance since the Affordable Care Act exchanges opened Oct. 1. In Maryland, for example, the number of newly eligible Medicaid enrollees is more than 25 times the number of people signed up for private coverage. Read more...

Medicare/Medicaid News

Key Senate, House Committee Chairmen Offer Plan To Fix Medicare Doctor Payments

Medicare physician payments will reduce by nearly 25 percent on Jan. 1 unless Congress intervenes; possible end to annual dilemma

By Mary Agnes Carey, KHN Staff Writer

Nov. 5, 2013 - The Democratic and Republican leaders of two key congressional committees have agreed on a framework to scrap the problematic Medicare payment formula for physicians and replace it with one that would link physician reimbursement to the quality of care provided, a step that could put an end to the annual "doc fix" debate. Read more...

Medicare & Medicaid News

Seniors Have More Reasons to Switch Medicare Prescription Drug Plans, Consultant Says

Editor’s Note: The window is open at Medicare for seniors to change the way they receive benefits in 2014 (open through Dec. 7). Most of the attention is focused on the Part D prescription drug plans, which tend to change – some drastically – from year to year. Below is an analysis provided by Allsup, a company that markets health plan consulting advice.

Nov. 4, 2013―A number of changes affecting prescription drug Part D plans signal important reasons for seniors and people with disabilities relying on Medicare to review coverage during the annual open enrollment, according to Allsup, a nationwide provider of Medicare plan selection services. Read more...

Medicare & Medicaid News

No Increase in Cost of Medicare Part B in 2014; More Savings in Drug Program

CMS says major savings for Medicare beneficiaries next year; good news for seniors facing small Social Security increase

Oct. 28, 2013 – Senior citizens facing a projected small increase in Social Security for next year got some good news today from the Centers for Medicare & Medicaid Services. CMS says that health care reform efforts are eliciting significant out-of-pocket savings for Medicare beneficiaries, pointing to zero growth in 2014 Medicare Part B premiums and deductibles, and more than $8 billion in cumulative savings in the prescription drug coverage gap known as the “donut hole.”  Read more...

Medicare/Medicaid News

Seniors Cautioned To Pay Close Attention To Details As Enrollment Begins In Medicare Plans

There’s a likely payoff for those who pay close attention to the details - enrollment open through December 7

By Susan Jaffe, Kaiser Health News

Oct. 16, 2013 - The seven-week enrollment period for next year’s Medicare prescription drug and managed-care plans began Tuesday, but seniors shouldn’t simply renew their policies and assume the current coverage will stay the same.  There’s a likely payoff for those who pay close attention to the details. Read more...

Medicare & Medicaid News

Medicare Opens Enrollment for 2014 Plans, Says Plan Prices Holding Steady

See video in story on how to use the Medicare Plan Finder to compare available plans, make your selection; lead video about Open Enrollment period

Oct. 15, 2013 - Medicare Open Enrollment opened today, according to an announcement by the Centers for Medicare and Medicaid Services (CMS) which has been dark since the government shutdown resulting from the Republican attack on the Affordable Care Act. The enrollment period will end on December 7. The CMS announcement encourages people with Medicare to review their current health and prescription drug coverage options for 2014 and reminds them this is not part of the Affordable Care Act’s new Health Insurance Marketplace, and people with Medicare do not need to do anything with Marketplace plans. Read more...

Senior Citizen Politics

National Council on Aging Tells Congress to Protect Social Security, Medicare

If Congress fails to increase the debt limit key payments to seniors may not be made

Oct. 14, 2013 – The National Council on Aging (NCOA) joined the Leadership Council of Aging Organizations (LCAO) in strongly urging Congress to end the government shutdown and extend the debt limit to December 2014, without putting at risk the Social Security, Medicare, and other benefits that millions of older Americans need to "stay healthy, independent, and secure." Read more...

Medicare & Medicaid News

Analysis Finds Good News on 2014 Medicare Prescription Drug Premiums

Overall stable or lower cost options available to seniors finds HealthPocket study

Oct. 11, 2013 - In an analysis of Medicare standalone prescription drug plans (Part D) based on data recently released by the Centers for Medicare and Medicaid Services (CMS), HealthPocket found that plans will have a stable average premium of $53.80 for 2014, compared to $53.74 for 2013. The analysis also found that the number of participating plans is consistently high throughout the states, ranging from the high 20s to low 30s. Read more...

Medicare & Medicaid News

Medicare Advantage Plan Out-of-Pocket Caps for 2014 Look Good For Consumers

Drug plans with low cost-sharing limits and no premiums available: HealthPocket

Oct. 11, 2013 - In an analysis of Medicare Advantage plans with a bundled prescription drug benefit (MAPD) based on data recently released by the Centers for Medicare and Medicaid Services, HealthPocket found that many plans for 2014 have substantially lower maximum out-of-pocket caps than the current $6,700 limit for MA plans. Read more...

Medicare & Medicaid News

AARP Offers Tips, Guidance on Choosing Plans During Medicare Open Enrollment

Changes can be made to Medicare plans from October 15 through December 7; Distinction between Medicare and Affordable Care Act open enrollment is important

Oct. 10, 2013 – AARP is offering senior citizens tips on choosing the right plan during the Medicare Open Enrollment period, which opens October 15. The organization is also cautioning those in Medicare to not be confused by the open enrollment for the Affordable Care Act (Obamacare) – senior citizens still get their health insurance at Read more...

Health & Medicine for Senior Citizens

Oral Health of Older Americans in 'State of Decay' – New Website to Help Find Care

 ‘Older adults face significant health challenges if their oral health is poor, and there is no coordinated program to help fund necessary services.’

Oct. 10, 2013 - The oral health of older Americans is in a state of decay, according to a new national report released today by Oral Health America (OHA). It finds more than half of the country received a "fair" or "poor" assessment when it comes to minimal standards affecting dental care access for older adults. Read more...

Senior Citizen Politics

Republicans Seem Ready to Shift Fight to Cutting Senior Entitlements

Speaker Boehner says on ABC that the fight in Washington is really about the growth in the senior citizen population… the important goal is reducing entitlement spending; may push for cuts that President Obama earlier suggested

By Tucker Sutherland, editor,

Oct. 6, 2013 – There are many who now say the real target of the Republicans in the current battle in Washington is not really Obamacare, it is entitlements, or, more specifically, Social Security and Medicare. These concerns were heightened today when House Speaker John Boehner said on ABC’s This Week that what is driving the conflict is the growth in the senior citizen population. Read more...

Medicare & Medicaid News

Consumer Reports Ranks, Scores Medicare Advantage, Other Health Plans for 2014

CR finds that higher cost does not mean better care; complete report in magazine, rankings free online, Medicare open enrollment starts October 15

Oct. 5, 2013 – Open enrollment for Medicare opens on October 15 and seniors should be exploring their options in insurance plans for 2014. For the fourth year, Consumer Reports is publishing rankings of hundreds of health insurance plans, including Medicare Advantage plans, and, for the first time, plans available in Obamacare. Among new choices in the health plan are Medicaid HMOs. This is also the first time for the organization to take additional steps to identify plans that both provide high-quality care and avoid costly care. Read more...

Medicare & Medicaid News

Understanding the Difference between Medicare and the Health Insurance Marketplaces

Marketplaces are for people who do not have insurance, people on Medicare are insured by Medicare

By Ron Pollack, Executive Director, Families USA

Ron Pollack, Executive Director, Families USA

Oct. 1, 2013 - If you have Medicare, you may be confused by the buzz surrounding the launch of the new health insurance marketplaces, which are part of the Affordable Care Act (also known as Obamacare). What do these marketplaces mean for you? It’s important to understand that Medicare and the marketplaces are entirely separate. Read more...

Medicare & Medicaid News

Senior Citizens Need to Get Ready for Medicare Open Enrollment

Seniors covered by Medicare do not need to buy health insurance on the Health Insurance Marketplace - Medicare Open Enrollment starts October 15

Oct. 1, 2013 – The timing of the government shutdown - there is no good time – has some direct implications for senior citizens, which are about to begin the annual Open Enrollment period, when those on Medicare can choose new health and drug plans. It opens on October 15 and closes on December 7, but making the right choices means researching what is available this year and making comparisons with your current program. It is critical that the Medicare website be functioning properly before and during this period. Read more...

Senior Citizen Opinions & Analysis

Poor Communication to Senior Citizens About Obamacare May Be Costly Error

Even key news release from Centers for Medicare & Medicaid Services misleads senior citizens – its primary audience

By Tucker Sutherland, editor & publisher,

Oct. 1, 2013 – One of the complaints we hear often is that the Obama Administration has done a poor job of communicating to the public about the Affordable Care Act, also known as Obamacare. We certainly agree with this opinion. The administration continues to not only fail to effectively market the programs benefits, but their poor communications continues to confuse the public and senior citizens in particular. Read more...

Medicare & Medicaid News

Medicare, Other U.S. Health Care Spending to Grow More Slowly in Years Ahead

Despite longer lives, growing senior population; Affordable Care Act constrains fee-for-service and private plan payment growth, says report from Centers for Medicare & Medicaid Services (CMS) Office of the Actuary

Sept. 23, 2013 - Medicare spending between 2015 and 2022 is expected to increase from the annual growth of 4.6 percent estimated for 2012, but it will be well below the previous decade’s 9.3 percent rate of growth as the Affordable Care Act constrains fee-for-service and private plan payment growth, according to a report by from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary. The report also says spending growth over the next ten years for all U.S. health care will be modest in comparison to historical trends. Read more...

Medicare/Medicaid News

Seniors on Medicare Don’t Need to Apply to the Health Law Marketplaces

Q&A by Kaiser Health News on what senior citizens need to know about the Affordable Care Act (Obamacare)

By Mary Agnes Carey, KHN Staff Writer

Sept. 23, 2013 - Nearly 50 million Americans are enrolled in Medicare, the federal health insurance program for the elderly and disabled. The 2010 health care law, known as the Affordable Care Act, will make some changes to the program. Here are some answers to frequently asked questions about Medicare and the health law. Read more...

Medicare & Medicaid News

As Medicare Open Enrollment Nears More Seniors Opting for Quality Medicare Advantage Plans

Open enrollment begins October 15 and ends on December 7; period when those in Medicare can choose new health and drug plans

Sept. 19, 2013 - Senior citizens are continuing to choose higher quality Medicare Advantage (MA) plans, according to a news release today from Health and Human Services (HHS) Secretary Kathleen Sebelius. She says for the fourth straight year enrollment in these health care plans is projected to increase. Read more...

Health & Medicine for Senior Citizens

Pay for Performance to Physicians Results in Better Patient Outcomes

Incentives offered a whole health care team did not have significant effect

Sept. 17, 2013 – Just modest monetary incentive paid to individual physicians resulted in a significant 8.36 percent increase in patients whose blood pressure was brought down to desired levels or who received an appropriate medical response when it was found that their blood pressure was uncontrolled. However, incentives to a whole health care team or to the physician plus health care team did not have a significant effect, according to a multi-year study reported in the Journal of the American Medical Association (JAMA). Read more...

Medicare & Medicaid News

Medicare Rights Center Launches New Website

Improved navigation, updates and latest on Medicare changes

Sept 13, 2013 - The Medicare Rights Center, New York, has announced the release of the new, an overhaul of the organization’s website. They say this will make it easier for beneficiaries, professionals, journalists and others to find answers to Medicare questions. Read more...

Alzheimer's, Dementia & Mental Health

Screening for Minor Memory Problems May Wrongly Label Many with Dementia

Experts gather in New Hampshire today to discuss threat to health, the waste of money by unnecessary care; Medicare covers annual cognitive test in wellness visit

Sept. 10, 2013 – The ongoing debate in medical circles over when people – in particular senior citizens – should be screened for various afflictions has not hit the battle against dementia. A political drive, led by the UK and US, to screen older people for minor memory changes (often called mild cognitive impairment or pre-dementia) is leading to unnecessary investigation and potentially harmful treatment for what is arguably an inevitable consequence of ageing, warn experts on today. Read more...

Medicare & Medicaid News

Senior citizens need to know details of how Obamacare affects them; don’t join Marketplace plan

Sen. Nelson posts detailed information on how health care reform impacts senior citizens on Senate Select Committee on Aging website

By Tucker Sutherland, editor,

Sept. 5, 2013 – There is a daily barrage of news and advertising for and against the Affordable Care Act – better known as Obamacare – and it has left many senior citizens confused about what they should be doing. Basically, seniors are not involved in the major provision of the plan, which mandates insurance for all Americans and has established the Health Insurance Marketplace to help them locate plans that meet their needs at the best price possible. Seniors on Medicare, however, already have outstanding insurance coverage and should not enroll in a Marketplace insurance plan. Read more...

Medicare/Medicaid News

Hospital ‘observation’ care bad, costly decision for many seniors on Medicare

Considered by Medicare an outpatient service which means seniors can face higher out-of-pocket expenses and fewer Medicare benefits.

By Susan Jaffe, Kaiser Health News

Sept. 4, 2013 - Some seniors think Medicare made a mistake.  Others are just stunned when they find out that being in a hospital for days doesn't always mean they were actually admitted. Instead, they received observation care, considered by Medicare to be an outpatient service. Read more...

Medicare & Medicaid News

Married Medicare beneficiaries get equal access to nursing homes regardless of sexual orientation

HHS change applies to Medicare Advantage plans; first guidance resulting from Supreme Court’s rejection of Defense of Marriage Act

Sept. 3, 2013 - All Medicare beneficiaries in private Medicare plans will have equal access to coverage in a nursing home where their spouse lives, regardless of their sexual orientation, says a news release issued by Health and Human Services last week. This is the first guidance issued by HHS in response to the recent Supreme Court ruling, which held section 3 of the Defense of Marriage Act unconstitutional. Read more...

Medicare & Medicaid News

Decrease in antipsychotic drugs for dementia patients in nursing homes hailed by CMS

Nursing homes moving toward more patient-center treatment as urged by CMS initiative

Aug. 28, 2013 – The Centers for Medicare & Medicaid Services (CMS) cheered new data showing that nursing homes are moving away from the use of antipsychotic drugs for the treatment of patients with dementia and other behavioral health problems. Instead, they are pursuing more patient-centered treatment. Read more...

Medicare/Medicaid News

HHS wants hospital observations credited toward Medicare nursing home coverage

Seniors kept for observation varies by hospital; Medicare doesn't pay for expensive follow-up nursing home care for observation patients

By Susan Jaffe, KHN

Aug. 1, 2013 - Medicare patients' chances of being admitted to the hospital or kept for observation depend on what hospital they go to - even when their symptoms are the same, notes a federal watchdog agency in a report released Tuesday, which also urges Medicare officials to count those observation visits toward the three-inpatient-day minimum required for nursing home coverage. Read more...

Medicare & Medicaid News

Cost of Medicare drug plans for seniors remains flat for fourth year in a row

Other good news celebrating 48th anniversary of Medicare and Medicaid is Obamacare has saved seniors and other beneficiaries $7 billion in prescription drug cost

July 31, 2013 – Health and Human Services celebrated the 48th anniversary of the signing of Medicare and Medicaid into law with the release of data showing that the average premium for a basic prescription drug plan in 2014 is projected to remain stable, at an estimated $31 per month. Read more...

Medicare/Medicaid News

Medicare Stepping Up Plans for Linking Doctor Pay to Quality of Care Rather Than Quantity

Current system encourages physicians to do more procedures that pushes Medicare cost higher

By Jordan Rau, KHN Staff Writer
This KHN story was produced in collaboration with The Washington Post

July 23, 2013 - Medicare is accelerating plans to peg a portion of doctors’ pay to the quality of their care. The changes would affect nearly 500,000 physicians working in groups. The federal health law requires large physician groups to start getting bonuses or penalties based on their performance by 2015, with all doctors who take Medicare patients phased into the program by 2017. Read more...

Medicare & Medicaid News

Medicare poses key questions for seniors

There are recurring penalties you will have to pay if you don’t sign up for certain types of Medicare coverage when you first become eligible

July 22, 2013 - One of the most important decisions seniors will make is choosing the right Medicare coverage when they become eligible for the federal health insurance program. “Your first year of Medicare eligibility is one of the most critical times because of the variety of choices you have to make and the potential for costly mistakes that may last your lifetime,” said Paula Muschler, manager of the Allsup Medicare Advisor, which helps seniors make Medicare selections. Read more in The Dallas Morning News

Caregiver & Elder Care News

Need to Address Long-Term Care Demands Highlighted in Report by AARP, Others

States struggling with high demand and limited resources to provide non-Medicaid long-term services and supports

July 16, 2013 - A report highlighting the challenges facing states in providing long-term services and supports (LTSS) was released today, just as states begin to implement LTSS options in the Affordable Care Act that increase access to Medicaid home and community based services (HCBS). Most states did not increase funding for non-Medicaid services – including senior centers, information and referral, transportation and caregiver supports, such as those under the Older Americans Act. Read more...

Medicare & Medicaid News

Rates of Major Cardiovascular Procedures Differ for Medicare Advantage, Fee-For-Service Patients

Large study of seniors finds Medicare Advantage patients had lower age, sex, race, and income-adjusted procedure rates for angiography and PCI; wide geographic variation, too – See Video

July 11, 2013 - In a study that included nearly 6 million senior citizens from 12 states in Medicare Advantage or Medicare fee-for-service plans, rates of angiography and percutaneous coronary interventions were significantly lower among Medicare Advantage beneficiaries and geographic variation in procedure rates was substantial for both payment types, according to a study in the July 10 issue of JAMA. Read more...

Medicare News

Federal Judge Says Medicare Patients Do Not Have to Improve to Get Physical Therapy

Center for Medicare Advocacy offers free "self-help" packets for Medicare patients explaining how to challenge a denial of coverage

By Susan Jaffee, Kaiser Health News
This KHN story was produced in collaboration with The Washington Post

June 25, 2013 - For years, seniors in Medicare have been told that if they don't improve when getting physical therapy or other skilled care, that care won't be paid for. No progress, no Medicare coverage - unless the problem got worse, in which case the treatment could resume. Read more...

Senior Citizen Alerts

Hype Begins on Health Insurance Marketplace Which Does Not Apply to Seniors on Medicare

Senior citizens need to be aware that the insurance portion of Obamacare does not apply to them – they stay in Medicare

By Tucker Sutherland, editor,

June 24, 2013 - The educational effort by the Obama administration to introduce the Health Insurance Marketplace – the centerpiece of the Affordable Care Act (Obamacare) – kicked off today. There will be lots of hype on this health insurance part of the plan but senior citizens need to know it does not apply to them. Those age 65 and older will continue their coverage in Medicare and, or Medicaid. Below are some key things seniors need to know. Read more...
Medicare & Medicaid News

Understanding Medicare Premiums; Now Projected to Grow Slower

There are different types of Medicare premiums and you can learn more about them in this Q&A from Families USA

By Ron Pollack, Executive Director, Families USA

June 21, 2013 - At the end of May, the Medicare Trustees reported that Medicare costs are expected to grow more slowly than was previously expected. One of the positive effects of this trend is that Medicare premiums are also expected to increase more slowly. What does that mean for you and your family? Here’s a look at the different types of Medicare premiums. Read more...

Medicare & Medicaid News

Senior Citizens May Soon Get Medicare Health Records on Smartphones, Carry on Doc Visits

Within the next 12 months seniors in Medicare will be able to get the same data on their smartphone their doctors send to each other, one doctor says; check out website of Medicare Blue Button

By Elizabeth Stawicki, Minnesota Public Radio

June 17, 2013 - It's one of those unhappy holiday surprises - a visiting family member gets sick. That happened to Dr. Farzad Mostashari last Thanksgiving. Read more...

Yahoo News

Sequester hits cancer patients — doctors, lawmakers seek fix

By Rachel Rose Hartman, Yahoo! News | The Ticket

June 10, 2013 - You may have heard that White House tours were cut due to across-the-board federal spending cuts known as the sequester. Or that Congress made sure to minimize disruptions to air travel. Or perhaps you know someone being furloughed as a result of the cuts.

But did you know a major fight is being waged over sequester cuts to some cancer drugs?

After Congress failed to pass a budget this spring, a 2 percent cut to Medicare chemotherapy drug reimbursements went into effect April 1 as part of the across-the-board federal spending cuts designed to save $85.4 billion this year. More at Yahoo News

Medicare & Medicaid News

New Medicare Statements in the Mail to Help Seniors Fight Fraud

Redesigned health care summaries designed to help seniors identify improper payments; mailed quarterly

June 10, 2013 – Medicare says senior citizens and other beneficiaries of the program will soon be receiving a redesigned statement of their claims for service and benefits. The new look is aimed at helping them spot “potential fraud, waste and abuse.” Read more...

Medicare & Medicaid News

Administration Says New Data Release Helps Patients, Doctors Improve Health Care

‘...committed to making the health system more transparent and harnessing data to empower consumers’

June 3, 2013 – On the heels of the Medicare Trustees Report saying the life of Medicare has been extended by better control of spending, the Centers for Medicare & Medicaid Services (CMS) and other agencies today released new data making the cost of health care even more transparent for patients and medical professionals. Read more...

Medicare News

Better Control of Spending Extends the Life of Medicare Trust Fund

See below news report: About Trustees Report (Links to detailed information); Summary of 2013 Reports; News Reports by Leading Media

By Mary Agnes Carey, Kaiser Health News

June 3, 2013 - Slower growth in spending is helping extend the life of Medicare’s hospital trust fund to 2026, two years beyond last year’s estimate, officials said Friday. Read more...

Social Security Q&A

How to Fix a Hole in Social Security Work History; Must You Buy Medicare Part A Hospital Insurance?

As more open ‘my Social Security’ accounts there are certain to be more questions for SSA to answer in this weekly Q&A

May 29, 2013 – As more senior citizens and others create personal online accounts at Social Security, there is a natural increase in questions about their records. Oscar Garcia, writing for the SSA Q&A explains what to do if you find part of your work history missing. He also has an answer for a senior wanting to know if they have to buy Medicare Part A – hospital insurance. Read more...

Medicare & Medicaid News

Can Medicare Save Money for Beneficiaries and Taxpayers Alike?

Drug program offers some sizable opportunities for the program and senior citizens to save

By Ron Pollack, Executive Director, Families USA

Health Care Matters

May 28, 2013 - Since Medicare Part D went into effect in 2006, prescription drugs have been an integral part of the Medicare benefit package. So, the question of how seniors can save additional money on medications often comes up, but so does the question of how the entire Medicare Part D program can be more cost-effective and save taxpayers money without jeopardizing enrollee benefits. Read more...

Caregiver & Elder Care News

Health Plan Offers Members Access to Walgreens Clinics; Geriatric Society Offers Tips on Use

AGS updates tip sheet on what senior citizens and caregivers need to know about using retail clinics; Wellcare makes deal for Medicare health plan members

By Tucker Sutherland, editor

May 23, 2013 - Health care services by retail clinics can be a safe option for older adults for occasional, minor health problems, but should not take the place of an individual’s primary care provider, according to a newly updated consumer tip sheet by the American Geriatrics Society (AGS) and A sign of the growing popularity of these clinics is an announcement this week by WellCare Health Plans that it will offer its Medicare Advantage members access to the more than 370 Take Care Clinics located at select Walgreens.

Medicare & Medicaid News

Senate Aging Committee Wants GAO Investigation of Medicare Drug Plan Information; Opens Hearing

'Aggressive marketing tactics used by Medicare Advantage plans may be misleading senior citizens about the true cost and scope of benefits'

May 22, 2013 – The bi-partisan leadership of the Senate Special Committee on Aging has requested an investigation of pricing and coverage details presented by sponsors of Medicare prescription drug programs on Medicare’s online Part D. prescription drug plan finder. The committee will also hold its own hearing today on the Medicare drug program, which is nearing its tenth anniversary. Read more...

Medicare & Medicaid News

Ideas on Cutting Cost of Medicare Released by Medicare Rights Center

Medicare advocate also unveils updated fact sheets on Medicare deficit reduction proposals

May 20, 2013 - The Medicare Rights Center, New York, recently released its latest fact sheet in a series on ways to reduce the Medicare deficit. The latest resource, “Build on What Works: Medicare Cost Savers,” outlines proposals to eliminate wasteful spending in Medicare and promote the delivery of high value, affordable health care. Read more...

Medicare & Medicaid News

Marilyn Tavenner Confirmed to Head Medicare, Medicaid After Six Years of Senate Inaction

Jennifer Haberkorn of Politico Pro discusses the confirmation and the future for the CMS chief in interview with Kaiser Health News

May 16, 2013 – It only took about six and a half years but the Senate has confirmed a chief administrator for the Centers for Medicare and Medicaid Services. Marilyn B. Tavenner, the Obama nominee, got the Senate nod yesterday on a 91-to-7 vote. She has been acting head for two years after serving as Virginia’s health secretary and as a hospital executive. Read more...

Medicare & Medicaid News

New Round of Health Care Innovation Awards Follows Year of Slower Growth in Medicare Costs

Program by Center for Medicare and Medicaid Services seeks more ideas for better health care at lower cost

May 15, 2013 – On the heels of news that healthcare spending by Medicare per beneficiary increased by just 0.4 percent last year – far below historical averages – the Obama administration today announced the second round of Health Care Innovation Awards as part of the effort to deliver better healthcare at a lower cost. Read more...

Medicare News

Wide Variance in What Hospitals Charge Exposed in Data Release by Obama Administration

Consumers don’t know what hospitals charge them or their insurance company; info aimed at helping them make smart choices

May 8, 2013 – The cost of healthcare just became a lot more transparent with the release of information by Health and Human Services on what hospitals charge for common inpatient services. The information shows an extreme variance across the country and even within communities. Read more...

Medicare & Medicaid News

Seniors Stunned by Costly Medicare Rules for Observation Care; Advocates Head to Court

Elderly patient shocked to learn two days of hospital stay were considered 'observation care' and kept her from nursing home coverage

By Susan Jaffe, Kaiser Health News

May 3, 2013 - After Lois Frarie, a 93-year-old retired teacher from Monterey, Calif., spent four days at a local hospital while being treated for a broken elbow and pelvis, she went to a nearby nursing home to build up her strength. But her family was stunned to find out that they would have to pay thousands of dollars up front since two of the days she spent in the hospital were considered "observation care." Read more...

Medicare Seeks To Limit Number Of Senior Citizens Placed In Hospital Observation Care

Statement issued by CMS is below this news story; now elderly must spend three days as hospital patient before being eligible for nursing home care

By Susan Jaffe, Kaiser Health News

May 3, 2013 - Medicare officials have proposed changes in hospital admission rules that they say will curb the rising number of beneficiaries who are placed in observation care but are not admitted, making them ineligible for nursing home coverage. Read more...

Medicare News

Obama Administration Offering Seniors a Reward of Almost $10 Million for Exposing Medicare Fraud

Also funding expansion of Senior Medicare Patrol to spread the word on fraud, waste and abuse - elderly are on  'frontlines of this fight,' 'critical partners' in protecting taxpayer dollars

April 24, 2013 – The Obama Administration made it clear today that it is out to stop Medicare fraud. The proposal of a new rule today indicates they want to increase rewards paid to Medicare beneficiaries and other individuals whose tips about suspected fraud lead to the successful recovery of funds to as high as $9.9 million from the current limit of $1,000. Read more...

Health & Medicine for Senior Citizens

Questions About Colon Screening Coverage Still Vex Consumers; Difference for Medicare, Others

People in group, individual health plans don't pay for polyp removal during a screening colonoscopy; feds say it is an integral part of screening and should be covered without cost sharing - Medicare may still require co-pay. Some remain vexed and confused about testing that begins at age 50 for second leading cancer killer

By Michelle Andrews, Insuring Your Health, KHN

April 16, 2013 - No one looks forward to screening tests for colon and rectal cancers. But under the Affordable Care Act, patients are at least supposed to save on out of-pocket costs for them. Coverage is not always clear, however, and despite the federal government's clarifications, some consumers remain vexed and confused. Read more...

Senior Citizen Politics

Five Ways the President's Budget Would Change Medicare; Reduce Spending $371 Billion in Decade

Wealthier beneficiaries to pay more for coverage and future retirees to pay higher copays for outpatient services such as doctor's visits and home health care

By Mary Agnes Carey, KHN Staff Writer

April 15, 2013 - President Barack Obama's fiscal 2014 budget includes a variety of what he says are "manageable" changes for Medicare's 54 million beneficiaries as well as for the hospitals, nursing homes and other health care providers that serve them. Read more...

Senior Citizen Politics

Ways and Means Draws Bead on Medicare Cuts, Chained CPI to Limit COLA for Social Security

HHS Secretary Sebelius in witness chair today on total budget for HHS, CMS with Social Security proposal the target this Thursday

April 12, 2013 – The Republican-led House Ways and Means Committee has grabbed the lead in questioning President Obama’s 2014 budget proposals for the Department of Health and Human Services, which includes the Centers for Medicare and Medicaid Services. HHS Secretary Kathleen Sebelius will testify there today and next Thursday the hearing topic will be on entitlement reform proposals, with emphasis on the controversial Chained Consumer Price Index, which will be used to lower cost-of-living adjustments for seniors and others in future years. Read more...

Senior Citizen Politics

Obama Says Budget Proposal Offers ‘Manageable’ Curbs on Medicare Cost, Social Security Benefits

Most media reports say focus of White House is to strike a ‘Grand Bargain’ with Republicans who want to change Medicare into a voucher-style system;  Medicare proposal has one revenue item - higher premiums for couples making more than $170,000 a year

April 11, 2013 - The White House says its budget is a good start toward controlling government entitlement programs by offering proposals to curb the growth of Social Security, Medicare and other federal benefit programs. The budget blueprint, released Wednesday, includes what the president called "manageable" curbs on Medicare spending growth, but GOP congressional leaders were dismissive, while some Democrats and virtually all senior citizen advocacy groups were unsettled. Read more...

Senior Citizen Politics

How Chained Consumer Price Index Proposed by Obama Works to Curb Social Security Benefits

Bureau of Labor Statistics provides a Q&A about inflation calculation that will slow cost-of-living adjustments for senior citizens

April 11, 2013 – The term “COLA” is a part of the Social Security program that has been highly cherished by senior citizens. It stands for “cost-of-living adjustment,” and was the government’s way of being trying to keep retired older Americans from seeing their Social Security benefits eaten away by inflation. Now, the Obama administration has come up with a new way to calculate inflation that will reduce COLA in the future. It is called the chained consumer price index and below is a Q&A on this method provided by the Bureau of Labor Statistics. Read more...

Senior Citizen Politics

Reporters Dig Into Obama Budget and Find Other Proposals that May Impact Seniors

More spending on Medicaid, mental health; replacing current formula for Medicare pay to doctors

April 11, 2013 – Senior citizens have – rightly so – primarily focused on the cuts to Social Security and Medicare in the 2014 budget proposal from the White House that was presented yesterday. Media sources have found other parts of the budget that may also impact many seniors - funding boosts for mental health and food and drug safety, as well as the elimination of the SGR formula to set Medicare physician payment rates. It also delays funding cuts to hospitals that treat the uninsured. Read more...

Senior Citizen Politics

Congress Could Lose Older Voters by  Cutting Social Security, Medicare, Vets Benefits: AARP Poll

Senior advocates seem solid in opposition to cuts expected to appear Wednesday in President Obama’s budget; Congressional call-in on Wednesday

April 8, 2013 – Groups that advocate for senior citizens and senior issues appear to be solid in their opposition to budget moves advocated by Republicans and now supported by the White House that will cut income from Social Security and reduce spending by Medicare. A survey released today by AARP says 84% of American voters age 50 and older oppose the chained CPI proposal for reducing Social Security benefits for years ahead. Read more...

Medicare News

Medicare Advantage Plans Win Major Concession from Obama Administration

Payments to insurers was forecast in February to be cut for 2014, but it goes up in revision released Monday

April 2, 2013 – The final rate announcement for Medicare was to be announced yesterday but was a little delayed as the Centers for Medicare & Medicaid carefully worded the news release revealing a 3.3 percent increase for insurance companies offering Medicare Advantage plans, rather than the 2.2 percent reduction forecast in a February announcement. Read more...

Medicaid News

Arkansas Medicaid Plan, Born Of Necessity, Shakes Things Up in Reluctant Republican States

By Karl Eisenhower, Capsules – the KHN Blog

 March 26, 2013 - Since the Supreme Court made the Medicaid expansion under the federal health law optional last year, states’ decisions have largely split along party lines. States run by Democrats have been opting in; states run by Republicans have mostly been saying no or holding back.. Read more...

Medicare News

Medicare a Hot Button as Budget Proposals from Political Parties Smash Head-On

GOP’S Ryan presents ‘austere budget proposal that looks a lot like one they approved last year that Democrats quickly dismissed. Republicans revived plans to overhaul Medicare, slash the social safety net for the poor and bolster defense — all while lowering corporate and individual tax rates to no more than 25%’

March 13, 2013 – The political parties are running out their budget proposals and the general consensus is they are “miles apart.” The House GOP plan, which was unveiled yesterday, would repeal the health law's subsidized insurance exchanges and Medicaid expansion and turn Medicare into a premium-support system. The Senate Democrats' plan, scheduled for release today, would lower domestic spending in part by saving $275 billion through changes to Medicare and Medicaid that are smaller than those proposed by Republicans. Read more...

Senior Citizen Politics

Senate Aging Committee Hears Changes to Medicare Unpopular with Senior Citizens, Voters

First hearing of this Congress lays out the problems and the options with a focus on fixing the cost of healthcare

Feb. 28, 2013 - The first hearing by the Senate Special Committee on Aging since the leadership was handed to Sen. Bill Nelson (D-Fl) and ranking member, Susan Collins of (R-Me) took on the challenge of Medicare’s future yesterday. But, rather than a doom-and-gloom hand wringing, it was an earnest, straight-forward approach at helping the popular senior program survive with little or no damage to its services. Read more...

Senior Citizen Politics

New Senate Aging Committee Tackles Future of Medicare in Hearing Wednesday

Sen. Bill Nelson (D-Fl) takes over as chairman; Sen. Susan Collins (R-Me) now leads Republicans (see members below news story)

Feb. 26, 2013 – The first hearing by the Senate Special Committee on Aging will convene tomorrow in hopes of finding the best way to shape the future of Medicare to meet the challenges of a booming senior population, climbing prices for health care and a strained federal budget. It is the first hearing under new chairman, Sen. Bill Nelson (D-Fl), and ranking member, Sen. Susan M. Collins (R-Me). Read more...

Medicare News

Changes To Medicare is Focus of Three Congressional Hearings This Week

Small signs that Democrats and Republicans are beginning to wrestle with the issue of what role Medicare should play in deficit reduction

By Mary Agnes Carey

Feb. 25, 2013 - With $85 billion in automatic federal spending cuts set to take effect on Friday and predictions of economic disruption, much of official Washington is focused on the “blame game.” Publicly, there has been no sign that Congress or administration officials has made any progress on averting these cuts or finding common ground on tackling the country’s fiscal problems. Read more...

Medicare News

Traditional Medicare’s Administrative Cost – 1%; Private Company Medicare Advantage – 6%

Setting the record straight on Medicare's overhead costs: New study finds surprising results

Feb. 20, 2013 - The traditional Medicare program allocates only 1 percent of total spending to overhead compared with 6 percent when the privatized portion of Medicare, known as Medicare Advantage, is included, according to a study in the June 2013 issue of the Journal of Health Politics, Policy and Law. Read more...

Medicare News

Seniors to See Lower Costs in Medicare Drug, Advantage Plans in 2014, Says CMS

Agency also says seniors getting greater value and improved payment accuracy in proposed 2014 payment and policy updates

Feb. 16 , 2013 – Medicare costs for seniors are going down, says an announcement yesterday by the Centers for Medicare & Medicaid Services. Since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have fallen by 10 percent and enrollment is expected to increase by an estimated 28 percent through this year. In addition, costs of the defined standard Part D plan will be lower in 2014 than they are in 2013. The standard Part D deductible will be $310, down from $325 in 2013, and cost-sharing amounts will also be lower. Read more...

Senior Citizen Politics

President Obama Calls For Two 'Modest Reforms' To Medicare

Obama suggests two specific changes in Medicare: drug-makers should go back to giving rebates for dual-eligibles, having wealthiest seniors pay more for Medicare

Feb. 14, 2013 - Jackie Judd and Kaiser Health New's Mary Agnes Carey examine the health care issues in Tuesday night's State of the Union address - and Sen. Rubio's Republican response - in this Health on the Hill discussion. Read more...

Medicare News

Medicare Says Obamacare Provided $5.7 Billion in Drug Savings; Free Preventive Service to 34 Million

Detailed reports shows state-by-state activity; emphasizes donut hole reduction, free preventive services, holding down costs, stopping fraud

Feb. 7, 2013 – A detailed report of the savings and benefits enjoyed by senior citizens in Medicare, since the passage of the Affordable Care Act (Obamacare), was released today by the Centers for Medicare and Medicaid Services. It highlights the $5.7 billion seniors saved by the shrinkage of the drug programs “donut hole,” the 34 million older Americans who have used a free preventive health service, program costs control and fight against fraud. Read more...

Senior Citizen Politics

Obama Says He Has Offered 'Sensible Reforms To Medicare' in Press Briefing on Budget

‘Reforms would reduce our government’s bills by reducing the cost of health care, not shifting all those costs on to middle-class seniors…’ see video

Feb. 6, 2013 – President Barack Obama spoke briefly to the press yesterday about budget negotiations and emphasized the need to reduce the cost of health care in the U.S. He also touched on entitlements and, specifically, Medicare. Below is the complete transcript with key words on senior programs highlighted in yellow. Read more, see video...

Medicare News

Hospice Group Says JAMA Report on Last Minute Use of Hospice Care is Call for Action

NHPCO calls for earlier and more frequent conversations between patients and healthcare professionals

Feb. 6, 2013 – Research published yesterday in JAMA found the rate of hospice use doubled from 2000 to 2009 but 28 percent of these dying Medicare patients used the service three days or less. This is “a call for action,” says a statement from the National Hospice and Palliative Care Organization. Read more...

Medicare News

Lower Percentage of Medicare Patients Dying in Hospitals; Increase in Use of ICUs, Hospice

The use of hospice care has doubled but it tends to be for a very short period before death - see video

Feb. 5, 2013 – In a study that included data on more than 800,000 Medicare patients who died between 2000 - 2009, a lower proportion died in an acute care hospital in recent years, although both intensive care unit (ICU) use and the rate of health care transitions increased during the last month of life, according to a study appearing in the February 6 issue of JAMA. Read more, see video...

Medicaid News

Florida Gets Okay to Shift Medicaid Long-Term Care for Seniors to Managed Care

Medicaid-eligible seniors needing long-term care likely will start enrolling later this year in managed care - in their homes!

By Jim Saunders, The News Service of Florida.

Feb. 5, 2013 - Federal health officials have approved a key part of Florida's effort to transform its Medicaid program, clearing the way for tens of thousands of seniors across the state to move into managed-care plans. Read more...

Medicare News

Sickest Senior Citizens Appear to be Leaving Medicare Advantage for Traditional Medicare

Some question if private HMO-style plans structure care to be less appealing to very ill, want to hold more profitable patients; maybe very sick seniors more interested in choosing doctors

By Jordan Rau, KHN Staff Writer

Feb. 4, 2013 - New research finds that many seniors who switch from their HMO-style Medicare Advantage plan to traditional Medicare have higher levels of significant health problems, fueling concerns that the private plans cater to more profitable, healthy beneficiaries but don’t provide the most attractive care for the very ill. Read more...

Medicare News

Medicare Patients with Heart Failure, Attack, Pneumonia Return to Hospital for New Reasons

Diagnoses associated with 30-day re-admission are diverse and not associated with patient demographics or time after discharge for older patients - see video

Jan. 23, 2013 – Among approximately 3 million Medicare patients hospitalized for heart failure, heart attack, or pneumonia, re-admissions were frequent throughout the 30 days following the hospitalization, and resulted from a wide variety of diagnoses that often differed from the cause of the index hospitalization, according to a study appearing in the January 23/30 issue of the Journal of the American Medical Association (JAMA). Read more, see video...

Medicare News

Medicare Efforts to Slow Hospital Re-Admissions, Hospitalizations Makes Some Gains in Tough Fight

Re-hospitalizations, hospitalizations down but rate of re-admissions to discharges holds steady

Jan. 23, 2013 – A top priority in Medicare’s effort to control cost has been to reduce re-hospitalizations and a new study finds some success. In communities where care transition initiatives were implemented for Medicare patients, there have been declines in all-cause 30-day re-hospitalizations and hospitalizations in general. But, there was no significant drop in the rate of re-hospitalization as a percentage of discharges. Read more...

Medicare News

Hospices May Be Discouraging Patients with Expensive Medical Needs

Medicare pays for most hospice care and a patient's doctor and hospice medical director must certify patient has 6 months or less to live; patients must agree not to seek curative care

Jan. 23, 2013 - Many people who are terminally ill delay entering hospice care until just a few days or weeks before they die, in part because they or their families don't want to admit that there's no hope for a cure. Read more...

Senior Citizen Politics

Senior Citizens Hear Encouraging Words on Entitlements in President's Second Inaugural

'The commitments we make to each other through Medicare and Medicaid and Social Security, these things do not sap our initiative, they strengthen us' - see video

Jan. 22, 2013 – President Barack Obama generally drew praise from senior citizen advocates for the words in his inaugural address yesterday that signaled his commitment to preserve the “entitlement programs” of Medicare, Medicaid and Social Security. Read more, see video...

Medicaid News

HHS Issues Rule to Equip Medicaid, States to Better Handle Influx of New Medicaid Patients

Hopes to streamline eligibility, appeals and give states more flexibility as millions more join Medicaid, Children’s Health Insurance Program

Jan. 14, 2013 – Medicaid is headed for significant expansion in 2014 due to the Affordable Care Act, and Health and Human Services proposed a rule today to promote consistent policies and processes for eligibility notices and appeals in this program, the Children’s Health Insurance Program (CHIP) and state-based health insurance marketplaces known as Exchanges. Read more...