HHS announces first guidance implementing Supreme Court’s decision on the Defense of Marriage Act

Today, the Department of Health and Human Services (HHS) issued a memo clarifying that all beneficiaries in private Medicare plans have access to equal coverage when it comes to care in a nursing home where their spouse lives.  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.

“HHS is working swiftly to implement the Supreme Court’s decision and maximize federal recognition of same-sex spouses in HHS programs,” said HHS Secretary Kathleen Sebelius.  “Today’s announcement is the first of many steps that we will be taking over the coming months to clarify the effects of the Supreme Court’s decision and to ensure that gay and lesbian married couples are treated equally under the law.”

“Today, Medicare is ensuring that all beneficiaries will have equal access to coverage in a nursing home where their spouse lives, regardless of their sexual orientation,” said Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner.  “Prior to this, a beneficiary in a same-sex marriage enrolled in a Medicare Advantage plan did not have equal access to such coverage and, as a result, could have faced time away from his or her spouse or higher costs because of the way that marriage was defined for this purpose.”

Under current law, Medicare beneficiaries enrolled in a Medicare Advantage plan are entitled to care in, among certain other skilled nursing facilities (SNFs), the SNF where their spouse resides (assuming that they have met the conditions for SNF coverage in the first place, and the SNF has agreed to the payment amounts and other terms that apply to a plan network SNF).  Seniors with Medicare Advantage previously may have faced the choice of receiving coverage in a nursing home away from their same-sex spouse, or dis-enrolling from the Medicare Advantage plan which would have meant paying more out-of-pocket for care in the same nursing home as their same-sex spouse.

Today’s guidance clarifies that this guarantee of coverage applies equally to all married couples.  The guidance specifically clarifies that this guarantee of coverage applies equally to couples who are in a legally recognized same-sex marriage, regardless of where they live.
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Affordable Care Act Saves $2.1B for 3.6 million Americans with Medicare

FOR IMMEDIATE RELEASE
February 2, 2012
Contact: CMS Public Affairs
(202) 690-6145


New data show average American with Medicare to save nearly $4,200 through 2021 thanks to health reform

Nearly 3.6 million people with Medicare saved $2.1 billion on their prescription drugs in 2011 thanks to the Affordable Care Act according to data issued today by the Department of Health and Human Services (HHS). Savings for people with Medicare will increase over time. According to a new report issued today from HHS, the average person with Medicare will save nearly $4,200 by 2021 because of the new law.

“The Affordable Care Act is already saving money for millions of Americans with Medicare,” said HHS Secretary Kathleen Sebelius.  “As we move forward, we will close the donut hole completely and save even more money for everyone with Medicare.”

The Affordable Care Act provides a 50 percent discount on brand-name prescription drugs and this year, a 14% discount on generics. Last year, it provided a seven percent discount on covered generic medications for people who hit the prescription drug coverage gap known as the donut hole, with 2,814,646 beneficiaries receiving $32.1 million in savings on generics.

In 2011, the 3.6 million Americans who hit the donut hole saved an average of $604 on the cost of their prescription drugs.

Data also show that women especially benefitted from the law’s provision with 2.05 million women saving $1.2 billion on their prescription drugs.

By 2020, the donut hole will be closed completely.  The new report released today by the Department of Health and Human Services finds that this provision and other features of the health reform law will generate substantial savings for people with Medicare. Typical Medicare beneficiaries will save an average of nearly $4,200 from 2011 to 2021. People with high prescription drug costs could save as much as $16,000.

The savings are a product of provisions in the Affordable Care Act and other cost trends that:

  • Decrease prescription drug costs for seniors
  • Make preventive services like mammograms free for everyone in Medicare
  • Reduce growth in Part B premiums (for physician services)
  • Reduce growth in cost-sharing under both Parts A (hospital care) and Part B.

These announcements come one day after HHS announced that in 2012, Medicare Advantage premiums have fallen by seven percent on average and enrollment has risen by about 10 percent since last year.  For more details on that announcement, visit http://www.hhs.gov/news/press/2012pres/02/20120201a.html

For state-by-state savings figures for today’s donut hole announcement, visit: http://www.cms.gov/Plan-Payment/

For a fact sheet about donut hole savings, visit http://www.cms.gov/apps/media/fact_sheets.asp

For the report regarding savings those with Medicare will see over time, visithttp://aspe.hhs.gov/hp/reports/2012/MedicareBeneficiarySavings/ib.shtml

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Medicare Advantage Premiums Down 7% on Average, Enrollment Up 10%

FOR IMMEDIATE RELEASE
February 1, 2012
Contact: CMS Press Office
(202) 690-6145

Medicare Advantage premiums have fallen by 7 percent on average and enrollment has risen by about 10 percent since this time last year, HHS Secretary Kathleen Sebelius announced today.

The enrollment numbers confirm projections from last September that enrollment in Medicare Advantage plans would continue to rise and average premiums would continue to fall.  Average premiums have fallen from $33.97 in 2011, to $31.54 in 2012, while enrollment has risen from 11.7 million in 2011 to 12.8 million in 2012.

“The Medicare Advantage program is stronger than ever,” said Secretary Sebelius.  “Premiums are down on average, enrollment is up, and thanks to the Affordable Care Act we have unprecedented new tools to ensure that seniors and people with disabilities are getting the best value out of their coverage.”

In addition to today’s enrollment and premium numbers, there is more evidence that the Medicare Advantage program remains strong:

  • On average, there are 26 Medicare Advantage plans to choose from in nearly every county across the country;
  • Access to Medicare Advantage remains strong: 99.7 percent of Medicare beneficiaries have access to a Medicare Advantage plan; and
  • Since 2010, when the Affordable Care Act was passed, Medicare Advantage premiums have fallen by 16 percent and enrollment has climbed by 17 percent.

“Not only are average premiums lower, but plans are better, with more beneficiaries enrolled in 4 and 5 star plans,” said CMS Acting Administrator Marilyn Tavenner. “The Affordable Care Act has strengthened Medicare Advantage by motivating plans to improve the quality of their coverage.”

In 2012, thanks to the Affordable Care Act, Medicare Advantage plans will start receiving incentives to achieve high quality scores through the use of quality bonus payments. As an extra incentive for high quality performance, CMS is allowing Five-Star Medicare Advantage and Part D plans to continuously market and enroll beneficiaries throughout the year.

To find the most recent publicly available MA and Part D contract and enrollment data, visit:http://www.cms.gov/MCRAdvPartDEnrolData/MCESR/list.asp#TopOfPage

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2012 Medicare Advantage Premiums Fall and Projected Enrollment Rises

FOR IMMEDIATE RELEASE
September 15, 2011
Contact: HHS Press Office
(202) 690-6343


Open enrollment is earlier this year – October 15 through December 7

On average, Medicare Advantage premiums will be 4 percent lower in 2012 than in 2011, and plans project enrollment to increase by 10 percent, the Department of Health and Human Services (HHS) announced today. Of people with Medicare, 99.7 percent continue to enjoy access to a Medicare Advantage plan, and benefits remain consistent with those offered in 2011. This follows an earlier announcement that average prescription drug plan premiums will remain virtually unchanged in 2012.

“Thanks to the Affordable Care Act, Medicare is stronger than ever,” said Health and Human Services Secretary Kathleen Sebelius. “On average, Medicare Advantage premiums will go down next year and seniors will enjoy more free benefits and cheaper prescription drugs.”

CMS was able to use authority provided by the Affordable Care Act to protect beneficiaries from significant increases in costs or cuts in benefits in 2012, leading to average premium declines for the second year in a row: 2012 premiums are projected to be 11.5 percent below 2010 premiums.

In 2012, all beneficiaries will have access to Medicare-covered preventive services without paying a co-pay or deductible, including an Annual Wellness Visit with their physicians. Those who reach the donut hole will enjoy deep discounts on brand name drugs and expanded coverage for generic drugs under provisions of the Affordable Care Act.

This year marks an important change in Medicare’s annual open enrollment, the time period during which people can choose to change plans or shift from Medicare Advantage to Traditional Medicare. Open Enrollment starts earlier – on October 15, 2011 – and lasts longer (7 full weeks) to give beneficiaries enough time to review and make changes to their coverage. As a result, however, beneficiaries will need to make their elections for next year’s Medicare coverage by December 7, 2011 rather than the usual December 31. The new open enrollment period will better ensure that individuals have their membership cards in hand and receive uninterrupted health care coverage on January 1, 2012.

“Medicare open enrollment is coming early this year, and as people with Medicare make their health and prescription drug coverage choices, they will see that we’ve strengthened consumer protections and improved plan choices,” said CMS Administrator Donald Berwick, M.D. “Due to the Affordable Care Act, Medicare Advantage and prescription drug benefits are stronger than ever, and beneficiaries will continue to have access to a range of affordable products.”

CMS is encouraging beneficiaries enrolled in Medicare Advantage and Medicare Prescription Drug plans to review their current health and drug plan coverage for any changes their plans may be making for 2012 before the annual open enrollment period begins on October 15. Beneficiaries should receive their 2012 Medicare & You handbook as well as a notice from their current plan that describes any changes from 2011 to 2012 by late September.

For the first time, in 2012 CMS will provide financial rewards to those Medicare Advantage plans with high quality scores, under its Five-Star rating methodology. CMS is also allowing Five-Star Medicare Advantage and Part D plans to continuously market and enroll beneficiaries throughout the year, as an extra incentive for high quality performance.

“Plans that do a better job serving the needs of their Medicare members should be rewarded and all plans should be encouraged to improve their performance,” said Jonathan Blum, CMS deputy administrator and director of the Center for Medicare.

Over the next several months, CMS will work with beneficiary advocates, State Health Insurance Assistance Programs and beneficiaries to ensure that people are well equipped to make decisions about health coverage that will best meet their needs in 2012. Only one percent of Medicare beneficiaries are enrolled in plans that will not be available next year, and those enrollees will receive a notice of non-renewal from their plan in the next few weeks. Beneficiaries currently enrolled in a Medicare Advantage plan will revert to Original Medicare if they do not choose a plan on their own; however everyone will need to enroll in a Part D plan to keep their drug coverage. Beneficiaries eligible for the Part D low-income subsidy will be enrolled in a zero-premium drug plan by CMS and will have the option to select a different Medicare plan throughout the year.

Starting October 1, 2011 users of the Medicare Plan Finder, available at www.Medicare.gov, will be able to compare plans’ quality summary rating from the previous year, identify which drugs may or may not be on a plan’s formulary or be restricted, and compare the cost ranges for plans available in their community. Information on 2012 plans will be available online starting October 1, and on October 12, will include the plans’ Five-Star quality rating. To make it easier for beneficiaries to choose high quality plans, users will find an icon that shows those plans that had a low overall quality rating the past three years and, new in 2012, will also see a gold star icon for those plans that have a five-star rating for 2012.

Each year plans change what they cost and what they cover. To find helpful Medicare tools and information, and compare the cost or benefits of 2012 Medicare health plans in your area, please visit:

http://www.cms.gov/center/openenrollment.asp

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