Changes in Medi­care: What is new this year?

Daily Local News (West Chester, PA) - - FIFTY PLUS - Kath­leen Martin Le­gal Ease

The Cen­ters for Medi­care and Med­i­caid Ser­vices (CMS) work con­stantly on up­grad­ing ser­vices and in­for­ma­tion re­sources for Medi­care ben­e­fi­cia­ries now and to come. Un­til De­cem­ber 7, it is the an­nual open en­roll­ment pe­riod when Medi­care ben­e­fi­cia­ries are in­vited to review their cur­rent plans and change ser­vice providers, move into or out of a Medi­care Ad­van­tage plan, or change a Part D plan. This is also a good time of year to note some changes in the world of Medi­care.

CMS is work­ing on sev­eral projects that will change the land­scape of Medi­care. Start­ing April, 2018, CMS plans to is­sue new iden­ti­fi­ca­tion cards to the roughly 60 mil­lion Medi­care ben­e­fi­cia­ries. Tra­di­tional Medi­care (the white card with the red and blue stripes) has looked the same for many years. Some time ago, an Act of Congress has or­dered CMS to re­move the So­cial Se­cu­rity num­ber from Medi­care cards be­cause of the dan­ger of iden­tity theft. Re­mem­ber that nearly ev­ery­one else is pro­hib­ited from us­ing So­cial Se­cu­rity num­bers, or at least the en­tire num­ber, as iden­ti­fy­ing in­for­ma­tion. De­spite that pro­hi­bi­tion, Medi­care cards tra­di­tion­ally dis­play one’s So­cial Se­cu­rity num­ber in its en­tirety. The plan is to sub­sti­tute So­cial Se­cu­rity num­bers with an 11digit al­pha –nu­meric code.

An­other ini­tia­tive was to update fed­eral nurs­ing home reg­u­la­tions which had not been done in some time. A por­tion of the reg­u­la­tions that is get­ting a lot of at­ten­tion is the sec­tion re­gard­ing pre-dis­pute ar­bi­tra­tion clauses espe­cially in nurs­ing home con­tracts. This refers to a clause in some nurs­ing home con­tracts, whereby the in­di­vid­ual is agree­ing not to sue but to use ar­bi­tra­tion and an ar­bi­tra­tor that is se­lected by the nurs­ing home sys­tem. That may not sound like a prob­lem but giv­ing up the right to seek re­dress in the court sys­tem for those who are in­jured can be sig­nif­i­cant, both for that in­di­vid­ual and for other sim­i­larly in­jured per­sons. The New York Times re­ported re­cently that the Con­sumer Fi­nan­cial Pro­tec­tion Bureau, the na­tion’s con­sumer watch­dog, is work­ing on a draft of a rule that would pre­vent credit card com­pa­nies and other fi­nan­cial firms from us­ing ar­bi­tra­tion clauses that would pre­vent con­sumers from band­ing to­gether to bring a class ac­tion law­suit. Read nurs­ing home con­tracts and credit card con­tracts care­fully.

CMS is slow­ing down the process of “seam­less con­ver­sion” that al­lows em­ploy­ers to “con­vert” Medi­care el­i­gi­ble em­ploy­ees with em­ployee health plans into lu­cra­tive Medi­care Ad­van­tage prod­ucts with­out the full un­der­stand­ing and con­sent of the em­ployee. The em­ployee may opt out but may not re­al­ize that they must af­fir­ma­tively do so. The em­ployer and plan must re­quest per­mis­sion from CMS to do this, and CMS has tem­po­rar­ily sus­pended ac­cept­ing new pro­pos­als.

The in­fa­mous “donut hole” in the Medi­care Part D pre­scrip­tion drug plan is get­ting smaller. In 2017, if ben­e­fi­cia­ries reach the cov­er­age gap or donut hole, they will pay 40 per­cent of the plan’s cost for cov­ered brand-name drugs and 51 per­cent of the plan’s cost for cov­ered generic drugs un­til reach­ing the end of the gap.

Preven­ta­tive care con­tin­ues to be em­pha­sized and ben­e­fi­cia­ries are en­cour­aged to take ad­van­tage of this op­tion. On­line tools are im­prov­ing; go to mymedi­care.gov for the lat­est en­hance­ments. The in­for­ma­tion on the 2017 Medi­care pre­mi­ums, de­ductibles, and co-in­sur­ance amounts are ex­pected to be an­nounced in Novem­ber.

The le­gal ad­vice in this col­umn is gen­eral in na­ture, con­sult your at­tor­ney for ad­vice to fit your par­tic­u­lar sit­u­a­tion.

Kath­leen Martin, Esquire is li­censed to prac­tice in the Com­mon­wealth of Penn­syl­va­nia and is cer­ti­fied as an El­der Law At­tor­ney by the Na­tional El­der Law Foun­da­tion as au­tho­rized by the Penn­syl­va­nia Supreme Court. She is a prin­ci­pal of the law firm of O’Don­nell, Weiss & Mat­tei, P.C., 41 High Street, Pottstown, and 347 Bridge Street, Phoenixville,610-323-2800, www. owm­law.com. You can reach Mrs. Martin at kmartin@owm­law.com.

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