April Medicare Must-Knows

By Jake Clark

RetireMEDiQ strives to keep individuals informed about the latest Medicare news. Each month, we recap the top information consumers need to know about recent developments in the Medicare industry and how it may affect you.

The Coronavirus Impact: Special Coverage

We have been diligently following the news to capture changes to Medicare during the ongoing coronavirus pandemic. To help keep you informed, RetireMEDiQ has launched a special series of articles covering the changes and how they might impact you. Check the RetireMEDiQ blog for updates as we continue to monitor the news, or begin by exploring our existing coverage below:

Government Launches All-New Part D Senior Savings Model to Lower Costs Insulin.

The federal government recently launched a new cost-savings model aimed at reducing the cost of insulin. This model, called the Part D Senior Savings Model, is a voluntary model that “enables participating Part D enhanced plans to lower Medicare beneficiaries’ out-of-pocket costs to a maximum $35 copay per 30-day supply throughout the benefit year,” according to a press release from the Centers for Medicare & Medicaid Services (CMS). This model could save beneficiaries an average of $446 in out-of-pocket costs for insulin in a year, assuming they are enrolled in a participating plan. 

The goal of this program is to enable those of age to have more consistent, lower-cost access to this important medication. With proper access to this drug, individual’s overall health will improve, thus reducing the demand on the health care system and lowering costs of care for seniors across the nation. The initial projections of the Part D Senior Savings Model indicate that it will generate over $250 million in savings for the federal government over five years. The list of participating insurance plans will be released during the 2021 Medicare Annual Enrollment Period. If you want to learn more about this program, visit the Centers for Medicare & Medicaid Services website.

Observation Stays Challenged at Federal Level

Amidst the changes to Medicare happening due to the current pandemic, other major changes are well underway regarding Medicare benefits and observation stays. Under Medicare rules, in order for an individual to qualify for skilled nursing care, that person must be in the hospital for three consecutive days under the status of “inpatient.” If, during their hospital stay, a doctor changes their status from “inpatient” to “observation,” their time in the hospital no longer counts towards the three-day stay requirement. A patient might be switched from inpatient to observation status for a variety of reasons, and the level of treatment does not always differ between the two statuses. This month, under a ruling from a federal judge, beneficiaries who were denied Medicare coverage for skilled nursing care due to being moved to “observation” status during their time in the hospital can now challenge that decision and make an appeal to receive funds to cover their post-hospital care. U.S. District Judge Michael Shea’s decision could impact hundreds of thousands of Medicare beneficiaries, as it “applies to all traditional Medicare beneficiaries who experienced such a switch since Jan. 1, 2009, spent at least three days in the hospital and were enrolled in Medicare’s Part A hospital benefit. If they win their appeal, most hospital expenses and any nursing home bills they paid would be reimbursed under Part A.” Follow the coverage of this story at Kaiser Health News

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If you have questions about anything covered in this post, please comment below, call our team of Client Advisors at 1-877-222-1942 or email us at client@retiremediq.com.

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