Would this apply to ESRD patients?

[Guest guest]

In this recent email/update from MRC

advocacy – wonder if anyone knows if the area I have highlighted in blue

would mean that patients with ESRD could sign up for such plans? (Now they

cannot).

And if the last paragraph comes to

fruition, would be helpful for us TFCs as we work to help our patients

understand their benefit packages!

************************************************************************

April 2,

2009 • Volume 9, Issue 13

The Centers for Medicare & Medicaid Services (CMS) took important steps

this week toward cleaning up the marketplace for Medicare private health plans.

In the 2010 Call Letter, which sets the contract terms for next year, CMS told

the insurance companies to consolidate their plan offerings by eliminating

plans that have low enrollment or offer substantially similar benefits as other

options offered by the same company. CMS is looking for companies to come up

with no more than three options for each market, with each option presenting a

meaningful difference for the consumer, such as the choice between an HMO and a

PPO.

This directive should go a long way toward

reducing confusion in the marketplace and clarifying the choices available to

consumers. When consumers are frustrated and confused by their coverage

choices, they are more likely to give in to the pat answers and high pressure

tactics of unscrupulous agents out for a quick buck. Agents who are trying to

give their clients affordable, quality coverage will have an easier time

identifying and explaining the best coverage options.

Even more importantly, CMS made it clear that

plans will no longer be able to design benefits to discriminate against

consumers with serious health problems. We hope that means no

more benefit packages that begin charging daily copays for care at skilled

nursing facilities before the 21st day, which is when Original Medicare starts

to assess daily copays.

The agency is pushing all plans to set an annual out-of-pocket limit for ALL

medical services of $3,400. We hope that means that plans will no longer be

able to advertise an out-of-pocket limit and carve out certain services in the

fine print, making enrollees pay unlimited copays for doctor visits or

chemotherapy drugs.

The first step in implementing these reforms is a rigorous review of the

benefit packages submitted by the plans. The second step will involve simplifying

the information consumers receive about benefit packages on medicare.gov, in

the Medicare and You handbook and in the marketing materials provided by the

plans. For example, consumers should know, without calling the plan or hunting

through the fine print, that the plan’s out-of-pocket limit includes all

Medicare-covered medical services.

Daryl Battin, MSW/LICSW

Financial Coordinator/Social Worker

Department of Transplantation -- Kidney

Lahey Clinic, 41 Mall Road, Burlington

MA 01805

Ph: / FAX:

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