The Center For Medicare Services (CMS) plays a vital role in administering Medicare, and recent updates have significant implications for beneficiaries. The Center for Medicare Advocacy actively monitors and responds to CMS directives to ensure that individuals receive the care they are entitled to.
In a recent announcement on February 13, 2024, CMS issued reminders to healthcare providers and Medicare adjudicators regarding the “Improvement Standard.” This standard had been erroneously applied, denying coverage for necessary care. The CMS action emphasizes the importance of proper training and adherence to correct coverage criteria within traditional Medicare and Medicare Advantage plans. This is a crucial step to rectify past misinterpretations and ensure beneficiaries with chronic conditions receive appropriate care.
Learn more about the Jimmo Settlement and CMS Implementation Activity
Flyer about Chronic Conditions Coverage under Medicare. Text includes: Chronic Conditions Are Coverable. Medicare covers people with chronic conditions. Coverage is available for services to maintain, or slow decline of your condition. For more information and resources visit MedicareAdvocacy.org. Center for Medicare Advocacy.
It’s important to understand that Medicare coverage extends to individuals with chronic conditions. Despite common misconceptions, Medicare is designed to support those who need ongoing care to maintain their health or slow decline. The Center for Medicare Advocacy provides resources to help individuals understand their rights and access the coverage they deserve for chronic conditions.
View the Chronic Conditions Coverage Infographic
However, challenges remain within the Medicare system, particularly concerning Medicare Advantage (MA) plans. The Center for Medicare Advocacy has long advocated for greater oversight of MA plans, which are often overpaid, contributing to increased Medicare spending. Furthermore, lax oversight can lead to inadequate consumer protections within these privatized plans. Policy makers are urged to increase scrutiny and implement measures to control overpayments and ensure equitable treatment for beneficiaries in both Medicare Advantage and traditional Medicare.
Read the Call to Action for Medicare Advantage Oversight
Another area of concern is the automatic enrollment of retirees into Medicare Advantage plans. This practice limits beneficiary choice and undermines the principle of informed decision-making within Medicare. Automatic enrollment can steer individuals into plans that may not best meet their needs, restricting their access to preferred providers or care options. Protecting beneficiary choice remains a critical aspect of Medicare advocacy.
Explore the Issue Brief on Retiree Auto-Enrollment in Medicare Advantage Plans
Finally, access to Medicare home health coverage often falls short of legal guarantees. While Medicare law ensures coverage for home health services for individuals with acute or chronic conditions, regardless of the expected duration of care, many beneficiaries face difficulties obtaining and affording necessary home care. The reality of accessing home health benefits often conflicts with the legal provisions intended to protect vulnerable individuals needing care in their homes.
Learn more about Medicare Home Health Coverage Challenges
The Center for Medicare Advocacy continues to work to bridge the gap between Medicare law and practice, advocating for policies and interpretations that truly serve the needs of Medicare beneficiaries and ensure access to comprehensive and equitable healthcare under the Center for Medicare Services guidelines.
