The Case for H.R. 3730

November 23, 2018 | Laura Power, 2018 AAPD Summer Intern

When I was applying to colleges, I was awarded a scholarship for writing an essay about how durable medical equipment (DME) affected my life. I have discovered that the definition of durable medical equipment I was using at the time was partially incorrect. My wheelchair, with its many supportive features, was not merely DME, but complex rehab technology (CRT). CRT and DME greatly differ. Medical insurance does not often cover aspects of CRT.

The implications of a related amendment, H.R. 3730, can be understood through comparison to existing legislation. The bill was created with a view to amending Title 18 of the Social Security Act (Medicare). The context, nuances, and implications of CRT and H.R. 3730 are worth exploring.

It is impossible to commence a thorough discussion of H.R. 3730 without considering the definitions of CRT or of the primary ways in which it differs from standard DME. According to the United Spinal Association’s materials, whereas DME is primarily used by beneficiaries who qualify for Medicare based on age, CRT is primarily used by Medicare and Medicaid recipients who are living with disabilities. Unlike standard DME, evaluation and maintenance of CRT requires a team of professionals including a physical therapist, an occupational therapist, and a certified rehab professional. In addition, customizing CRT to reflect individual needs requires a more thorough evaluation process. Finally, CRT quality standards are more rigorous than those of DME.

Currently, prices for standard durable medical equipment in certain parts of the country are determined by the Centers for Medicare and Medicaid Services’ (CMS) competitive bidding program. This means that DME and CRT providers compete to be accepted by CMS. The competitive bidding program is disadvantageous to the consumer because, in order to be eligible to furnish products to individuals who need them, companies are incentivized to offer the lowest price. This often means neglecting coverage of “accessories” or critical components needed by people using manual wheelchairs and related features and deeming them medically unnecessary. These components or features include electronically powered rear wheels, which allow individuals lacking upper body strength or endurance to propel themselves (Smart Drive), and cushions and tilting features designed to relieve pressure. Access to these features would promote independence and prevent hospitalization of manual wheelchair users, allowing them to easily live in the community. H.R. 3730 would exempt manual wheelchair accessories from the competitive bidding program and it would allow individuals to choose vendors in their price range and prohibit Medicare from fixing prices. Congressman Lee Zeldin sponsored H.R. 3730. It now has 120 cosponsors. When signed into law, this legislation would allow Medicare to better serve the disabled community.

H.R. 3730 accounts for the many differences between CRT and DME by acknowledging that prices should not be fixed on customized features thereby offering consumers a choice. If the consumer is offered options to find the technology that works best for them, they are likely to maintain their health. For these reasons H.R. 3730 is important and should be codified.

 

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Laura Power is a 2018 AAPD Summer Intern. She interned with the United Spinal Association.

____________________

“Competitive Bidding Program.” Medicare.gov. The U.S. Centers for Medicare and Medicaid Services.
2018. Web. July 28, 2018.

“H.R.3730 – To amend title XVIII of the Social Security Act to provide for the non-application of Medicare
competitive acquisition rates to complex rehabilitative manual wheelchairs and accessories.” Congress.gov. Library of Congress. 2018. Web. July 28, 2018.
“2012 Position Paper.” United Spinal Association. United Spinal Association. 2018. Web. July 28, 2018.

 

Return of the Medicare Advantage Open Enrollment Period

November 8, 2018 | Jagger Esch, President & CEO of Elite Insurance Partners and MedicareFAQ

Graphic depicting a medicare enrollment form

If you or a loved one is a Medicare beneficiary due to disability, you know how complicated and confusing Medicare can be. Each year changes are made to Medicare.

This year, for 2019, the Medicare Advantage Open Enrollment Period will make a return. There will also be increases in Part A and Part B of Medicare, including premium and deductible increases.

 

Part A Premium Increases

If you have fewer than 40 quarters of employment or you’re disabled, you probably pay a monthly premium since you voluntarily enrolled in Medicare Part A. If this is the case, you will notice a premium increase.

If you had a minimum of 30 quarters or were married to someone with 30 quarters of coverage, you may buy into Part A at a lowered monthly fee, which would be $240 in 2019, an $8 increase from the fee in 2018.

Anyone that has exhausted other entitlement will pay the full premium, which to $437 a month for 2019 (an increase of $15 since 2018).

 

Part A Deductible Increases

The Part A deductible increased by $24, for a total of $1,340 in 2019. Beneficiaries with only Medicare as their coverage will be expected to pay this if admitted to the hospital.

If you have Original Medicare, you will be expected to pay a coinsurance amount of $341 per day for the 61st through 90th day of hospitalization in 2019. In 2018, the amount was $335 per day for 61 to 90 days of hospitalization.

For your lifetime reserve days, the amount went up from $670 to $682 per day.

If you’re in a skilled nursing facility, you can expect their daily coinsurance for days 21 through 100 of extended care services in a benefit period to be $170.50 in 2019, this is an increase from $167.50 in 2018.

 

Part B Premium Increases

The new Part B premium for 2019 will be $135.50, only $1.50 more per month than in 2018.

The income-related monthly adjustment amount (IRMAA) impacts about 5 percent of people with Medicare Part B.
The Centers for Medicare and Medicaid Services (CMS) has added a high-income bracket, if your income is $500,000 or more ($750,000 or more for a married couple) then you will pay $460.50 a month for Part B in 2019.

 

Part B Deductible Increase

The Part B deductible will increase from $183 to $185 in 2019. Beneficiaries with a Medicare Supplement Plan F or Plan C have coverage for this deductible.

Medicare Advantage plan enrollees have low copays and deductibles; this shouldn’t change with the increases in Medicare.

 

Help Affording Medicare Increases

Having coverage in addition to Medicare will help cover the costs of many of these increases. Talking to a licensed insurance expert can make your life easier and help you gain confidence in your health care coverage.

 

Return of the Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period (OEP) was discontinued in 2010 and now, in 2019, it will make a return. From 2011-2018 Medicare beneficiaries were given only the Medicare Advantage Disenrollment Period (MADP), during this time beneficiaries were able to disenroll from their Medicare Advantage plan and switch only to Original Medicare.

Now all that is about to change. The Medicare OEP will begin on January 1st and end on March 31st. During this time Medicare beneficiaries will be able to disenroll from there Medicare Advantage plan and enroll into another Medicare Advantage plan or switch back to Original Medicare, with or without Part D coverage.

Medicare beneficiaries won’t be able to switch Part D prescription drug plans. If you are currently enrolled into a stand-alone Prescription Drug Plan, you will need to change your policy during the annual enrollment period from October 15 through December 7.

Each year, by September 30, Medicare Advantage recipients receive an Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) from their existing insurance carrier for their Medicare Advantage and Medicare Prescription drug plan providers.

CMS posts plan changes for the following year sometime in October, several months before the new year. Medicare.gov is a valuable online resource for Medicare beneficiaries; you can compare plans, look up information and learn about Medicare.

 

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Jagger Esch is the President & CEO of Elite Insurance Partners and MedicareFAQ, a senior healthcare learning resource center. As a young entrepreneur and seasoned insurance expert, he has a passion for helping people. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate them on all their Medicare options. Jagger lives in the Florida sunshine state and loves boating with his family on the weekends.

It’s Time To Check On Your Health Insurance!

Blue and white medical symbol on a red background with text: "2019 Open Enrollment November 1 - December 15"

2019 Open Enrollment Begins November 1, 2018

 

November 1, 2018

If you’re uninsured or looking for more affordable health insurance, the “open enrollment” period is the time to visit healthcare.gov, or your state’s marketplace or health insurance exchange. During “open enrollment” you can review private health insurance options and purchase coverage. People with low and moderate incomes may be able to get financial help to pay for health insurance coverage. This includes help with the cost of premiums and possibly also reduced cost sharing, depending on your income. If you get health insurance through your employer, Medicaid, or Medicare, you are not eligible for this assistance.

 

2019 Open Enrollment

  • November 1, 2018 – Open enrollment begins
  • December 15, 2018 – Open enrollment ends
  • January 1, 2019 – Coverage begins

 

For many people, open enrollment is the only time to change insurance plans or buy new coverage during the year. However, you can sign up for insurance outside of open enrollment if you lose your job, get married, divorced, have a baby, or experience another major life event. You may also enroll in Medicaid or the Children’s Health Insurance Program (CHIP) year-round.

 

Do all states have the same open enrollment dates?

Most states have enrollment periods from November 1 to December 15, but some states have longer enrollment periods. States with extended open enrollments periods are:

  • California: Oct. 15, 2018 – Jan. 15, 2019
  • Colorado: Nov. 1, 2018 – Jan. 15, 2019
  • Washington, DC: Nov. 1, 2018 — Jan. 31, 2019
  • Massachusetts: Nov. 1, 2018 – Jan. 23, 2019
  • Minnesota: Nov. 1, 2018 – Jan. 13, 2019
  • New York: Nov. 1, 2018 — Jan. 31, 2019
  • Rhode Island: Nov. 1, 2018 – Dec. 31, 2018

 

If you have a disability or a health condition, plan details and any annual changes matter. Be sure to ask before you select a plan:

  • Are a broad range of health care providers included in the health plan’s provider network?
  • Are there enough medical specialists in the network to meet your specific needs?
  • Are the medications you need included in the plan’s list of covered drugs? Has the cost sharing changed? Are there other requirements like prior authorization?
  • Is there adequate access to non-clinical, disability-specific services and supports?
  • Does the plan have service limits, such as caps or limits on the number of office visits, the amount of therapy services, or exclusions for medical devices?
  • Are mental health services covered to the same extent as other “physical” health benefits?

This year, there will be plans for sale in some states that are NOT required to provide all of the benefits mandated by the Affordable Care Act. These plans may be able to charge you more if you have a pre-existing condition, and may not offer adequate coverage for your needs or if you get sick. It is more important than ever to thoroughly review what benefits a plan offers and not only look at plans with low premiums.

 

I already have health insurance through the Marketplace. Do I need to do something?

  • It is important to update your income and household information in the Marketplace to make sure you get all the assistance available to you.
  • This is also a good time to check your health insurance coverage and see if it still meets your healthcare needs.
  • If a new plan does not cover your providers or services, investigate your right to change plans.
  • You should carefully read all health insurance notices and updates.
  • If your income has increased, updating your information with the Marketplace will help avoid payment penalties later.

 

I and/or my family members are uninsured. Can we sign up?

Most individuals can get health insurance coverage regardless of pre-existing health conditions or prior denial of coverage. Just go to healthcare.gov, enter your information, and review insurance options. Each plan should provide information on monthly premiums, deductibles, provider networks, hospitals, and covered medications. Only individuals who live in the United States and are U.S. citizens, nationals, or non-citizens who are lawfully present, and are also not currently incarcerated, may apply. If you were uninsured during the prior year, you may be subject to a state fee for not having coverage.

 

Where can I go to get help?

Purchasing health insurance can be complicated. If you or your family member needs assistance with understanding the options, healthcare.gov can help. Each state has health insurance “navigators” to help people enroll in health insurance plans. Individual health plan information should be available in late October 2018 on the healthcare.gov website. If you would like more information on specific topics, the National Disability Navigator Resource Collaborative has a comprehensive set of materials available on disability issues and the Affordable Care Act.

Website: www.healthcare.gov

Phone: 1-800-318-2596 (Available 24/7 with access to 150 languages)

TTY: 1-855-889-4325

In-Person Assistance Resources: localhelp.healthcare.gov

 

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This post was developed with content provided by the Consortium for Citizens with Disabilities (CCD).

How Healthcare is Oppressing with Disabilities

October 30, 2018 | Angelique Long, 2018 AAPD Summer Intern

I’m a walking medical textbook. I have over a dozen diagnoses, with nearly half of them being rare. I have seen hundreds, if not thousands, of doctors in my lifetime and have fought my body to stay alive on more than one occasion. For now, I am able to have a life and function relatively well with the assistance of a fantastic team and an impressive list of pharmaceuticals. I have fought a long, hard battle to get where I am today. But recently, all of that was threatened.

I proudly acknowledge the reason I am alive today is because of the Affordable Care Act (ACA); I was able to stay on my parents’ insurance plan longer and I didn’t have to worry about pre-existing conditions. There is no doubt that the ACA was, and still is, a revolutionary movement in our nation. However, with the lack of support in 18 states, millions of Americans fall in what is now known as the coverage gap. This gap consists of poorer individuals living in those states that have opted to not expand Medicaid and that do not qualify for their state’s existing Medicaid program.2

I have recently found myself among the millions of Americans in the coverage gap, as Missouri, my home state, has not expanded Medicaid. I was aging out of my parents’ plan, and, because of the confusing language of healthcare, I would soon find myself without medical coverage. I went on the marketplace to see what they might have to offer me, like we are so often advised to do, and was told that I didn’t make enough money to enroll in any of their plans. They told me, in the most impersonal way possible, that because I live in a state that hasn’t expanded Medicaid, I couldn’t get a comprehensive health plan. As I have already mentioned, I would not be here today if it weren’t for my insurance. I was terrified – I didn’t have insurance and couldn’t afford to get any.

Despite all of that, I am one of the lucky ones. After resolving some miscommunications, my parents’ insurance provider deemed me completely and permanently disabled. They decided that I am not able to hold gainful employment, and that therefore, they will keep me on. But not without stipulations:

  • I must maintain this disabled status;
  • I cannot make more than $10,000 a year;
  • My address has to remain at my parents’ residence.

Though this is a fantastic temporary fix and I am grateful for it, I don’t want to be stuck in forced poverty my entire life.

Disabled people want to work. Disabled people want to live independently. Disabled people want to live a productive life. But, for some reason, our government sees us as invalid. Things such as not expanding Medicaid put us in a box: either apply for disability or don’t have access to healthcare. Either way, we are limited in our ability to function or lead a gainful life.

I’m a daughter and an aunt. I’m a student and a volunteer. I’m a mentor and an intern. Don’t ever make me just another statistic.

 

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Angelique Long is a 2018 AAPD Summer Intern. She interned with Families USA.

Action Alert! Tell Congress to Fund CHIP and Protect Children’s Health

December 21, 2017

The Children’s Health Insurance Program (CHIP) provides low-cost health insurance to children in families that do not qualify for Medicaid, but still need assistance to access health care. Nearly 9 million children, including many children with disabilities, depend on CHIP for health coverage.

Unfortunately, Congress’s failure to reauthorize CHIP puts the health and well-being of these children at risk. Federal funding for CHIP expired on September 30, 2017, and as a result, many states are beginning to run out of funds to support the program. Sixteen states expect to exhaust all of their CHIP funding before the end of January 2018, with another 21 states running out of funds by March 2018 (Kaiser Family Foundation).

CHIP was a bipartisan initiative when it was first passed in 1997 and has received bipartisan support since then. It is a program that supports children in all states and has helped lower the uninsured rate of children to 5% since the program began.

Time is of the essence – Congress must act now to fund CHIP!

 

Take Action

Call your Members of Congress

Call the Capitol Switchboard at (202) 224-3121 or (202) 224-3091 (TTY) and ask to be connected to your Senators or Representative.

 

Email your Members of Congress

Contacting Congress provides unique links to email your Senators and Representative directly.

 

Tweet your Members of Congress

Twitter has become a powerful tool to communicate with elected officials directly. Find your Senators and Representative on Twitter and tell them to protect children’s healthcare by funding CHIP!

 

 

Additional Resources

 

Healthcare Open Enrollment #5 – Changes and Challenges

October 13, 2017 | Chris Corsi, AAPD intern

 

Open Enrollment (OE) 5 begins on November 1, 2017.

From November 1, 2017 through December 15, 2017 (in most states), individuals will be able to purchase health insurance through the marketplace established by the Affordable Care Act (ACA).

 

Enrollment Changes in 2018

IMPORTANT:

2018 ACA Open Enrollment starts November 1, 2017 in all 50 states and DC

It ends on December 15, 2017 in all states except:

California (1/31/18)

Colorado (1/12/2018)

Connecticut (12/22/2017)

District of Columbia (1/31/2018)

Massachusetts (1/23/2018)

Minnesota (1/14/2018)

New York (1/31/2018)

Rhode Island (12/31/2017)

Washington (1/15/2018)

*Special enrollment period (12/16/2017 – 12/31/2017) available for hurricane victims*

 

There are a number of changes that have occurred to the 2018 OE period, which will run from November 1st to December 15th in most states.

Shorter Enrollment Period. The first major change is a shorter enrollment period. The 2018 enrollment period was originally scheduled to run November 1, 2017 through January 31, 2018. However, the Department of Health and Human Services cut the period in half so that it only runs until December 15, 2017. This means it is crucial to get information out to individuals about OE5 before and during the open enrollment period since individuals will have less time to sign up for ACA healthcare.

Cuts to the outreach, education, and enrollment budget. The second change refers to a series of deep budget cuts that happened in late August. These cuts include a 90% reduction for marketplace advertising, a 42% cut for HealthCare.gov (the website that allows individuals to sign up for health insurance), and a $25.7 million cut to Navigators (trained individuals that help guide people through the ACA sign-up process).

Website Outages. It was recently announced that the federal health insurance exchange – HealthCare.gov – will be shut down for maintenance once a week, every week for 12 hours, during the open enrollment period. With the already shorten open enrollment period, these outages will make it even more difficult for people to sign up for health insurance through the marketplace.

These changes will suppress marketplace enrollment and will likely limit the number of people who gain health insurance. Having less people sign up for coverage could lead to less-balanced risk pools and higher costs.

 

What does this mean for people with disabilities?

The ACA has helped, and continues to help, people with disabilities in a number of ways. Providing protections for people with pre-existing conditions opened the door for many people with disabilities to receive affordable, comprehensive health insurance. The ACA also eliminated lifetime benefit limits, meaning there were no caps to the amount of money one could receive in a lifetime from an insurer. Medicaid expansion in 32 states, including Washington, DC, provided individuals with incomes at or below 138% of the poverty line affordable healthcare. These provisions resulted in 20 million people gaining health insurance by January of this year.

Government health insurance is extremely important to people with disabilities – in 2015 58.3% of adults with disabilities had government health insurance compared to 17.4% of adults without disabilities. Shortening the Open Enrollment period and cutting funding means less uninsured individuals will have the opportunity to enroll in health insurance, and fewer individuals will be able to take advantage of the opportunities ACA has created for people with disabilities.

 

What can we do now?

Help spread the word about Open Enrollment Period #5! While a significant amount of funding has been cut and the enrollment period shortened, we can make a difference by spreading information through our own networks. Post to Facebook or send a Tweet about the Open Enrollment period. Ask your friends and family if they have health insurance. Every effort helps!

 

Open Enrollment Resources

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