Medicare Patient News

Updates on services and programs covered under Medicare to help senior patients achieve optimal health.

Medicare Proposes Lung Cancer Screening Coverage For Those At Risk

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Medicare beneficiaries at high risk for lung cancer may get free annual screenings if proposal is approved.

Medicare beneficiaries at high risk for lung cancer may get free annual screenings if proposal is approved.

Medicare is proposing to pay for annual lung cancer screenings for beneficiaries at high risk for lung cancer. Evidence suggests that properly done CT scans can help doctors find tiny lung tumors in longtime smokers while the cancer can still be treated effectively.

To qualify, patients would have to first meet with a doctor to talk through the pros and cons of scans, which involve a low-dose of radiation.

Patients would have to be:

*Between the ages 55 and 74;

*Have no symptoms of lung disease;

*Have smoked the equivalent of 30 pack-years (or a pack a day for 30 years);

*And be a current smoker or have given it up in the past 15 years.

Lung cancer is the No. 1 cause of cancer deaths in the U.S. More than 159,000 Americans are expected to die from cancers of the lung and bronchus in 2014, according to the National Cancer Institute.

About 4.9 million people with Medicare coverage would meet the criteria for screening. The average annual cost of Medicare screening was estimated at $241 for each person screened.

The Medicare proposal “likely means that thousands of Medicare beneficiaries will have access to this important and potentially life-saving service,” said Dr. Richard Wender in a statement on the American Cancer Society’s news blog. “This would place Medicare policy in line with current guidelines and the recommendations of many interested advocacy and professional organizations, including the Society.”

For more information on this topic, go to NPR’s Medicare Poised to Cover CT Scans To Screen for Lung Cancer

and

Medicare Proposes Paying for Lung Cancer Screenings for Older Longtime Smokers

 


Traditional Medicare Rated More Favorably in Quality and Access

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Traditional Medicare is particularly favored among beneficiaries who are sick.

Traditional Medicare is particularly favored among beneficiaries who are sick.

How do quality and access compare in Medicare Advantage versus traditional Medicare?

With so many seniors indecisive about whether to use a Medicare Advantage health plan or stick with traditional Medicare, the Kaiser Family Foundation commissioned a comprehensive review to compare how quality and access to care differ between the two.

Since 2000, 45 studies were published comparing traditional Medicare and Medicare Advantage plans. The data in these reports tend to be old and provide limited examination of the experience since 2010, when the Affordable Care Act altered the landscape, reports the Kaiser Family Foundation.

Due to data constraints, most studies focus on a limited set of quality and access measures, rather than the experiences of plans and enrollees nationwide.

Within those limitations, the Kaiser Family Foundation analysis, conducted by lead author Marsha Gold, Senior Fellow Emeritus with Mathematica Policy Research, found that:

*Beneficiaries themselves continue to rate traditional Medicare more favorably than Medicare Advantage plans in terms of quality and access, though one study suggests that the difference may be narrowing for the average beneficiary. Among beneficiaries who are sick, the gap is particularly large, and favors traditional Medicare.

*Performance varies widely across Medicare Advantage plans even within the same type, which limits the ability to generalize across the program.

Read entire analysis here.


FAQ: Hospital Observation Can Be Costly for Medicare Patients

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Admitted patient or on observation status? Many Medicare beneficiaries assume they were admitted to the hospital, but instead received "observation care," which means higher out-of-pocket expenses and fewer Medicare benefits.

Admitted patient or on observation status? Many Medicare beneficiaries assume they were admitted to the hospital, but instead received “observation care,” which means higher out-of-pocket expenses and fewer Medicare benefits.

The following story is courtesy of Kaiser Health News

Some seniors think Medicare made a mistake. Others are stunned when they find out that being in a hospital for days doesn’t always mean they were actually admitted.

Instead, they received observation care, considered by Medicare to be an outpatient service. The observation designation means they can have higher out-of-pocket expenses and fewer Medicare benefits. Yet, a government investigation found that observation patients often have the same health problems as those who are admitted.

More Medicare beneficiaries are entering hospitals as observation patients every year. The number rose 88 percent over the past six years, to 1.8 million nationally in 2012, according to the Medicare Payment Advisory Commission, which helps guide Congress on Medicare issues. At the same time, Medicare hospital admissions stayed about the same.

Here are some common questions and answers about observation care and the coverage gap that can result. (Seniors enrolled in Medicare Advantage should ask their plans about their observation care rules since they can vary.)

Q. What is observation care?

A. Hospitals provide observation care for patients who are not well enough to go home but not sick enough to be admitted.  This care requires a doctor’s order and is considered an outpatient service, even though patients may stay as long as several days. The hospitalization can include short-term treatment and tests to help doctors decide whether the patient should be admitted. Medicare guidance recommends that this decision should be made within 24 to 48 hours, but observation visits exceeding 24 hours more than doubled to 854,454 between 2006 and 2012, including a five-fold increase in stays lasting more than 48 hours, federal records show.    Read more