Susan Jaffe

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By Susan Jaffe | October 15, 2013 | Kaiser Health News produced in collaboration with

The seven-week enrollment period for next year’s Medicare prescription drug and managed-care plans begins Tuesday, but seniors shouldn’t simply renew their policies and assume the current coverage will stay the same. There’s a likely payoff for those who pay close attention to the details.[More in KHN] [More in USA Today]

Seniors Cautioned To Pay Close Attention To Details As Enrollment Begins In Medicare Plans

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By Susan Jaffe | October 11, 2013, 6:24 pm

Shirley Mierzejewski was “very upset” when she found out her Medicare health insurance premiums will nearly double next year.

“I cannot afford that, I cannot,” said Ms. Mierzejewski, 77, who lives in Euclid, Ohio, and works part time as a receptionist at a local college. She has a private Medicare Advantage policy from Anthem, which provides drug and medical coverage.

“So I started thinking about the marketplaces,” she said, referring to the online insurance exchanges created by the Affordable Care Act. “Maybe I could find something cheaper there.”

While thousands of Americans are trying to sign up for insurance on the exchanges, Medicare counselors like Semanthie

Brooks, who spoke at the meeting Monday in Euclid, are trying to steer seniors away. They worry that Ms. Mierzejewski and other older adults may not realize that Medicare is a pretty good deal compared to exchange policies and may try to buy one anyway.

…To clear up confusion in Montgomery County, Md., officials held meetings at six centers for the elderly. “They want to know if they are better off in the exchange than in Medicare,” said Leta Blank, director of the Montgomery County State Health Insurance Assistance Program. “Everyone is looking for a less expensive way to get health care.”

So in a year in which the insurance market is being turned upside down, here are some shopping tips for people with Medicare and caregivers. MORE

Q & A: Medicare and the Insurance Exchanges

Appeals, Observation care

Judge Dismisses Hospital ‘Observation Care’ Lawsuit

By Susan Jaffe | Connecticut Health Investigative Team Writer | Sept. 23, 2013

Today, A lawsuit filed by fourteen seniors, including seven from Connecticut, seeking Medicare nursing home coverage was dismissed Monday by a federal court judge in Hartford.

The seniors were among more than a million Medicare beneficiaries who enter the hospital for observation every year. Because they did not spend at least three consecutive hospital days as admitted patients, Medicare will not pay for their nursing home care.

In their lawsuit, they argued that there is little difference between observation and admitted patients, except when it comes to paying tens of thousands of dollars in nursing home bills. They asked the judge to eliminate the ‘observation care’ designation or at least set up an expedited appeals process so that their observation status would be reviewed. They also wanted the judge to order Medicare officials to require hospitals to tell patients if they are receiving ‘observation care’ and have not been admitted.MORE

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By Susan Jaffe | Sept. 17, 2013 | KAISER HEALTH NEWS in collaboration with

The U. S. Department of Labor issued new rules Tuesday that mandate home health care agencies pay their workers the minimum wage and receive overtime pay starting in 2015.

“Almost 2 million home care workers are doing critical work, providing services to people with disabilities and senior citizens who want to live in community settings and age in place in their familiar surroundings,” said Secretary of Labor Thomas Perez.

But when it comes to getting paid, they are “lumped into the same category as teenage babysitters,” he said. “This is wrong and this is unfair.”

For nearly 40 years, home care workers had been exempted from the pay rules because their services were considered “companionship.” But advocates, including organized labor organizations, had argued that these workers were often doing much more, providing assistance with dressing, eating and other daily activities. [More from KHN or Washington Post]

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By Susan Jaffe | Sept.13, 2013 | KAISER HEALTH NEWS in collaboration with

After reassuring seniors that Medicare is not part of the new health insurance marketplaces, administration officials have a warning for anyone who may have other ideas: selling marketplace coverage to people who have Medicare is illegal.

Federal officials are eager to get the word out that seniors and disabled individuals enrolled in Medicare Part A — which covers hospitalization and limited nursing home care and is free for most beneficiaries – do not need to buy a marketplace plan, because they are already meeting the insurance requirements.

And no one needs to sell them one, either, according to information on a new “Medicare & the Marketplace” government webpage and in a “frequently asked questions” flyer officials recently distributed to Medicare counselors and other seniors advocates. MORE

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By Susan Jaffe and Kaiser Health News in partnership with

A commission created by Congress to address the country’s surging need for long-term health care released recommendations Friday but did not reach a consensus on how to pay for these often expensive services.

The proposals were part of a report that received bipartisan support from nine of the 15 commissioners, five Republicans and four Democrats. It also was rejected by a bipartisan minority, five Democrats and a Republican.

The three-page summary of recommendations tackles a wide-ranging list of concerns but offers few specific remedies. Among its many proposals, the panel calls for supporting criminal background checks for long-term care workers, ensuring that family caregivers are included in care planning, using more technology to share information; revising scope of practice rules to allow nurses and others to provide medical services and improving working conditions and opportunities for direct care workers. [MORE from KHN ] [MORE from NewsHour]

How to Fix Long-Term Care in U.S.? Panel Releases Some Ideas

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FAQ: Hospital Observation Care Can Be Poorly Understood And Costly For Medicare Beneficiaries

By Susan Jaffe | September 4, 2013 | KAISER HEALTH NEWS

Some seniors think Medicare made a mistake. Others are just 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. Yet, a recent government investigation found that observation patients often have the same health problems as those who are admitted. But the observation designation means they can have higher out-of-pocket expenses and fewer Medicare benefits. Here are some common questions and answers about observation care and the coverage gap that can result. [Continued here]

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Susan Jaffe, Kaiser Health News produced in collaboration with

August 25, 2013 – While the Obama administration is stepping up efforts encouraging uninsured Americans to enroll in health coverage from the new online insurance marketplaces, officials are planning a campaign to convince millions of seniors to please stay away – don’t call and don’t sign up.

“You hear programs on the radio about the health care law and they never talk about seniors and what we are supposed to do,” said Barbara Bonner, 72, of Reston, Va. “Do we have to go sign up like they’re saying everyone else has to? Does the new law apply to us seniors at all and if so, how?” [More in KHN] [More in USA Today]

No Shopping Zone: Medicare Is Not Part Of New Insurance Marketplaces

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Volume 382, Issue 9892, 17 August 2013

WORLD REPORT Despite delaying some provisions of the Affordable Care Act, the US Government says it is on target to begin enrolling millions of Americans in the law’s new health coverage. Susan Jaﬀe reports.

Less than 7 weeks before millions of Americans begin enrolling in the new health insurance plans offered under President Barack Obama’s landmark Affordable Care Act (ACA), critics claim that his Administration isn’t ready and will preside over a monumental failure and a waste of taxpayer dollars.

…While federal officials continue to fend off Republican attacks on the law (unabated despite Obama’s re-election and the Supreme Court’s ruling upholding most of the law) they are also trying to complete work on the system needed to help Americans choose and enroll in an insurance plan and to determine their subsidy eligibility. …“Let me be clear”, US Health and Human Services (HHS) Secretary Kathleen Sebelius told reporters on Aug 5. “We are on target and ready to flip the switch on Oct 1.” [MORE] [PDF]

Obama Administration races to meet key ACA deadline

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HHS Inspector General Scrutinizes Medicare Rule For Observation Care

By Susan Jaffe | July 30, 2013 | Kaiser Health News in collaboration with

Medicare patients’; chances of being admitted to the hospital or kept for observation depend on what hospital they go to — even when their symptoms are the same, notes a federal watchdog agency in a report to be released today, which also urges Medicare officials to count those observation visits toward the three-inpatient-day minimum required for nursing home coverage.

The investigation, conducted by the Department of Health and Human Services Inspector General, was based on 2012 Medicare hospital charges. Its findings, which underscore several years of complaints that the distinction between an inpatient and observation stay isn’t always clear, come just days before the Centers for Medicare and Medicaid Services (CMS) is expected to issue final regulations intended to address the problem. [Continued in Washington Post and in KHN]

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By Susan Jaffe | June 28, 2013 | KAISER HEALTH NEWS

The Commission on Long-Term Care held its first meeting Thursday on Capitol Hill with some members acknowledging that their late start adds to their challenges in offering Congress recommendations on how to finance the expensive services for seniors and disabled Americans.

The panel is hobbled with a meager budget and staffing, and it is facing a three-month deadline for its report. Speakers at the meeting reminded the commission that the effort is daunting.

The commission heard a litany of statistics from four experts who explained how the nation’s growing population of seniors will become more dependent on long-term care services. But the rising cost of those services threatens to deplete individuals’ savings and add to the nation’s budget problems because of the expenses borne by Medicare and Medicaid. MORE

Appeals, Long term care, Medicare Advantage, Medicare costs, Physical therapy

FAQ: Medicare Beneficiaries May See Increased Access To Physical Therapy Or Some Other Services

By Susan Jaffe | June 25, 2013 | Kaiser Health News in collaboration with

For years, seniors in Medicare have been told that if they don’t improve when getting physical therapy or other skilled care, that care won’t be paid for. No progress, no Medicare coverage — unless the problem got worse, in which case the treatment could resume.
This frustrating Catch-22 spurred a class-action lawsuit against Health and Human Services Secretary Kathleen Sebelius. In January, a federal judge approved a settlement in which the government agreed that this “improvement standard” is not necessary to receive coverage.

“This will help a lot of older or disabled people who clearly need the skilled care and aren’t getting it because they will not get better,” said Margaret Murphy, associate director of the Center for Medicare Advocacy, which helped bring the lawsuit. “The settlement recognizes that Medicare will pay for care to maintain their condition and prevent backsliding.”

Yet providers may not know about the settlement yet and may still be telling patients, incorrectly, that Medicare won’t cover treatment if there’s no improvement. MORE

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By Susan Jaffe | June 21, 2013 | KAISER HEALTH NEWS in collaboration with

Within days, the company that handles an average of more than 60,000 calls daily about Medicare will be deluged by new inquiries about health insurance under the Affordable Care Act.

The six Medicare call centers run by Vangent, a company based in Arlington, Va., will answer questions about the health care law from the 34 states that opted out of running their own online health insurance marketplaces or decided to operate them jointly with the federal government.

The Department of Health and Human Services estimates that Vangent’s call centers will receive 42 million calls about the federal marketplaces this year, a daily average of up to 200,000; plus answer 2,400 letters and 740 e-mails, and host 500 Web chats daily. Customer service representatives will take consumers through the process — from shopping for a plan to enrolling.

Running the 800-Medicare call centers may provide valuable experience, but Vangent’s track record reveals that it was slow to adapt when changes in the Medicare program caused dramatic spikes in demand.

“It’s going to be huge,” said Bonnie Burns, a training and policy specialist at California Health Advocates. “The number of calls they are likely to get will probably dwarf anything they saw in Medicare.” MORE

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Volume 381, Issue 9882, Pages 1975 – 1976, 8 June 2013

WORLD REPORT Health and science agencies in the USA have been operating on reduced budgets, enforced by sequestration, for just over 3 months Susan Jaﬀe reports from Washington, DC.

The automatic budget cuts known as sequestration that the US Congress approved in 2011 were intended to be so onerous that they would never happen. Lawmakers would surely find a more reasonable way to save at least US$1·2 trillion over the next decade before the cuts would begin in 2013. Instead, Republicans and Democrats could not agree on an alternative, and the first wave of cuts, totalling $85 billion through to September, 2013, are phasing in for most non-defence US Government operations. Everything from White House tours to the most promising cancer research have been limited by a lack of funding.

..Many services provided by the US Department of Health and Human Services (HHS) are affected, including programmes at the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), and medical research funded by the National Institutes of Health (NIH). Even the Affordable Care Act (ACA)—President Barack Obama’s landmark health reform law—will feel the impact, with supporters worried that enrolment for next year’s new health insurance coverage will have a difficult start in October. [FULL STORY AS PDF]

US sequester hits health and science programmes

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Seniors Sue Medicare To Close Nursing Home Coverage Gap

By Susan Jaffe | Connecticut Health Investigative Team Writer | May 3, 2013

…Today, lawyers representing 14 seniors, including 7 from Connecticut, will go to U.S. District Court in Hartford to ask a judge to eliminate the observation care designation because it deprives Medicare beneficiaries of the full hospital coverage they’re entitled to under Medicare, including coverage for follow-up nursing home care. More seniors are falling into the observation care coverage gap: the number of observation patients has skyrocketed 69 percent in the past five years, to 1.6 million nationally in 2011, according federal records.

Government lawyers will ask the judge to throw out the case because the seniors should have followed Medicare’s appeals process before going to court if they believed they were unfairly denied benefits.
And yet federal records and interviews with patients and advocates show that many observation patients who call Medicare about the billing problem hear something quite different – there is nothing that Medicare can do to help. MORE

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