September 15, 2022

Medicare Advocacy Project is available to help elders and persons with disabilities with denials and appeals

BY Rachel Shannon BrownGreenfield Recorder

It’s not often that there’s exciting news to share about Medicare, yet recent legislation is, in fact, good news. On Tuesday, Aug. 16, 2022, President Biden signed the Inflation Reduction Act into law. Among other things, this bill includes important expansions to Medicare that will be phased in between now and 2026.

Starting in 2023, Medicare will cap beneficiaries’ insulin co-pays at no more than $35 per month. Also, drug companies will be required to pay rebates if certain drug prices increase faster than inflation. Finally, Medicare beneficiaries will have access to additional free vaccines, such as the shingles vaccine.

In 2024, Medicare Part D drug plans will face limits on how much they may increase their monthly premiums per year. Next, those Medicare beneficiaries who reach the “catastrophic” prescription drug coverage level will have their co-insurance obligation eliminated. Finally, the Low-Income Subsidy, also known as Extra Help, will be expanded to provide assistance to beneficiaries with incomes up to 150% of the federal poverty level. (Those on the Low-Income Subsidy can get help with their Medicare Part D premiums, deductibles and out-of-pocket costs).

Starting in 2025, Medicare beneficiaries will pay no more than $2,000 in annual out-of-pocket drug cost expenses. And, in 2026, Medicare will be permitted to negotiate with drug manufacturers regarding the prices of some medications; the White House estimates that 5-7 million Medicare beneficiaries’ prescription drug costs could go down because of these negotiations.

Even with these expansions, many elders and persons with disabilities may be wrongfully denied Medicare coverage. Some may be denied coverage for physicians’ services, durable medical equipment, home health care, or skilled nursing facility care. Others could be forced to leave the hospital prematurely, will be denied prior approvals by their managed care plans, or will be made to wait for coverage to begin while facing permanent surcharges on their monthly health insurance premiums. Countless others could hit roadblocks, such as medication denials, created by Medicare’s complex systems. As a result of these denials, beneficiaries risk gaps in insurance coverage, interference with access to necessary medication or medical care, and/or severe financial duress.

Medicare beneficiaries can get help with these issues, and more, by reaching out to the Medicare Advocacy Project (MAP). Whatever the problem, MAP’s experienced advocates provide free legal assistance for Medicare-related issues. In Franklin County, MAP can be reached via Community Legal Aid, which provides free civil legal assistance to low-income and elderly families and individuals in central and western Massachusetts. We encourage anyone facing a Medicare denial or appeal to reach out to us through our website, www.communitylegal.org, or through our intake line, 855-252-5342.

Rachel Shannon Brown is a Senior Supervising Attorney at Community Legal Aid, Inc. Community Legal Aid provides free civil legal services to the low-income and elderly residents of the five counties of Western and Central Massachusetts (Berkshire, Franklin, Hampden, Hampshire, and Worcester), and maintains full-time offices in Worcester, Fitchburg, Springfield, Northampton, and Pittsfield. CLA works to assure fairness for all in the justice system, protecting homes, livelihoods, health and families. Residents of Berkshire, Franklin, Hampden, Hampshire and Worcester Counties who would like to apply for assistance should visit Community Legal Aid’s website, www.communitylegal.org/gethelp, or call 1 855 252 5342.