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California Health Advocates

We are a non-profit organization dedicated to Medicare advocacy and education for Californians. Our website provides accurate and unbiased information about Medicare benefits and long-term care for people who live in California.

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Medicare Marketing Misconduct with Julie Lowry of DMHC Aug 19, 2015 WEBINAR » Join our free webinar at 10 a.m. Thursday August 27 on the current types of marketing misconduct as seen from the perspective of the California Knox-Keene Act.Julie Lowrie, Investigator with the CA Department of Managed Health Care will present the current Do's and Don'ts of Medicare Marketing, the kinds of activity that can be considered misleading, deceptive, and potentially fraudulent in the sale of Medicare Advantage products and how to report such activities. Register Today! Can a Nursing Home Evict You for Being “Difficult”? Know Your Rights Aug 4, 2015 BLOG Can a nursing home evict you for being “too difficult”, limit the hours your family and friends can come visit, or deny you needed physical therapy services because you’re not improving? The answer to all of these questions is a big NO. Learn about your rights through an updated guide, 20 Common Nursing Home Problems and How to Resolve Them . OIG Reports Show Part D is Vulnerable to Fraud & Provides Tips for Improvement Jul 7, 2015 BLOG Last month the Department of Health and Human Services announced the largest national take down charging 243 individuals for $712 billion in fraudulent billing. Forty-four of those individuals were charged with fraud involving the Part D prescription drug benefit. Learn about Part D vulnerabilities and OIG improvement tips. Are You New to Medicare? Review Your Medicare Enrollment Periods Jul 1, 2015 BLOG Are you new to Medicare and Medicare’s various enrollment periods? If so, it is important to learn the basics of Medicare requirements and options for enrollment to make the most of your coverage and avoid costly mistakes. Retirement “Nest Eggs” May Increasingly Go Towards Rising Health Care Costs Jun 23, 2015 BLOG Many people save up for retirement with visions of traveling and pursuing their dreams. Yet, our country’s elders may need to make a different plan as increasingly more of their retirement nest egg is funneled into rising health care costs. CHA Supports Task Force to Create a Statewide Long-Term Care Program July 6, 2015 ADVOCACY » CHA submits another letter in support of AB 332 to create task force for developing a statewide long-term care program. In the coming years, almost a quarter of California’s population will be comprised of people 60 and older. Planning, providing and paying for long-term care is critical to the social and economic health of all populations. Long-Term Care and the Graying of America June 23, 2015 LONG-TERM CARE Many people today are familiar with the term “long-term care” because they or someone they know is caring for an elderly relative. As more people live into their 80s and 90s, the need for long-term care (LTC) services has been increasing. This article provides an overview of LTC, its cost, and long-term care as a growing national issue. Medicare Celebrates Its 50 th ! June 23, 2015 BASICS This year marks half a century of health care coverage for our country’s seniors. Learn just what it took, including key players, debates and strategies, to create a successful program that helps prolong lives, increases well-being and peace of mind, and gives access to both acute and preventive care to over 55 million beneficiaries nationwide. What Happens When a Beneficiary is Marked as Dead but is Still Very Much Alive?

Importance of Advocacy June 12, 2015 BILLING Medicare mistakenly marked a woman as deceased while she was still very much alive. When she had a stroke less than a month later, health care coverage chaos ensued. This article highlights the importance of advocacy, particularly the work of the Health Insurance Counseling and Advocacy Program and the ways they help beneficiaries correct problems, navigate the health care system and receive their entitled care. Learn About Balance Billing & Concierge Medicine June 25, 2015 WEBINAR » What is balance billing? What is "concierge medicine", "retainer medicine" or "boutique doctors"? Can a doctor bill a Medicare beneficiary for what Medicare does not pay? Listen to our recorded webinar with presenters: Georgia Burke, Justice in Aging; Elaine Wong Eakin, California Health Advocates; Micki Nozaki, California Health Advocates. Meet the National Center on Elder Abuse May 28, 2015 WEBINAR » Julie Schoen, Deputy Director of the National Center on Elder Abuse presents on the role of the National Center on Elder Abuse (NCEA) and World Elder Abuse Awareness Day, (WEAAD) which occurs June 15, 2015. She covers the many layers, types and complexities of elder abuse and how this issue is evolving into a global social justice movement. Doc Fix and H.R. 2

It Could Have Been Worse May 14, 2015 BASICS After 17 “doc fix” patches in the past 11 years, Congress finally passed a bill to replace a broken payment system and reform the way Medicare pays its doctors. The new law includes many changes, including making the Qualified Individual program permanent, ending the use of Social Security numbers on Medicare cards and adding increased costs for beneficiaries. SMP Superheroes in Action! Humorous Skits Educate Public on Medicare Fraud May 5, 2015 BLOG Be entertained by our Senior Medicare Patrol superheros in action! As there is a lot of scary news and doom and gloom reports regarding scams, we thought is was time to turn up the fun factor and spread our message with some humor and a dose of silliness. Enclosed are two funny SMP superhero skits on back brace scams and genetic testing scams. Are You Aware of the Issues LGBT Elders Face? Let’s Be Inclusive May 1, 2015 DISPARITIES Many of the over 4 million lesbian, gay, bisexual and/or transgender elders (LGBT) in the U.S. remain invisible to most service providers and to the LGBT community at large. Becoming aware of the challenges these elders face and implementing easy, subtle yet powerful ways of being inclusive make a big difference in their access to care, services and a better quality of life. Spreading Awareness & Empowering Seniors Through Laughter! Apr 9, 2015 BLOG One way to make a change is to get people laughing! This is what an acting troupe of seniors do…traveling and performing comedy as a way to educate their peers on senior scams. CHA Calls for Task Force to Create a Statewide Program to Provide Long Term Care Apr 6, 2015 ADVOCACY CHA submitted this letter of support for AB 332 which would establish a task force to begin exploring the feasibility of a statewide program to provide and pay for long term care, and subsequently to recommend options to the Governor and the legislature. CHA Supports AB 763 to Raise the Aged & Disabled Program Income Level to 138% of the FPL Apr 6, 2015 ADVOCACY California Health Advocates submitted this letter of support for AB 763, which would raise Medi-Cal's Aged and Disabled program income level of to 138% of the federal poverty level, the same as the income ceiling for MAGI Medi-Cal, California’s adoption of expanded Medicaid provided by the Affordable Care Act. What's New with the DMEPOS Competitive Bidding Program? Mar 26, 2015 WEBINAR » Malisa Rogan of Palmetto presents updates on the Durable Medical Equipment Competitive Bid program that has expanded in both scope of items covered and the areas in the country affected since it began in 2011. It's estimated to save the Medicare Trust funds over $25 billion dollars by 2022. Learn how the program began, where we are now and what to expect in the future. CHA Supports SB 426 Requiring Deferred Annuity Death Benefits to be Equal to Annuity Value Mar 25, 2015 ADVOCACY CHA submitted this letter of support for SB 426 which would require the death benefit of a deferred annuity sold to an individual 65 years of age or older to be at least equal to the annuity value at the time death occurs. CHA Calls for Annual Notification to Beneficiaries with "Banked" Long Term Care Benefits Mar 25, 2015 ADVOCACY CHA submitted this letter of support for SB 575 which would require annual notification of long term care insurance benefits that were "banked" as a result of increased or unaffordable premiums. SGR Legislation is a Bad Deal for Beneficiaries Mar 25, 2015 BLOG California Health Advocates supports a long-term solution to the physician payment formula known as the Sustainable Growth Rate (SGR) that is good for beneficiaries and doctors and does not add extra costs to our elders and people with disabilities. Fraud Prevention Efforts Recoup Over $3.3 Billion for Medicare Mar 20, 2015 BLOG The Obama Administration announced the recovery of over $3.3 billion in fraudulent health care payments for fiscal year 2014. This amounts to a return of $7.70 for every $1 invested in fraud prevention, detection and investigation efforts in the last 3 years. CHA Calls for Limit on Medi-Cal's Estate Recovery Mar 19, 2015 ADVOCACY California Health Advocates wrote this

letter in support of SB 33 to limit Medi-Cal estate recovery to what is federally required. This would help protect the homes and health of some of our state's most vulnerable families. CHA Says No to Shifting Doc Fix Cost onto Beneficiaries’ Shoulders Mar 13, 2015 BASICS House Speaker John Boehner and Minority Leader Nancy Pelosi are looking for ways to pay for the cost of fixing the way that Medicare pays doctors known as the “doc fix,” yet several proposals put much of the cost on beneficiaries' shoulders. Without Congressional action, doctors who treat Medicare beneficiaries are facing a 21% cut in their Medicare payments beginning on April 1 st. Medicare Covers Lung Cancer Screening for Qualified Beneficiaries Mar 10, 2015 BASICS Did you know lung cancer is the leading cause of cancer deaths for both men and women in the U.S. Only 15% of cases are detected in an early stage, and if the cancer has already spread, the 5-year survival rate is only 4%. Because of its affect on a growing number of beneficiaries and the benefit of early detection, Medicare now covers lung cancer screening for qualified beneficiaries. CHA Advocates for Making the Part D Exceptions and Appeals Processes More Accessible for Beneficiaries Mar 6, 2015 ADVOCACY CHA and other advocates submitted this letter to the Centers for Medicare and Medicaid Services in support of making the Part D appeals process more accessible for beneficiaries, including improving the clarity of denial notices and streamlining the appeals process. Seniors Pay Skyrocketing Price for "Free" Ice Cream Mar 2, 2015 FRAUD Have you or groups of elders you know been offered a free ice cream social AND a “free” Medicare-covered cheek swab genetic test? If so, it's a scam that is happening around the country. The Importance of Inclusivity for LGBT Older Adults Feb 26, 2015 FRAUD Learn more about SMP's LGBT Integration Project; the unique issues lesbian, gay, bisexual and transgender (LGBT) older adults face; why inclusion is important; trends and changes in aging services; how language, forms, and communication make a difference; ways SMP has become more inclusive; and links to a powerful short film by Project Visibility. Beware of Genetic Testing for Beneficiaries in Group Settings Feb 17, 2015 FRAUD This alert warns of genetic testing scams where beneficiaries are offered a presentation or an ice cream social along with a "free cheek swab" test to help their doctors prevent adverse medication affects. Available in English, Spanish, Chinese, Vietnamese, Korean and Russian. Pressure in Poverty: How One HiCAP Saved $1.4 Million for Seniors Feb 2, 2015 BASICS Medicare’s open enrollment is the busiest time of year for our partners, the Health Insurance Counseling and Advocacy Program. Learn of some of the successful strategies of one of the HICAP programs that conducted 36 enrollment clinics this fall and helped their clients save over $1.4 million in health care costs for 2015. This story inspires and shows how each HICAP’s team efforts contribute much in service and wellbeing for the entire community. Large Newspaper Ad Falsely Promises FREE Medicare-Covered Back Brace Jan 15, 2015 PRESS RELEASE Watch out for large newspaper ads that lure Medicare beneficiaries to call to get a free, “Medicare-covered” back brace in exchange for their Medicare number. This is one of many scams to designed to collect beneficiaries' Medicare numbers. NAIC Appoints Bonnie Burns as Consumer Representative for 23rd Term Jan 13, 2015 PRESS RELEASE Bonnie Burns, our Training and Policy Specialist, begins her 23rd term as one of the 20 appointed and funded consumer liaison representatives by the National Association of Insurance Commissioners (NAIC). Ms. Burns spearheaded the standardization of Medicare supplemental insurance, known as Medigap and has provided numerous Congressional testimonies guiding the standardization of long-term care insurance and the policies for financing long-term care. CHA Calls for Government Notifications to Inform People Nearing 65 of Their Medicare Rights and Obligations Dec 11, 2014 ADVOCACY CHA and other advocates submitted this letter to several government agencies requesting them to inform people nearing 65 of their rights and obligations surrounding Medicare enrollment, including their options to enroll, when they can delay enrollment and consequences of not enrolling (such as life time late enrollment penalties). Medicare Marketing Do’s & Don’ts for 2015 Nov 17, 2014 FRAUD Learn what agents and plan sponsors can and cannot do as they market Medicare Advantage and Part D plans to beneficiaries. Also, Medicare recently expanded the scope of what plan sponsors and agents can call their enrollees about to include other Medicare plan products as well their current plan. CHA Responds to Proposed Health Plan Innovation Initiatives for Supplemental Insurance Nov 3, 2014 ADVOCACY A pilot program proposed by the Centers for Medicaid and Medicare Innovation to help Medicare beneficiaries better manage their daily chronic care needs and utilize existing community services and supports could be very beneficial for certain beneficiaries. Yet, this is not an appropriate task for Medigap carriers, as discussed in the submitted comments. Windsor. DOMA and Medicare Benefits Oct 16, 2014 BASICS Windsor. a 2013 Supreme Court decision, was a victory for lesbian, gay, bisexual and transgender populations and has opened the door for same-sex spouses to apply for more than 1,000 federal spousal benefits, which previously had been denied to them. CHA Testifies on Behalf of Beneficiaries "Trapped in the Gap" at White House Conference on Aging Sep 29, 2014 ADVOCACY Elaine Wong Eakin of California Health Advocates provided oral and written testimony at the White House Conference on Aging. She illuminates the challenges many low and middle income beneficiaries “trapped in the gap” face, explains why proposals to increase Medicare cost-sharing on beneficiaries could be harmful, and advocates for innovative and affordable solutions for long-term care services. See written testimony (PDF). (updated) Medicare & Covered California

Get Your Questions Answered Sep 9, 2014 REFORM Get answers to some of the most common questions about Medicare and Covered California, our state's new health insurance marketplace. Getting HIP at Walgreens! SMP/HICAP Expands Community Outreach in CA Pharmacies Jul 16, 2014 FRAUD SMP/HICAP are creating partnerships with pharmacies across the state as a way to reach more Medicare beneficiaries and spread the word on fraud prevention. This partnership program is known as HIP – Health In Pharmacies. Beware of Providers and Suppliers Who Advertise Free Services Jul 8, 2014 BLOG We’re getting several reports of fraudulent providers and durable medical equipment (DME) suppliers who are offering beneficiaries “free” services or equipment in exchange for their Medicare numbers. “Free” is the red flag. Why Can’t Medicare Negotiate Lower Drug Prices for Part D? May 29, 2014 BLOG Both Medicaid and the Department of Veteran Affairs negotiate for lower drug prices, but Medicare Part D, from it’s inception in 2006, is barred from doing this. New Medicare Card Scam – Skit by SMP Thespian Society! May 15, 2014 BLOG This video, featuring SMP Liaisons Pat Macholl and Doug Shaw, demonstrates a common Medicare Part D fraud scam involving mail-order medications and provides a fun example of creative outreach. Are You Eligible for a Re-Review of Past Denied Medicare Claims? May 12, 2014 BILLING Certain beneficiaries who were wrongly denied maintenance coverage for skilled nursing or therapy services now have an opportunity to have their claims re-reviewed. Learn the background on the Jimmo settlement, who is eligible for a re-review process, and a timeline to apply. California SMP’s Efforts Result in Over $7 Million in Recoverable Funds to Medicare Apr 1, 2014 BLOG The amount of funds recovered to Medicare for fraudulent claims that is attributed to cases our California Senior Medicare Patrol closed in 2013 totals over $7 million. This success mirrors success on the national level as reported in the 2013 OIG report where government teams have recovered a record $4.3 billion for FY 2013, and $19.2 billion over the past 5 years. Tips to Prevent Medicare Part D Prescription Drug Fraud Mar 10, 2014 FRAUD Are you getting the most out of your Part D benefit? Does your doctor prescribe less expensive generics when they're available? Do you receive the correct number of pills in your prescription bottles? Learn several simple tips to make sure: you are making the best use of your drug benefits; you know how to prevent fraud and abuse, and you know how to detect fraud if it occurs. SMP Forms Fruitful Community Outreach Partnership with Local Pharmacy Feb 24, 2014 FRAUD Chico Rite Aid's "Wellness Ambassador" reached out to HICAP and our Senior Medicare Patrol program to see if we'd come to the pharmacy on a regular basis to offer an information table on Medicare fraud to help educate their customers on fraud. This is turning out to be a win/win partnership and can easily be modeled in pharmacies statewide. California Bill AB 1553 Says No to Gender-Based Pricing Feb 13, 2014 BLOG Without legal intervention, women could end up paying 40% more for long-term care insurance coverage than men. And this could happen as early as January 2015. AB 1553 introduced by Assembly member Mariko Yamada seeks to prohibit such gender-based pricing products in California.

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