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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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Latest News for Professionals:

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 1st.
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.
Anthem Insurance Data Breach Effects Millions ~ Tips on Best Response
Feb 11, 2015 FRAUD Tens of millions of Americans may be affected by the latest corporate data breach at Anthem Insurance. Learn some tips from the Better Business Bureau on how best to respond and protect yourself and/or loved ones.
Medicare & Covered California
Feb 4, 2015 WEBINAR » Learn about Medicare and Covered California. In the webinar we discuss: who can have a qualified health plan and Medicare and who cannot; what you should do if you have a qualified health plan and then become eligible for Medicare; and what the tax consequences are if you receive premium tax credits and then become Medicare eligible.
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.
Overview of Medicare Part A Payment Systems with Diane Caradeuc
Jan 29, 2015 WEBINAR » Review the Part A program and how its benefits are paid. In this webinar, Diane discusses both how program payments historically started and the current Part A benefits payment methods. She also reviews some of the controls established to protect the financial solvency of the Medicare program and some commonly used Medicare terms like DRG, HAC, RACs, and consolidated billing.
Updated! ~ Do You Have an Aetna Medicare or First Health Part D Plan?
Jan 20, 2015 ADVANTAGE The Medicare's Plan Finder tool had incorrect information on Aetna and First Health Part D plan network pharmacies during the AEP which has left some members thinking their pharmacy is in-network when it is not. Aetna is putting in place a temporary solution so that members pay the network price. Medicare is also giving affected beneficiaries the right to an Special Election Period to change plans.
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.
Medicare’s Open Enrollment is Over, Can I Still Switch Plans?
Dec 15, 2014 ADVANTAGE Medicare’s Open Enrollment period is over, yet some people may have some options for changing coverage. This article provides a Q&A to review these options, including for people whose Medicare Advantage and/or Part D plan is terminating December 31, 2014.
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 Misconduct with Julie Lowry of DMHC
Nov 20, 2014 WEBINAR Learn about the current types of marketing misconduct as seen from the perspective of the California Knox-Keene Act. In the archived webinar, Ms. Lowrie reviews the do's and don'ts of Medicare Marketing, and provides examples of activities considered to be misleading, deceptive, and potentially fraudulent in the sale of Medicare Advantage products. She also reviews how to report marketing fraud.
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.
Are You Spending More On Drugs?
Nov 1, 2014 DRUGS Are you spending too much on your medications but unsure how to navigate other plan options? Learn clear navigating tips during Medicare's Open Enrollment, and where to go for help.
Quality Improvement Organization Update for California
Oct 23, 2014 WEBINAR Two Quality Improvement Organizations (Livanta and Health Services Advisory Group) now cover California. This webinar reviews the their current scope of work and the separation of the care reviews and discharge appeals work with the quality of care improvement work with providers.
Open Enrollment is Here! Do You Know Your Plan Changes for 2015?
Oct 16, 2014 BASICS Open Enrollment is upon us. This enrollment period runs from October 15 through December 7, and is one of the few times you can change, enroll into or disenroll from a Medicare Advantage or Part D plan. Learn your options and review changes for 2015.
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.
Medicare Changes in 2015
Oct 14, 2014 WEBINAR Learn what's new for Medicare in 2015. We discuss: 2015 Medicare Part D cost-sharing; stand-alone Medicare Part D plans available in California; benchmark plans in 2015; Medicare Advantage- landscape of 2015 plans; and Special Election Periods.
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.
Concierge Medicine
Aug 28, 2014 WEBINAR A relatively new business model in healthcare is concierge medicine. While some people embrace this type of healthcare service, others wonder if it violates Medicare rules and regulations. Find out how concierge medicine does or doesn't work for a Medicare beneficiary. Learn some of the questions a Medicare beneficiary needs to ask their doctor who is now offering them concierge medicine.
New Pilot Program Allows Some Beneficiaries Access to Both Hospice & Life-Prolonging Care
Aug 12, 2014 BLOG This program would allow some beneficiaries covered under the Medicare hospice benefit with certain health conditions to receive both hospice care and life-prolonging treatments.
Can I Choose Health Coverage through Covered California Instead of Medicare?
Aug 8, 2014 REFORM The Centers for Medicare and Medicaid Services released FAQs Regarding Medicare and the Marketplace (PDF) in response to questions from us and other advocacy organizations. The 5-section document answers questions about prescription drug coverage, premium tax credits and penalties that may apply to Medicare beneficiaries.
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.
Is It Fishy? How to Identify Scams as They Morph and Multiply
Jun 25, 2014 BLOG The traditional phone scam keeps morphing and now shows up as email scams, post office scams, delivery scams, bank scams. But all of these scams do have something in common. They are fishy. Learn from these few examples and what to watch out for.
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.
Are You Affected by Cal MediConnect?
Apr 22, 2014 LOW-INCOME Starting April 1, 2014, beneficiaries dually eligible for Medicare and Medi-Cal in a few counties have received notices about or experienced changes in how they receive benefits. These changes are brought about by “Cal MediConnect,” a demonstration to integrate Medicare and Medi-Cal that affects 8 counties statewide.
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.
Support AB 2025 ~ Legislation Raises Income Level for Aged & Disabled Medi-Cal Program
Mar 31, 2014 LOW-INCOME Assemblymember Roger Dickinson recently introduced AB 2025 to raise the income level of the Aged and Disabled Medi-Cal program to 138% of the federal poverty level. This change would create consistent income eligibility for different Medi-Cal programs and parity for seniors and people with disabilities.
Will the Therapy You Need be Covered?
Mar 13, 2014 BILLING Currently Medicare limits payment for outpatient therapy services at an annual dollar amount, commonly called “therapy caps.” If a beneficiary needs services above the capped amount, the therapist can help a beneficiary request an exception through an “exceptions process.” Yet, the exceptions process is about to expire on 3/31/14, and we urge Congress to extend the exceptions process or, better yet, repeal the therapy caps.
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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