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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
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.
Autumn Brings Fond Farewells & Warm Welcomes
Oct 13, 2014 CHA News This year’s autumn brings the fond farewells of two long-time staff and dedicated team members, Julie Schoen and Anne Gray. It also brings some exciting promotions and the welcoming of our newest staff member, Michele Kogler.
Fall Open Enrollment Starts Oct 15th ~ Tips to Prepare & Protect Yourself from Fraud
Oct 7, 2014 BLOG Fall Open Enrollment starts on Oct 15th and is the time of year when you can switch your Medicare health and drug coverage. Learn 3 points to guide you in reviewing your Medicare coverage and options AND tips to protect yourself from fraud.
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.
New IRS Phone Scam Threatens Pending Lawsuit
Jun 10, 2014 BLOG In a new scam, a caller posing to be from the IRS says there is a pending lawsuit against the beneficiary and attempts to get some personal information. We've received several reports, and ask people to report any such suspicious calls to our Senior Medicare Patrol office.
World Elder Abuse Awareness Day is June 15
Jun 5, 2014 BLOG Did you know that an estimated 5 million elders are victims of elder abuse each year in the U.S.? World Elder Abuse Awareness Day is June 15 and is a good platform to educate both the public and our Congress on this issue.
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.
SMP Thespian Society Presents Skit on Mail-Order Medication Scams
May 6, 2014 BLOG This video, featuring SMP Liaisons Ray Jones and Paula Holden, demonstrates a common new Medicare card scam. It took off in the fall of 2013 with the beginning of Obamacare's open enrollment and Medicare's annual open enrollment period.
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.
Qualified Individual Program Expires 3/31 ~ Tell Congress to Make the QI Program Permanent
Mar 16, 2014 LOW-INCOME Over half a million low-income Medicare beneficiaries depend on this the Qualified Individual (QI) program to pay their Medicare Part B premium, which covers outpatient medical services. Unlike the other Medicare Savings Programs, which are permanent, the Qualified Individual (QI) program is not. Join us in urging Congress to make the QI program permanent.
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.
Protect Your Durable Medical Equipment Benefits ~ Be Aware of Common Scams & Report Fraud
Feb 6, 2014 BLOG One of the biggest “avenues” of Medicare fraud is with suppliers of durable medical equipment (DME). Last February the Centers for Medicare and Medicaid Services reported that 2/3 of the roughly $10 billion Medicare spent on the DME program were “improper” payments.
SMP Introduces Fraud Schemes & Prevention Tips
Jan 23, 2014 WEBINAR View our archived webinar and learn about Medicare fraud and abuse, and common schemes in outpatient, inpatient, home health and hospice care, and in the Part D prescription drug benefit. Also review the Senior Medicare Patrol's work and how you can participate in sharing the "Protect, Detect, Report" message.
Observation Status Issue on NBC Nightly News
Jan 13, 2014 BLOG The problem of beneficiaries being held in under observation while receiving hospital care is growing. It often leaves affected beneficiaries with unexpected, large and sometimes financially devastating bills.
Celebrating SMP Successes in 2013!
Jan 13, 2014 FRAUD 2013 statistics demonstrate our staff and volunteers' great work that benefits tens of thousands of beneficiaries, providers and the integrity of the Medicare program.
NAIC Appoints Bonnie Burns as Consumer Representative for 22nd Term
Dec 19, 2013 PRESS The National Association of Insurance Commissioners (NAIC) appointed Bonnie Burns, our Training and Policy Specialist, for her 22nd term as one of their 20 funded consumer liaison representatives. Burns has served with the NAIC since 1992, protecting consumer rights and reforming policy at the state and federal levels.
California Health Advocates & Equality California Create Partnership for Mutual Medicare Fraud Trainings
Dec 5, 2013 PRESS CHA and Equality California Institute team together to train our Senior Medicare Patrol volunteer workforce on culturally competent outreach strategies to the lesbian, gay, bisexual and transgender community, and to train Equality California’s staff on Medicare fraud and abuse. This partnership allows both organizations to do better outreach within the LGBT senior community and helps our Californian LGBT elders become informed healthcare consumers.
Actions to Take If Your Doctor is No Longer in Your Medicare Advantage Plan’s Network
Dec 5, 2013 ADVANTAGE If you've been notified that one of your doctors in your Medicare Advantage plan is no longer in the plan's network, you may switch to another MA plan or return to Original Medicare. Medicare's Annual Election Period to make this switch, however, ends Saturday, Dec 7th at midnight. Learn your options.
Watch Out for Deceptive Sales Practices During Medicare’s Open Enrollment
Nov 12, 2013 BLOG Beware of improper sales practices during Medicare’s annual open enrollment period for Medicare Advantage and prescription drug plans.
California SMP Recovers $5.8 Million to Medicare
Nov 6, 2013 FRAUD Our California Senior Medicare Patrol recovered over $5.8 million to the Medicare system for just one case, thanks to the persistent and dedicated efforts of our SMP casework team.
Karen Fazio Joins Our SMP Team!
Nov 6, 2013 CHA NEWS Join us in welcoming Karen Fazio! As our Senior Medicare Patrol Special Projects Manager, Fazio provides outreach and education to California’s lesbian, gay, bisexual and transgender (LGBT) populations as part of our SMP integration project.
United Healthcare Cuts Doctors from its Medicare Advantage Plans
Oct 30, 2013 BLOG United Healthcare is dropping 10 to 15% of its doctors nationwide. This cut will likely include Californian physicians as there are many United Healthcare HMO plans offered throughout the state.
Medicare Announces Major Savings for Medicare Beneficiaries in 2014
Oct 29, 2013 BLOG Health care reform efforts continue to yield significant savings to Medicare beneficiaries, such as zero growth in Medicare Part B premiums and deductibles in 2014, and more than $8 billion in cumulative savings in the prescription drug coverage gap known as the “donut hole.”
Open Enrollment is Here! Do You Know Your Plan Changes for 2014?
Oct 17, 2013 BASICS Open Enrollment, referred to as the Annual Election Period, runs from October 15 through December 7. It is one of the few times you can change, enroll into or disenroll from a Medicare Advantage or Part D plan.Review your options and learn about 2014 Medicare Part C and D changes.
Learn About Medicare Changes in 2014
Oct 10, 2013 WEBINAR View our archived webinar, and learn about 2014 Medicare changes. Topics include: Medicare Part D cost-sharing; Part D stand-alone and benchmark plans, and Medicare Advantage plans in California; new Explanation of Benefits requirement for MA plans; star ratings for plans; and a review of Special Election Periods.
Medicare Open Enrollment Starts October 15
Oct 9, 2013 BLOG Medicare’s fall Open Enrollment runs from October 15 through December 7, and is main time when you can change your coverage.
Fraudulent Health Care Exchange Website Taken Down
Sep 26, 2013 BLOG One of the many bogus websites popping up about the new health care insurance marketplaces was recently shut down.
What is a Medicare Administrative Contractor & Why Should I Care?
Sep 26, 2013 BILLING If you are a Medicare fee-for-service provider, applying to be a provider, or are a beneficiary filing a Part A or B appeal, you need to know who your Medicare Administrative Contractor is and what they do. California’s MAC recently changed to Noridian Healthcare Services.
Long-Term Care and the Graying of America
Sep 25, 2013 LONG-TERM With 10,000 people becoming eligible for Medicare each day for the next 17 years, the need for long-term care services in America is steadily increasing. Learn about long-term care (LTC), its costs, LTC insurance and things to consider if purchasing, and the national issue of long-term care.
Warm Welcomes to Paula Holden as She Joins Our SMP Team!
Sep 23, 2013 CHA NEWS Based in Chico, Paula will head up our SMP Liaison and volunteer coordination, and develop new outreach opportunities. We are thrilled to have her join our team!
Protect Yourself from Obamacare Scams this Fall
Sep 20, 2013 FRAUD The roll out of the new health care program known as "Obamacare" begins in October, with enrollment from October 1, 2013 – March 31, 2014. This enrollment period is not to be confused with Medicare’s fall Open Enrollment which is October 15 – December 7, 2013. Learn important tips to avoid scams both for people with Medicare and those without.
Take Simple Actions to Prevent Phone Scams & Protect Yourself If Scammed
Sep 20, 2013 FRAUD Use this quick action plan checklist if you feel you have been scammed or your identity compromised.
Learn About Changes in Health Care Policy Affecting California's Low-Income Seniors
Sep 12, 2013 WEBINAR If you missed our live webinar on 9/12, you can access the archived recording, slides and other posted materials online. Learn about Medi-Cal expansion and who is eligible after January 2014, Medi-Cal Managed Care expansion in rural areas, Covered California, and updates on the California Care Initiative.
How Does Covered California™ Affect People with Medicare?
Aug 19, 2013 REFORM Covered California™ is our state's insurance marketplace and was set up as a result of the Affordable Care Act. It won’t affect your Medicare choices or your benefits, and if you have Medicare, you don’t need to do anything. You are considered covered. You should, however, be aware of potential scams to sign you up for insurance you don’t need.
The Numbers are Out! California SMP Saves Money for Both Medicare & Beneficiaries
Aug 6, 2013 FRAUD The Office of Inspector General (OIG) numbers are out and California’s Senior Medicare Patrol has much to celebrate! Our SMP, serving over 4.5 million beneficiaries across the state, accounts for 10% of the total SMP volunteer base, 28% of the Medicare funds expected to be recovered, 28% of the cost avoidance for beneficiaries, and 70% of the actual savings for beneficiaries.
CHA Testifies on the Need for Long-Term Care Services & Recommends Innovative, Comprehensive Solutions
Aug 1, 2013 ADVOCACY Bonnie Burns of California Health Advocates provided oral and written testimony to the Commission on Long-Term Care. She speaks to the urgent, growing need of long-term care services, our current broken system of care, the limits of long-term care insurance, and provides several recommendations for creating a new system. Some recommendations include: looking at what's working in other countries; drawing ideas from the deceased CLASS Act and the Federal long-term care insurance program; standardizing each element of LTC insurance policies for ease of comparison; and making personal care a mandatory benefit of each state's Medicaid program. See written testimony (PDF).
A Baby Boomer Alert: Who Is Stealing From Your Elderly Parents Today?
Jul 18, 2013 FRAUD MetLife’s Mature Market Institute estimates that seniors lost $2.9 billion due to financial abuse in 2010, an increase of $200 million from 2009. Because many seniors have saved a "nest egg" in the form of home equity and some savings, they are attractive targets, and vulnerable to a variety of investment fraud, credit card fraud and identity theft.
Beware of Insurance Agents Giving Misleading Information on Cal MediConnect
Jul 17, 2013 FRAUD We have reports of insurance agents giving beneficiaries false information about losing access to their doctors' this fall unless they switch plans. This false information may be given deliberately to secure enrollment commissions or may stem from a misunderstanding about a new demonstration called Cal MediConnect.
Proposals for Changed Medicare Benefit & Cost-sharing Structures Could Harm Beneficiaries
Jun 26, 2013 ADVOCACY California Health Advocates, the Center for Medicare Advocacy and the Medicare Rights Center submitted written testimony to the Subcommittee on Health of the U.S. House of Representatives Committee on Energy and Commerce. Their testimony addresses proposed changes to Medicare's benefit and cost-sharing structures. Advocates point out the harm these changes could cause and outline other methods to reduce costs and address systemic rises in health care.  See written testimony (PDF).
Beneficiaries Avoid Growing Medical Alert System Scam
Jun 26, 2013 FRAUD Our recent fraud notice about a Medical Alert company offering to give free equipment has attracted much media coverage and helped numerous beneficiaries statewide avoid this scam. Notices are translated into 5 languages.
Health & Human Services Secretary Accepts NAIC Recommendations Against Increased Cost-Sharing for Medigap Plans C & F
May 31, 2013 BLOG After 2 long years of advocacy, Secretary Sebelius agrees to accept the National Association of Insurance Commissioners' recommendations against added cost-sharing for Medigap Plans C and F.
Beneficiaries Face Financial Hardship with Proposed Increases in Medicare Cost-Sharing
May 24, 2013 PRESS California Health Advocates and 2 other advocacy groups submitted testimony opposing proposals that would shift costs to beneficiaries to the Subcommittee on Health of the U.S. House of Representatives Committee on Ways and Means.

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