50 Wishes for Medicare’s Future

On July 30, 2015, Medicare celebrated 50 years since it was signed into law. In those 50 years, Medicare has provided guaranteed health benefits to millions of older adults and people with disabilities. Today, more than 50 million Americans and their families rely on Medicare for basic health and economic security. This landmark anniversary represents an important opportunity to celebrate the undeniable successes of the Medicare program. It is also a chance to look forward and explore how policymakers can make the Medicare program even better over the next 50 years.

Thinking ahead to the next 50 years, it is critically important for lawmakers to advance global changes to modernize benefits in both Original Medicare and private Medicare health plans. But it is equally important for policymakers to press forward on seemingly small fixes to improve how Medicare beneficiaries navigate their coverage day-to-day. Here are our 50 wishes for Medicare’s future.

1006, 2015

Add a dental benefit

Medicare Rights routinely hears the same question from beneficiaries and family caregivers—does Medicare cover dental? In most cases, the answer is no. Some Medicare Advantage (MA) plans have dental benefits, but often this coverage is limited and includes only routine care. Despite the fact that oral health is increasingly linked to overall health and wellbeing, there is little political will to fill this longstanding gap in health benefits for seniors and people with disabilities. Congress should add a comprehensive dental benefit to Original Medicare and to MA plans once and for all.

906, 2015

Make Medicare more affordable

Half of all people with Medicare—over 25 million seniors and people with disabilities—live on annual incomes of $23,500 or less. All too often, Medicare Rights counsels beneficiaries who are unable to afford premiums and cost-sharing—in both Original Medicare and Medicare Advantage. Congress should make Medicare more affordable, most importantly by expanding assistance for vulnerable, lower-income beneficiaries through the Medicare Savings Programs.

806, 2015

Cover vision and hearing care

Medicare will not cover care for vision or hearing needs, such as a visit to the optometrist or hearing aids. Like with dental, some Medicare Advantage plans offer supplementary vision or audiology coverage but the quality and cost varies considerably from plan to plan. The absence of meaningful coverage for these basic health needs represents a stark gap in coverage for older adults and people with disabilities, who are more likely than other populations to need this care. Congress should add standardized vision and hearing benefits to Original Medicare and Medicare Advantage plans.

706, 2015

Expand coverage for long-term services and supports

Medicare (including Original Medicare and Medicare Advantage) does not cover many long-term services and supports. And it covers help with activities of daily living, like eating and bathing, only in very limited circumstances. Reflecting broad national trends, many callers to the Medicare Rights national helpline seek help paying for this care. Medicare should adapt to meet this growing need by expanding coverage for services that allow beneficiaries to remain in their homes and for family caregiver supports, like respite care.

606, 2015

Add a standard Medicare out-of-pocket maximum for beneficiary cost sharing

Original Medicare altogether lacks an out-of-pocket maximum to protect beneficiaries from catastrophic health care costs. The federal government does require Medicare Advantage (MA) plans to include an out-of-pocket maximum in their benefit packages, but these MA maximums are too high—permitting costs up to $6,700 annually. Congress should establish a standard, affordable out-of-pocket maximum in the Medicare program, applicable to both Original Medicare and MA plans.

506, 2015

Allow open enrollment in Medigap for all people with Medicare

Beneficiaries are entitled to select a Medicare Advantage plan every year during the annual enrollment period, but most are only guaranteed the right to enroll in a Medigap plan during very limited times. Additionally, in most states, Medigap insurers are permitted to charge more or deny coverage outright to some populations, including people with disabilities and people with End Stage Renal Disease. Congress should expand Medigap enrollment rights to ensure that all beneficiaries have access to Medigap plans and to allow all Medicare beneficiaries to make a choice about the coverage best suited to their needs each year.

406, 2015

Consolidate and standardize Medicare Advantage and Part D plans

Selecting an MA or Part D plan is a daunting task for most people with Medicare. There are simply too many plan choices and too many variables to compare. Alarmingly, only 13 percent of Medicare beneficiaries opt to reevaluate their coverage options year to year—despite annual changes to premiums, plan coverage rules, and cost-sharing. Congress should enact legislation to consolidate MA and Part D plan choices and standardize options in order to facilitate informed decision-making by Medicare plan enrollees.

306, 2015

Provide a federal notice for everyone approaching Medicare eligibility

No federal agency provides notification about Medicare eligibility to individuals not yet collecting Social Security benefits—meaning those not automatically enrolled in Medicare are not informed about enrollment rules and policies. Honest enrollment mistakes can result in lifetime premium penalties, gaps in health coverage, and higher health care costs. The federal government should provide a notice to all people approaching Medicare eligibility about how and when to enroll.

206, 2015

Close the Part D doughnut hole sooner

The Affordable Care Act took a historic step toward making prescription drugs more affordable by closing the Part D prescription drug coverage gap (or doughnut hole). Until 2010, while in the doughnut hole, beneficiaries were responsible for the full cost of needed medications. Over time, this obligation is gradually diminishing, and the doughnut hole will be fully closed by 2020. Congress should close the doughnut hole sooner by increasing discounts expected from pharmaceutical manufacturers. This policy proposal represents a win-win by lowering the cost of prescription drugs for beneficiaries and securing over $16 billion in savings for the Medicare program over 10 years.

106, 2015

Eliminate (or ease) the asset test for Medicare low-income assistance programs

Eligible low-income Medicare beneficiaries can benefit from government assistance to pay for premiums and cost-sharing. Unfortunately, these programs (Medicare Savings Programs) have very low asset thresholds, making health care costs less affordable for those who saved even a small nest egg for retirement or for emergencies. In addition, administering these asset tests creates a tremendous burden for the state Medicaid departments that operate these programs. Congress follow the lead of some states to eliminate (or ease) the asset tests for these programs to help vulnerable Medicare beneficiaries access needed assistance.

3005, 2015

Ease and align income tests for Medicare low-income assistance programs

The existence of multiple programs to help beneficiaries pay for Medicare premiums and cost-sharing is vitally important to the most vulnerable people with Medicare. These varied programs (Medicare Savings Programs and Part D’s Extra Help) have disparate income tests that are administered by multiple federal and state agencies. This disjointed system—combined with income thresholds that are simply too low—create barriers to allowing beneficiaries to access the help they need. To address this, Congress should increase and align income tests for low-income assistance programs.

2905, 2015

Improve and streamline the application process for Medicare low-income assistance programs

Beneficiaries must navigate multiple state and federal agencies to apply for low-income assistance programs (Medicare Savings Programs and Part D’s Extra Help) to help afford Medicare premiums and cost-sharing. Some information sharing between agencies occurs, but only in one direction—federal to state. Yet state agencies are not required to accept the information from the federal government as true, leading some to seek duplicative information from applicants. For beneficiaries, this sometimes results in unnecessary delays and improper denials. Congress should integrate the application processes, qualifying criteria, and administration of these interrelated low-income assistance programs.

2805, 2015

Integrate Medicare low-income assistance applications in state Marketplaces

The vision behind the Affordable Care Act was to create one-stop shopping for consumers—regardless of the health insurance they are eligible for, either in the private Marketplace or through Medicaid. But lower-income people with Medicare are currently not a part of this “no wrong door” system. State Marketplaces should integrate screening and enrollment for Medicare low-income assistance programs (Medicare Savings Programs) into their state Marketplaces to realize the vision of a “no wrong door” consumer assistance portal.

2705, 2015

Put beneficiary needs at the center of delivery system and payment reforms

Recent legislation is fundamentally changing the way that Original Medicare pays doctors and other health care providers to deliver care. Over time, the federal government will increasingly pay for high-value care as opposed to high-volume care. As these payment reforms are implemented, the federal government must actively engage, involve, and educate Medicare beneficiaries and consumer advocates. Strong oversight and transparency is also important to protect against discriminatory practices and diminished access to care.

2605, 2015

Ensure appropriate financing is available to sustain and strengthen Medicare for the future

It is critically important that Congress ensure the Medicare program is adequately financed to deliver on its promise of guaranteed access to health benefits to today’s and tomorrow’s beneficiaries. Cuts to Medicare benefits, radical changes to the program’s basic structure, and cost shifting to seniors and people with disabilities should not be used to reduce federal spending. Where Medicare savings are needed, Congress should rely on responsible solutions, such as through the advancement of delivery system reforms, the elimination of wasteful spending, programs to restrict fraud and abuse, and new revenue generation.

2505, 2015

Equalize payments between Original Medicare and Medicare Advantage (MA) plans

Prior to the Affordable Care Act (ACA), the federal government paid MA plans $14 billion more for care provided to MA enrollees than if the same care had been provided under Original Medicare—or about $1,000 more per enrollee. Through the ACA, these overpayments were gradually reduced. Still, more can be done to create a level playing field between Original Medicare and MA plans. Congress should eliminate remaining overpayments to MA plans and implement reforms to halt abuses of patient categorization rules —known as “upcoding”—that some health plans engage in to secure unacceptably high payments.

2405, 2015

Eliminate coverage gaps during the Initial Enrollment Period (IEP)

Even beneficiaries who enroll in Medicare during their IEP (the seven-month period to enroll when someone is first Medicare-eligible) can face gaps in coverage. Enrollment in the last months of the IEP can result in up to three months without any outpatient (Part B) Medicare coverage. Congress should eliminate needless gaps in coverage during the IEP and start coverage the month immediately following enrollment.

2305, 2015

Minimize coverage gaps during the General Enrollment Period (GEP)

People who do not enroll in Medicare during their Initial Enrollment Period and do not have access to a Special Enrollment Period must enroll in Medicare Part B during the GEP, from January to March of each year. Yet coverage does not begin until July of that same year—meaning some people go up to seven months without coverage after trying to enroll in Part B. These gaps increase reliance on emergency room care and create needless health risks. Congress should eliminate gaps in coverage during the GEP and start coverage the month immediately following enrollment.

2205, 2015

Align all enrollment periods for Original Medicare, Medicare Advantage, and Part D

The fall open enrollment period for Medicare Advantage (MA) and Part D plans runs from October to December of each year, followed by an MA disenrollment period from January through February. In contrast, the General Enrollment Period (GEP) for delayed Part B enrollment runs from January to March of each year. Congress should align these disparate enrollment periods to create a Medicare enrollment season, allowing the federal government, community-based organizations, and others to more effectively educate beneficiaries about their Medicare enrollment options.

2105, 2015

Expand equitable relief

Limited avenues for relief are available to those who make mistakes when enrolling in Medicare. Specifically, beneficiaries facing lifetime penalties and gaps in coverage can only remedy their situation if they can prove that an agent of the federal government misinformed them about enrollment rules. Yet many people turn to their employer or health plan—not a federal agency—when transitioning to Medicare. To provide adequate recourse for those who make honest enrollment mistakes, Congress should expand equitable relief to include misinformation from employers, health plans, and insurance brokers.

2005, 2015

Reduce or eliminate the Part B lifetime late enrollment penalty

Erroneously delaying Medicare enrollment can have lifetime consequences—currently, a lifetime premium penalty of 10 percent is levied for every year a person should have been enrolled in Medicare Part B but was not. This penalty is designed to encourage enrollment by healthy individuals who otherwise might delay enrollment. Yet the penalty is also imposed on those who simply made a mistake. Congress should enact policies to reduce or eliminate lifetime premium penalties for beneficiaries who were misinformed or uninformed about Medicare enrollment rules.

1905, 2015

Require Part D plans to give the reason for a medication denial at the pharmacy counter

Knowing why a prescription drug is refused at the pharmacy counter is critical to helping beneficiaries determine their next steps—whether it is working with their physician to secure an alternative or appealing for coverage from their Part D plan. The federal government should require Part D plans to provide an individually tailored notice at the pharmacy counter when a medication is refused. The notice should explain why the prescription cannot be filled, for instance because it is off-formulary or because prior authorization is needed.

1805, 2015

Require Part D coverage determinations at the pharmacy counter

After being refused a prescribed medication at the pharmacy, a beneficiary must formally request coverage from their Part D plan before the appeals process can even begin. In other words, a beneficiary must ask for a denial that she can then appeal. Being told no at the pharmacy doesn’t count as a formal denial. To ease beneficiary burdens and streamline the appeals process, the federal government should require Part D plans to make some types of coverage determinations at the pharmacy counter—eliminating a needless step in the appeals process for Medicare beneficiaries.

1705, 2015

Allow appeals on the Part D specialty tier

When medically necessary, people with Part D have the right to request that their plan allow them to pay less for high-cost medications when a similar, lower-cost medicine is available on their plan’s formulary—this is known as a tiering exception. Unfairly, these same rights are not granted to beneficiaries whose prescription drugs are placed on the plan’s specialty tier, where cost-sharing can be exorbitant. Congress should pass legislation allowing Medicare beneficiaries the right to a tiering exception for specialty tier medications.

1605, 2015

Add Part D to an integrated appeals process for Medicare-Medicaid managed care plans

In some states that are testing new care coordination models for dually eligible Medicare and Medicaid beneficiaries, the federal government is allowing the state and health plan to use an integrated appeals process. These innovative appeals models combine the best of the Medicare and Medicaid systems. But, this process is missing a critical element—prescription drug denials and appeals. The federal government should integrate Part D appeals as it continues to test how best to integrate care for those with Medicare and Medicaid coverage.

1505, 2015

End passive enrollment for Medicare-Medicaid managed care plans

Ongoing demonstration programs to test new models of care for dually eligible Medicare and Medicaid beneficiaries are allowing private health plans to passively enroll beneficiaries. This means low-income, vulnerable individuals are not actively choosing their coverage or determining if the selected plan is the best option for their needs. Congress should prohibit the use of passive enrollment, a practice that fundamentally undermines beneficiary choice and informed decision-making.

1405, 2015

Create a publicly-administered Part D benefit

The Medicare prescription drug program is operated solely by private health plans. Adding a public drug benefit to the Part D program would diminish confusion among beneficiaries who now must navigate a complicated maze of private health plans and year-to-year formulary changes. In addition to enhancing beneficiary choice, a Medicare-administered plan also has the potential to create federal savings through simplified administrative processes. Congress should create a publicly-administered Part D benefit.

1305, 2015

Eliminate the two-year Medicare waiting period for people with disabilities

In 1972, Congress granted Medicare benefits to people receiving Social Security disability benefits. This historic step forward was marred by an arbitrary limit, requiring that people with disabilities wait a full two years before gaining access to needed coverage. This provision was included merely to cut costs. Now, beneficiaries with disabilities must navigate two benefit start dates and obtain temporary coverage during this gap. Congress should eliminate this outdated, complicated, and confusing waiting period and allow people with disabilities access to Medicare at the same time they receive their disability benefits.

1205, 2015

Prohibit Medicare Advantage plans from dropping doctors mid-year without cause

Beneficiaries enrolled in MA plans should be able to count on stability in their plan networks and the knowledge that their doctors will be there when they need them. Congress should pass legislation to prohibit MA plans from dropping doctors without cause in the middle of the plan year and strengthen beneficiary notice on provider network changes.

1105, 2015

Incorporate Medicare Advantage (MA) provider network information in the Plan Finder tool

Information about which health care providers are in network and out of network is vital for helping beneficiaries make smart decisions about their coverage. Yet this critical information is absent from Medicare’s primary online decision-making tool—Plan Finder. The federal government should incorporate accurate and timely MA provider network information in Plan Finder.

1005, 2015

Create an individually tailored Annual Notice of Change for Medicare Advantage (MA) and Part D plans

Annual changes to MA and Part D plan coverage rules, cost-sharing amounts, and provider networks are commonplace. At the same time, comparing and contrasting plan options during the Medicare open enrollment period is a dizzying task for many. To help beneficiaries make informed decisions, the federal government should require that Medicare private health plans provide a tailored notice to beneficiaries, based on claims data, describing how a plan will change in the coming year.

905, 2015

Enhance audit capacity and increase transparency on Medicare Advantage (MA) and Part D sanctions

The federal government is currently only able to audit 10 percent (about 30 of 300) of Medicare private health plan sponsors each year. Recent audits uncovered noncompliance among most plan sponsors on multiple measures related to beneficiary grievances and appeals. These audits are critical to judging plan performance, assessing customer service, and ensuring beneficiary access to needed care. Both Congress and the federal government should prioritize avenues to mandate more regular and consistent auditing of MA and Part D plan sponsors.

805, 2015

Improve beneficiary education on low-to-no cost preventive services and screenings

Prior to the Affordable Care Act, many preventive screenings were not covered by Medicare. Now, not only are certain preventive services covered, most of the time they are covered without cost sharing. Unfortunately, too many Medicare beneficiaries remain unaware of the preventive services now available to them. At the same time, many are uninformed about when cost sharing might apply, such as when a screening test automatically leads to a diagnostic procedure. The federal government should work with physicians and consumer advocates to ensure people with Medicare have the right information about preventive coverage and benefits.

705, 2015

Improve Medicare Advantage (MA) and Part D denial notices

The most common call to the Medicare Rights national helpline comes from a beneficiary denied access to a health care service or prescription medication, and most of these calls are from people enrolled in an MA or Part D plan. All too often, beneficiaries struggle to interpret denial notices and remain unclear about their appeal rights. The federal government should require that MA and Part D plan denial notices include the right information (including clinical content), are available in languages other than English, and include content accessible to diverse health literacy levels.

605, 2015

Eliminate the 190-day lifetime cap on inpatient psychiatric hospital stays

The Medicare Improvements for Patients and Providers Act of 2008 achieved partial mental health parity in Medicare, but unequal treatment remains. For instance, Medicare caps coverage for care at inpatient psychiatric hospitals at 190 days over a beneficiary’s lifetime. This same cap does not apply for inpatient psychiatric care received at non-specialized facilities, or for non-psychiatric care. Congress should do away with this arbitrary, outdated cap on access to inpatient care at psychiatric hospitals.

505, 2015

Do away with the three-day stay required for skilled nursing facility care

Medicare will only cover a beneficiary’s medically necessary stay in a skilled nursing facility if that person is first an inpatient in a hospital for three days—a rule established in 1965 when Medicare was first created. This outdated requirement precludes Medicare from covering medically necessary care in a facility even if returning home would be unsafe. Congress should reevaluate the three-day hospital stay requirement, particularly given advances in care that have reduced the length of hospital stays since the law’s passage.

405, 2015

Count time spent in observation (outpatient) status toward the three-day rule for nursing care

Absent elimination of the three-day stay rule, Congress should count all time a patient spends in the hospital—as an inpatient or outpatient—toward the three-day rule. Shifting hospital practices are increasing the number of Medicare beneficiaries who spend multiple days in the hospital under “observation” or “outpatient” status. These beneficiaries are not eligible for Medicare coverage of subsequent skilled nursing facility care. All days in the hospital should count toward coverage for needed skilled nursing facility care.

305, 2015

Eliminate the homebound requirement for Medicare coverage of home health care services

Medicare coverage for care at home currently requires that a person be “homebound” and that they meet several other technical requirements. Medicare Rights often hears from beneficiaries who would benefit from receiving care, such as nursing or physical therapy care, in their homes but who do not meet technical coverage requirements. Congress should expand Medicare coverage for homecare services, both to reduce overall costs and to allow older adults and people with disabilities to stay in their homes and communities where appropriate.

205, 2015

Decrease limitations on coverage for Durable Medicare Equipment (DME) outside the home

Medicare only covers DME that is needed inside the home. This limitation restricts access to DME for those who are in skilled nursing facilities and altogether ignores a beneficiary’s need to safely navigate in the community. Congress should revise DME coverage criteria in the Medicare program. These criteria should be based on the functional requirements of the individual living in their chosen setting, including equipment needed outside their home.

105, 2015

Create Medicare Part E—a public supplement to Original Medicare with Part D benefits and a catastrophic cap

Medicare beneficiaries who opt for the flexibility and simplicity of Original Medicare should be protected from catastrophic costs by an out-of-pocket maximum and should benefit from an integrated Part D benefit. Congress should introduce a public supplement to Medicare—Part Extra or Part E—that wraps together all Medicare benefits, including hospital, outpatient, and prescription drug coverage. Paid for through beneficiary premiums, this benefit would create another choice along with existing private options, including Medicare Advantage and Part D.

3004, 2015

Exclude the sale of a primary home from the calculation for premiums based on income

Higher-income individuals are required to pay a higher amount in Medicare Part B and Part D premiums. These amounts are calculated based on income tax information from two years prior to the current year. Some individuals are subjected to these higher premiums after selling their home, often to relocate to more affordable or suitable housing. To accurately target higher-income individuals, Congress should exempt all proceeds from the sale of a primary residence from the calculation for income-related premiums.

2904, 2015

Provide Medicare coverage for continuous glucose monitors

Medicare does not currently cover monitoring devices for people with diabetes whose blood sugar can rapidly change. Many Medicare beneficiaries and family caregivers contact Medicare Rights about the dire need for these devices, and how essential they are to the safe management of this serious condition. The federal government should revise its coverage criteria for these devices.

2804, 2015

Eliminate beneficiary coinsurance for care coordination services not received in person

Adequate payment of providers for non-in-person care coordination services, like conversations with other treating doctors, assistance setting up appointments, and monitoring communications, is essential. The federal government recently established a system to pay Medicare physicians and other providers for this important care. To further encourage providers and beneficiaries to adopt and use these services, Congress should enact a law to eliminate beneficiary cost-sharing for this care, as it has done for preventive care and screenings.

2704, 2015

Create an appeals process for beneficiaries in hospice care

Currently, beneficiaries receiving Medicare-covered hospice care do not have any recourse if they disagree with a determination made by their hospice provider, like the determination that a particular service is curative and non-covered. Congress should create a system for external review of provider decisions when the beneficiary disagrees with the hospice plan of care.

2604, 2015

Allow peer-reviewed literature to support medically-accepted indications for Part D prescription drugs

Medicare has two standards for determining when a medication is covered. One standard, requiring strong evidence in peer-reviewed literature, is used for prescription drugs covered under Part B and select medications under Part D.  The other standard, used for all other Part D medicines, is very narrow. This second standard allows coverage only when the use is listed in one of three privately published compendia, which are expensive to access. Accompanied by strong oversight and consumer marketing protections, Congress should unify these disparate standards.

2504, 2015

Require all states to enter Part A buy-in agreements

Part A buy-in agreements are contracts between state Medicaid offices and the Social Security Administration that allow eligible individuals with very low incomes and limited assets to enroll in Medicare outside of standard enrollment periods. Not only are buy-in agreements helpful to beneficiaries who might otherwise face higher costs and gaps in coverage, they reduce state Medicaid costs, decrease costly reliance on emergency room care, and minimize future medical expenses by ensuring that those eligible for Medicare are enrolled in the program. Congress should require all states to enter into Part A buy-in agreements.

2404, 2015

Enhance beneficiary education on quality and star ratings scores across all parts of Medicare

The star ratings programs are becoming an important tool to help Medicare beneficiaries identify high quality (and low quality) Medicare private health plans, nursing homes, hospitals, and more. Yet available evidence suggests that beneficiaries rarely reference these quality scores when making health care decisions. Congress should support a wide-reaching education campaign to help beneficiaries better understand what the star ratings scores mean and how to use them.

2304, 2015

Increase federal funding for State Health Insurance Assistance Programs (SHIPs)

SHIPs provide in-depth, one-on-one counseling to seniors and disabilities about how to navigate Medicare. SHIPs play a critical role in ensuring that beneficiaries make informed decisions about their coverage, including selecting among Medicare Advantage and Part D prescription drug plans as well as supplemental Medigap insurance. SHIPs are also integral to helping beneficiaries and their families find their way in an evolving and increasingly complex benefit, with many ongoing pilot initiatives changing how care is delivered, both in Original Medicare and private health plans. For too many years, SHIPs have been flat funded, meaning that federal resources have not kept pace with growing needs.  Congress should increase funding for SHIPs, to account for both the growing need, as 10,000 Baby Boomers age into Medicare daily, and the shifting landscape of Medicare choices.

2204, 2015

Restore Medicare prescription drug rebates

When the Medicare Part D drug benefit was created, the federal government lost important discounts from pharmaceutical makers for prescription drugs made available for low-income beneficiaries. At a minimum, Congress should restore these discounts—lowering drug prices, preserving beneficiary access to needed medications, and saving over $120 billion in the Medicare program over 10 years. Even better, Congress should pass legislation securing discounts on prescription drugs provided to all Medicare beneficiaries.

2104, 2015

Allow Medicare to negotiate Part D prices—especially for high-cost, specialty drugs

Unlike state Medicaid programs and the Veteran’s Administration, Medicare is prohibited from negotiating the price of prescription drugs directly with pharmaceutical makers. This prohibition is becoming increasingly problematic as more high-cost specialty medications come onto the market. Lifesaving medications for Hepatitis C—costing $84,000 per treatment and higher—are emblematic of this worrying trend. Congress should allow the Medicare program to negotiate drug prices, especially for high-cost specialty medicines.


Modernize Benefits

Increase Affordability

Streamline Enrollment

Enhance Education
and Choice

Strengthen Part D

Simplify Appeals

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