Asclepios
Medicare and Health Reform
May 28, 2009 • Volume 9, Issue 21
The big questions about Congress’s health reform plan remain unanswered.
Will low- and moderate-income people receive financial help that makes high-quality health coverage affordable?
How will we pay for providing that help?
Will Americans be forced to buy insurance from the same insurance companies that now deny us care and coverage when we need it?
Or will we have the choice to buy coverage from a public plan that can keep health care costs in check?
The answers to those questions will largely determine whether health reform allows Americans to get the health care they need without spending themselves into poverty or bankruptcy. For older adults and people with disabilities, the Medicare Rights Center believes the right answers translate into the following Medicare reforms:
- End the two-year waiting period for Medicare for people with disabilities. The two-year wait for Medicare puts effective treatment and care for people with severe disabilities at risk. Many forgo medical treatment and stop taking medications, compromising their already fragile health and resulting ultimately in conditions that are often more costly to treat when Medicare coverage finally begins.
- Raise income limits for Medicare Savings Programs, which help pay Medicare premiums and cost-sharing for medical coverage, and for the Extra Help program, which helps with copayments and premiums for drug coverage. The asset test, which penalizes individuals for saving a modest nest egg for their retirement, should also be eliminated for both programs. Under current eligibility criteria, an individual earning just $21,660 per year (200 percent of the federal poverty level) could face in excess of $6,154 in out-of-pocket spending for prescription drug costs, well over one quarter of annual income. That modest income level is too high to qualify for help from Medicare Savings Programs.
- Provide people with Medicare the choice to receive ALL their health coverage through a publicly administered plan. For people with Medicare, that means the option to obtain affordable health coverage directly from Medicare, including an out-of-pocket limit covering all Part A and Part B services, predictable copays for primary care and specialist consultations and affordable copays for inpatient hospital care. People with Medicare should also have the option to receive Part D drug coverage through Original Medicare so that they can benefit from the stability, simplicity and cost savings that a Medicare-run drug benefit would provide.
Congress needs to know that access to affordable health care for older adults and people with disabilities is a central part of health reform. Please write your senators and representative and remind them to Remember Medicare.
Medical Record
“Health reform presents a unique opportunity to update the income and asset eligibility criteria for Medicare Savings Programs and Extra Help to make cost-sharing for low-income people affordable and provide limits on out-of-pocket spending in line with the protections health reform affords the under-65 population.” (Comments to Senate Finance Committee, Medicare Rights Center, May 2009)
“The Committee may want to consider proposals to simplify Medicare beneficiary cost-sharing obligations and make them more consistent with benefits that are available in the private sector. This might be accomplished by making changes to Medicare’s cost-sharing requirements while simultaneously placing certain restrictions on Medigap policies.” (Financing Comprehensive Health Reform: Proposed Health System Savings and Revenue Options, Senate Finance Committee, May 2009)
“We urge the Finance Committee to set its sights on complete elimination of the waiting period and to use the duration of the phase-out period as the chief mechanism to accommodate budgetary pressures,” (Letter to Senate Finance Committee, Coalition to End the Two-Year Wait for Medicare, May 2009)
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Medicare Part D Appeals Help for Advocates Is Here!
Medicare Rights Center’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
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Medicare Part D Monitoring Project
The Medicare Rights Center would like to hear about your experience, or that of someone you know, enrolled in a private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed.
Submit your story at http://www.medicarerights.org/issues-actions/tell-your-story.php.
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The Louder Our Voice, the Stronger Our Message
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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.
Visit our online subscription form to sign up for Asclepios at http://www.medicarerights.org/about-mrc/newsletter-signup.php.
Get answers to your Medicare questions from Medicare Interactive at http://www.medicareinteractive.org.