Medicare Watch

Berwick Touts the Benefits of the ACA for People with Medicare

People with Medicare have already benefited from the Affordable Care Act (ACA) and will continue to benefit more greatly from the law in the future, according to testimony by Dr. Donald Berwick, administrator of the Center for Medicare & Medicaid Services (CMS), before the House of Representatives Committee on Ways and Means. Also testifying at the hearing was Rick Foster, chief actuary of CMS, who provides technical assistance on Medicare to policymakers in the Administration and Congress.

While Foster holds a more guarded view of the benefits of the ACA for the health system at large, Dr. Berwick’s statements were more optimistic. Dr. Berwick discussed improvements to Medicare, such as the prescription drug doughnut hole discount and the elimination of cost-sharing for preventive services, but much of the most heated conversation centered on reductions in government subsidies to Medicare private health plans, also known as Medicare Advantage (MA) plans. The government pays MA plans 9 percent more per enrollee than it costs to provide care for the same person under Original Medicare. Under the ACA, the government will reduce these overpayments over time to bring the cost of the MA program more in line with that of Original Medicare. Opponents of the law have said that reductions in overpayments to private insurance companies will damage the MA market, and many have used Foster’s forecasts, which he discussed today at the hearing, as support. However, Dr. Berwick reported that according to current data, the MA program was stronger than ever this year: MA enrollment increased by six percent, and on average, consumers in MA plans have seen a six percent reduction in their premiums.  

The Medicare Rights Center submitted testimony for the record that discusses how real people with Medicare have already gained and will continue to gain from the ACA. For example, consumers who reach the doughnut hole this year will receive a 50 percent discount on brand-name drugs. The testimony also emphasizes that people with Medicare will continue to benefit from the law because of the Medicare program’s new emphasis on care coordination and efficiency. 

Read the Medicare Rights Center’s testimony.

Read the Medicare Rights Center’s answers to frequently asked questions on Medicare and health reform.

 

Medicare Rights Center Report Discusses Ways to Improve Low-Income Consumers Access to Medicare

Today, the Medicare Rights Center released a report that explores New York State’s procedures to help low-income individuals who are eligible for—but cannot afford—Medicare to enroll in the program through the state’s Part A buy-in program. The report, Streamlining Medicare and QMB Enrollment for New Yorkers: Medicare Part A Buy-In Analysis and Policy Recommendations, was made possible through funding from the United Hospital Fund. 

Most people with Medicare are eligible for premium-free Part A, but for those who are not, the cost can be prohibitive. Fortunately, the Qualified Medicare Beneficiary (QMB) program, a Medicare Savings Program (MSP), helps individuals with limited means pay for Medicare Part A and B premiums (including the Part A premium when it is owed), deductibles, copays and coinsurance. However, QMB requirements create a “catch-22” for low-income older adults without premium-free Part A: they cannot afford to enroll in Medicare until they have QMB, but they need Medicare in order to qualify for QMB.

The report explains how many states, such as New York, have entered into Part A buy-in agreements with the federal government, which allow states to enroll eligible consumers into Part A and QMB at the same time. This and other measures taken in New York have allowed the state to automate enrollment and vastly improve participation for those with Supplement Security Income (SSI). But as the report states, these policies have been less helpful for persons who lack SSI. As a result, most eligible but unenrolled individuals navigate a complicated, two-step application that few can successfully complete. The report recommends steps to improve the enrollment process, including screening for Part A buy-in no matter where an individual applies and improving coordination and data exchange between state and federal agencies. Finally, the report identifies lessons from New York’s experience that can be applied to improve programs in other states as well. 

Read the report.

Read the Medicare Rights Center’s press release on the report. 

 

Medicare Reminder

Medicare consumers who are dissatisfied with their Medicare private health plans, also known as “Medicare Advantage” plans, have until Monday, February 14, to disenroll. Consumers have had the opportunity to drop their private plans and enroll in Original Medicare since January 1, when the Medicare Advantage Disenrollment Period (MADP) began. After the MADP, most people with Medicare will be unable to make another change to their health coverage until the Fall Open Enrollment Period, which begins on October 15.

Learn more about switching to Original Medicare during the MADP.

If you were disenrolled from a Medicare Advantage plan or prescription drug plan on December 31, 2010, because your plan was discontinued, and have not yet enrolled in a Medicare prescription drug plan, you now have more time to do so. Last week, the Centers for Medicare & Medicaid Services (CMS) announced that the Special Enrollment Period (SEP) for people whose plans were not renewed this year has been extended to February 28.

Read a memo to providers and a sample letter to consumers about the extended SEP.

Learn more about choosing a prescription drug plan.

Find more answers to your Medicare questions at www.MedicareInteractive.org

 

Spotlight

A new report by the AARP Public Policy Institute examines how much people with Medicare spend out of their own pockets on health care. The report analyzes this spending against the backdrops of demographics, health status and supplemental insurance.

Read the report.