Supercommittee Eyes Medicare for Cuts
The Medicare program continues to take center stage in the deficit-reduction debate, figuring
prominently in recent discussions
held by the Joint Select Committee
on Deficit Reduction, also known
as the supercommittee.
In recent weeks, both Republican and Democratic members of the supercommittee have offered proposals that include changes to Medicare, though many of the details of the plans have not been made public. In a series of recent papers, the Center on Budget and Policy Priorities (CBPP) offers an analysis of the general framework of both proposals. According to CBPP, the Democrats’ plan, which is more conservative than previously released bipartisan proposals, includes $475 billion in cuts to government health programs, with $75 billion in cuts to Medicaid and $400 billion in cuts to Medicare. Of the $400 billion in Medicare cuts, half represent cuts to providers and half would directly affect beneficiaries, likely increasing out-of-pocket costs under Medicare. In contrast, the Republican plan includes $500 billion of cuts to Medicare, $400 billion of which are achieved through changes that would directly impact beneficiaries, such as imposing higher premiums and cost-sharing and implementing more restrictive eligibility criteria. The Republican plan also includes $185 billion in cuts to Medicaid.
This week the supercommittee held a public hearing on previously proposed debt plans. Witnesses included Erskine Bowles and former Senator Alan Simpson, who lead the National Commission on Fiscal Responsibility and Reform, and Dr. Alice Rivlin and former Senator Pete Domenici, who worked as co-chairs of the Bipartisan Policy Center Debt Reduction Task Force. While the witnesses discussed the importance of increased revenues in deficit-reduction proposals, they also discussed sweeping changes to Medicare, ranging from raising the eligibility age to premium support proposals that would increase costs for Medicare beneficiaries. In response, Medicare Rights Center President Joe Baker released a statement discussing the adverse impacts of such proposals on those with Medicare, and pointing out that the Medicare population already faces significant out-of-pocket costs. Because people with Medicare have limited means, the increased costs and benefit changes discussed in the hearing would negatively affect their ability to afford and access care.
Read CBPP’s paper “Republican Plan Contains Minuscule Revenue Increase Alongside Deep Cuts in Medicare and Medicaid.”
Read CBPP’s paper “Democrats Offer Significant Concessions; Plan Is to the Right of Bowles-Simpson and Gang of Six.”
Read Medicare Rights Center President Joe Baker’s statement on the hearing.
Watch the Joint Select Committee on Deficit Reduction’s hearing on previous debt proposals.
Medicare Rights Comments on Streamlining Enrollment for People with Medicare
The Medicare Rights Center submitted comments this week on three sets of proposed rules concerning eligibility and enrollment for expanded Medicaid and the health insurance exchanges, and the premium tax credits that will be used to help individuals purchase coverage through the exchanges beginning in 2014. The Medicaid expansion, as well as the premium tax credits and associated exchanges, are the result of the Affordable Care Act (ACA). The comments specifically focus on ensuring that those with Medicare and others excluded from the new Modified Gross Adjusted Income (MAGI) budgeting, which will be used to determine eligibility for ACA programs, are able to benefit from improved enrollment systems and policies developed for the newly established ACA pathways.
The proposed rules envision a streamlined enrollment process in which individuals will have no wrong door to apply for coverage, whether that coverage includes premium tax credits to purchase a Qualified Health Plan (QHP) or expanded Medicaid, which will cover people with incomes up to 138 percent of the Federal Poverty Level (FPL). In addition, the proposed rules lay the foundation for data exchanges between federal agencies, state agencies, and exchanges that will allow for real-time eligibility determinations and prevent the need for individuals to supply additional documentation to prove information provided on applications is accurate. However, it is unclear how eligibility determination and enrollment simplification will apply to those excluded from the new MAGI budgeting, also called the non-MAGI population.
Medicare Rights Center’s comments ask that federal agencies require states to use newly created Medicaid eligibility and enrollment systems for non-MAGIs as well. This will help avert onerous documentation and other requirements that often block access to benefits. Non-MAGI benefits include traditional Medicaid coverage categories, such as Aged, Blind and Disabled, and Medicare Savings Programs (MSPs), which are state-administered programs that help people with Medicare with limited incomes pay for Medicare cost-sharing. The comments also discuss the importance of coordination between programs and outreach and education to help facilitate seamless transitions from Medicaid or QHPs to Medicare. These transitions are particularly important because people with Medicare will not be eligible for premium tax credits that will make QHPs affordable and may lose Medicaid eligibility once they become Medicare-eligible. A seamless transition to Medicare will ensure that people avoid gaps in coverage and unnecessary, and potentially unaffordable, out-of-pocket costs.
Read the Medicare Rights Center’s comments on eligibility changes to Medicaid.
Read comments on functions, eligibility and standards of health insurance exchanges.
Read comments on the health insurance premium tax credit.
Private Fee-for-Service (PFFS) plans are Medicare Advantage plans (Medicare private health plans) you can enroll in as a different way to get your Medicare benefits.
PFFS plans must cover all services that a patient would receive under Original Medicare. This includes both inpatient services (Part A) and outpatient services (Part B).
PFFS plans may offer Medicare prescription drug coverage (Part D) but this is not required. If a PFFS plan does not offer drug coverage, you may join a stand-alone Medicare drug plan to get your prescription drugs (Part D).
Starting in 2011, most PFFS plans have health care provider networks. If you see in-network doctors or other health care providers, you may pay less. However, PFFS plans cannot restrict you to their network of providers. PFFS plans must cover care received from any Medicare-approved doctor as long as that provider knows you are enrolled in the plan and agrees to treat you. Give your doctor your PFFS plan card so they know you are a member before they treat you.
Learn more about PFFS plans at www.medicareinteractive.org.