Your Weekly Medicare Consumer Advocacy Update
House Democratic Leaders Urge New Notice for People Nearing Medicare Eligibility
Democratic Leaders in the House Send Letter Urging Notice for Those Close to Medicare Eligibility
This week, ranking leaders of key U.S. House Committees and the co-chairs of the U.S. House Seniors Taskforce sent a letter urging the Department of Health and Human Services, the Department of Labor, and the Social Security Administration to develop a system to ensure that all individuals nearing Medicare eligibility receive timely and complete notice about Medicare enrollment.
The letter recognizes the complexity of making informed decisions about when to enroll in Medicare and the consequences of enrollment errors, and urges these federal agencies to use the 2015 White House Conference on Aging as a platform for change. Today, 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.
Led by Congressman Sander Levin, Ranking Member of the Committee on Ways & Means, the letter is also signed by Congressman Frank Pallone, Ranking Member of the Committee on Energy & Commerce, Congressman Robert C. Scott, Ranking Member of the Committee on Education & the Workforce, as well as Congresswoman Jan Schakowsky and Congresswoman Doris Matsui, co-chairs of the U.S. House Seniors Taskforce.
The Medicare Rights Center is encouraged by this call to action and looks forward to working with partners, with the federal agencies identified, and with Congress to ensure all people new to the Medicare program have the information and tools they need to successfully enroll.
A Historic Week for the U.S. Supreme Court
Last week, the Supreme Court issued two decisions affecting Medicare beneficiaries and their families. First, on Thursday, June 25, it released the decision in King v. Burwell. The plaintiffs in that case argued that the Affordable Care Act (ACA) allows premium tax credits only to people enrolled in health insurance plans through a state-created marketplace and not to those with health plans administered through the federal marketplace. If the court agreed, hundreds of thousands of people would have lost affordable access to health insurance. Instead, the court reasoned that when Congress passed the ACA, it intended to facilitate—not destroy— health insurance markets. Therefore, the Supreme Court decision preserves access to premium tax credits for all eligible individuals, in both state and federal marketplaces.
Second, on Friday, June 26, the court released its decision in Obergefell v. Hodges, a combination of cases brought by same-sex spouses, challenging several state’s refusals to issue them marriage licenses or to recognize marriages entered into in other states. The court ruled that the constitution requires states to honor marriages that are entered into in other states and to issue marriage licenses without regard to the gender of the people applying. While same-sex couples were able to access many Medicare benefits after an initial Supreme Court ruling in 2013, some benefits—including access to premium-free Part A based on a spouse’s work history—depended upon the state in which the couple lived. This will no longer be the case.
Volume 6, Issue 25
Sometimes, you may want to get a second opinion on a medical recommendation or diagnosis from a different doctor. Original Medicare will pay for you to see a doctor and get a second opinion if a doctor has recommended that you have surgery or a major diagnostic or therapeutic procedure. Original Medicare will pay for a third opinion if the first and second opinions are different. The second and third opinions will be covered even if the surgery or other procedure is determined not to be covered.
If you are in a Medicare Advantage plan, your plan must cover the same services as Original Medicare does, but may have different rules you have to follow. For example, the plan may only cover second and third opinions if you see doctors that are in network or if you have a referral from your Primary Care doctor. Call your plan to find out the rules for getting second opinions.
As the 50-year anniversary of Medicare and Medicaid approaches, the Centers for Medicare & Medicaid (CMS) is looking for your success stories about Medicare.
Whether you have just enrolled in Medicare coverage or you have been a beneficiary for years, CMS is interested in hearing your story. Stories can be a specific experience or just a general appreciation for Medicare.
To share your story, visit http://www.medicare.gov/anniversary/share-your-story.html.