Your Weekly Medicare Consumer Advocacy Update
The Future of Medicare Advantage
Medicare Rights Center President Testifies on the Future of Medicare Advantage
Today, Medicare Rights Center President Joe Baker testified before the U.S. House Committee on Ways & Means, Subcommittee on Health about the future of the Medicare Advantage (MA) program, the positive impact of the Affordable Care Act (ACA) on MA, and how to further improve MA plans for people with Medicare.
The ACA improved plan quality, created fairer cost sharing, added benefits, and began to bring MA costs in line with Original Medicare costs. Baker clarified that these changes have not negatively impacted the MA program stating, “Today, MA plan enrollment is at an all-time high, with nearly 16 million enrollees—and premium costs, benefit levels, and the availability of plans all remain relatively stable.”
According to Baker, Congress should continue to strengthen MA by:
- Adequately funding State Health Insurance and Assistance Programs (SHIPs)
- Lessening the impact of mid-year changes to MA provider networks
- Passing the Medicare Advantage Participant Bill of Rights Act (H.R. 4998 and S. 2552)
- Enhancing transparency through publicly available data and notification, particularly on appeals
- Encouraging meaningful variation among plans through standardization and consolidation
- Enhancing the quality star ratings program to help consumers make better choices
Rep. Henry A. Waxman (D-CA) Joins Advocates to Call on Congress for Medicare Drug Savings
The emergence of blockbuster medicines to treat Hepatitis-C—like Sovaldi, priced at $84,000 for a 12-week treatment or $1,000 per pill—has spurred many advocates and lawmakers to renew longstanding questions about how to secure needed Medicare drug savings. These sky-high prices are likely to limit access to life-saving treatments for those who need them, while also exacerbating budgetary pressures within the Medicare program. Medicare cost growth has slowed significantly in recent years, furthering the program’s long-term sustainability, but Congress can do more to shore up Medicare financing, while also making prescription drugs more affordable for seniors and people with disabilities.
This week, Congressman Henry A. Waxman (D-CA), ranking member of the House Committee on Energy & Commerce, co-hosted a telephone press conference with the Medicare Rights Center and Social Security Works, releasing a comprehensive report detailing policy options to lower Medicare drug costs. As a complement to the report, over 71,000 Americans signed a petition calling on Congress to enact policies that would allow Medicare to secure better prices on prescription drugs.
Rep. Waxman has introduced legislation that would save billions of dollars on Part D drugs, and has recently called for hearings on the high cost of Sovaldi. Rep. Waxman said, “It makes no sense that Medicare pays the highest prices for prescription drugs. We improved Medicare Part D in the Affordable Care Act by closing the doughnut hole. Now we should take the next step and enact policies that reduce Medicare drug costs for seniors and taxpayers.”
Volume 5, Issue 28
Medicare Part D prescription drug coverage will cover most of a person’s prescription drugs. However, there are certain cases when prescription drugs may be covered by Medicare Part A or Part B.
Part A will cover the drugs you need during a Medicare-covered stay in a hospital or skilled nursing facility. However, if you are getting skilled nursing care that is not covered by the Part A benefit, your drugs may be covered by the Medicare drug benefit (Part D) (if you are enrolled in a Medicare private drug plan).
Most outpatient prescription drugs are covered under Part D. However, certain drugs are covered by Part B. For example, Part B should pay for your flu shot as long as you follow your plan’s rules. Antigens – a type of drug often used to treat allergies – are also covered by Part B.
Last week, the Medicare Rights Center released a new report analyzing how ACA changes to MA payments have affected New York’s Medicare Advantage (MA) marketplace. The report’s findings contradict predictions that a reduction in payments to MA plans under the ACA would cause insurers to exit the market, decrease plan benefits, or immediately pass through costs to Medicare beneficiaries. A companion piece issued by the United Hospital Fund examines MA market enrollment and financial results from 2010 to 2012, the initial phase of the ACA implementation.