Your Weekly Medicare Consumer Advocacy Update
To Congress: Make Smart Changes to Medicare
Advocates Release Call to Action Asking Congress to Find Savings on Prescription Drugs
This week, the Medicare Rights Center and Social Security Works released a call to action urging Congress to make smart changes to Medicare that create savings on prescriptions medications—not by cutting benefits or shifting costs to people with Medicare. Medicare is better at containing rising health care costs than private insurance, while at the same time delivering quality care. Still, some in Washington continue to demand cuts to Medicare benefits.
The petition highlights a few ways Medicare can secure better prices on prescription medicines, including:
- Restoring Medicare prescription drug rebates that ended when Medicare Part D was created. The Medicare Modernization Act, which created Medicare Part D, severely limited the government’s ability to control the prices it paid for prescription drugs. Reinstating this discount would save an estimated $141.2 billion over 10 years.
- Allowing Medicare to negotiate drug prices for a public Part D option. Both the Veteran’s Administration and Medicaid directly negotiate on prescription drug prices, but Medicare is expressly prohibited from participating in the same negotiations. This proposal has the potential to save up to $20 billion over 10 years.
- Closing the Medicare Part D doughnut hole sooner. The Part D doughnut hole poses significant financial and health risks to people with Medicare. The Affordable Care Act gradually closes this coverage gap, but it should be closed sooner, which would not only make the drugs more affordable, it will save an estimated $16.6 billion over 10 years.
- Promoting cost-effective prescribing for Part B prescription drugs. Medicare Part B covers many drugs that treat cancer, macular degeneration, anemia and arthritis. In general, these drugs are very costly both for the Medicare program and for beneficiaries. The Medicare program could save considerably if policies were in place to encourage the use of less expensive—but equally effective—alternatives to the highest cost drugs.
KFF Spotlights Medicare Advantage Enrollment Market in New Report
The Kaiser Family Foundation (KFF) recently released a report spotlighting the enrollment market for Medicare Advantage plans in 2014. Overall, the report found that an increasing number of beneficiaries are choosing to enroll in Medicare Advantage plans. Additionally, the costs and availability of Medicare Advantage plans has largely remained the same.
Approximately 15.7 million beneficiaries (30 percent of the Medicare population) are enrolled in Medicare Advantage plans. There has been a 41 percent increase in the number of beneficiaries enrolled in Medicare Advantage plans since 2010. Also, the additional premium that beneficiaries typically pay for a Medicare Advantage plan with prescription drug benefits has remained relatively stable, decreasing from an average of $43 in 2010 to an average of $35 in 2014. Additionally, the percentage of beneficiaries that have access to a Medicare Advantage plan that charges no extra premium has remained relatively consistent at 84 percent.
When the Affordable Care Act (ACA) passed in 2010, it included provisions to bring payments to Medicare Advantage plans in line with what it costs for Original Medicare to pay for beneficiary care. There was some concern that these changes in payments would cause plans to leave the market and increase costs for beneficiaries. As demonstrated by the KFF report, none of these concerns have come to pass. In fact, an increasing number of beneficiaries are enrolling in Medicare Advantage plans, and the benefits and costs remain largely unchanged.
Volume 5, Issue 21
All Medicare Advantage plans must offer the same benefits as Original Medicare, but are allowed to have different costs and restrictions. Certain Medicare Advantage plans offer additional limited benefits, such as vision or dental coverage.
There two most common types of Medicare Advantage plans – health maintenance organizations (HMOs) and preferred provider organizations (PPOs). HMOs generally only cover care from providers who are within their networks. If you go out-of-network, you will usually be responsible for the full cost of your care. They also often require referrals to see specialists. On the other hand, you will pay the least if you see a provider within a PPO’s network, but it provides limited coverage for out-of-network providers. Additionally, PPOs do not require referrals to see specialists. Due to this additional freedom, the premiums for a PPO are generally higher than that of an HMO.
This week, Medicare Rights posted a new course in the Special Topics section of Medicare Rights University (MRU) entitled, “Medicare Coverage of Durable Medical Equipment (DME).”
MRU is a web-based curriculum designed to empower any professional to better help their own clients, patients, employees, retirees, and others navigate a multitude of Medicare questions. The tool is structured as a four-level Core Curriculum, with four to five video-based courses in each level.
The Special Topics section addresses subjects not covered in the Core Curriculum. Each MRU course contains Medicare Rights’ clear, expert content and comes complete with quizzes, case examples, and downloadable materials to test your knowledge and enable you to effectively educate your colleagues and clients.