50 Wishes for
Medicare’s Future

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Streamline Enrollment

Allow open enrollment in Medigap for all people with Medicare

Beneficiaries are entitled to select a Medicare Advantage plan every year during the annual enrollment period, but most are only guaranteed the right to enroll in a Medigap plan during very limited times. Additionally, in most states, Medigap insurers are permitted to charge more or deny coverage outright to some populations, including people with disabilities and people with End Stage Renal Disease. Congress should expand Medigap enrollment rights to ensure that all beneficiaries have access to Medigap plans and to allow all Medicare beneficiaries to make a choice about the coverage best suited to their needs each year.

Consolidate and standardize Medicare Advantage and Part D plans

Selecting an MA or Part D plan is a daunting task for most people with Medicare. There are simply too many plan choices and too many variables to compare. Alarmingly, only 13 percent of Medicare beneficiaries opt to reevaluate their coverage options year to year—despite annual changes to premiums, plan coverage rules, and cost-sharing. Congress should enact legislation to consolidate MA and Part D plan choices and standardize options in order to facilitate informed decision-making by Medicare plan enrollees.

Provide a federal notice for everyone approaching Medicare eligibility

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. The federal government should provide a notice to all people approaching Medicare eligibility about how and when to enroll.

Integrate Medicare low-income assistance applications in state Marketplaces

The vision behind the Affordable Care Act was to create one-stop shopping for consumers—regardless of the health insurance they are eligible for, either in the private Marketplace or through Medicaid. But lower-income people with Medicare are currently not a part of this “no wrong door” system. State Marketplaces should integrate screening and enrollment for Medicare low-income assistance programs (Medicare Savings Programs) into their state Marketplaces to realize the vision of a “no wrong door” consumer assistance portal.

Eliminate coverage gaps during the Initial Enrollment Period (IEP)

Even beneficiaries who enroll in Medicare during their IEP (the seven-month period to enroll when someone is first Medicare-eligible) can face gaps in coverage. Enrollment in the last months of the IEP can result in up to three months without any outpatient (Part B) Medicare coverage. Congress should eliminate needless gaps in coverage during the IEP and start coverage the month immediately following enrollment.

Minimize coverage gaps during the General Enrollment Period (GEP)

People who do not enroll in Medicare during their Initial Enrollment Period and do not have access to a Special Enrollment Period must enroll in Medicare Part B during the GEP, from January to March of each year. Yet coverage does not begin until July of that same year—meaning some people go up to seven months without coverage after trying to enroll in Part B. These gaps increase reliance on emergency room care and create needless health risks. Congress should eliminate gaps in coverage during the GEP and start coverage the month immediately following enrollment.

Align all enrollment periods for Original Medicare, Medicare Advantage, and Part D

The fall open enrollment period for Medicare Advantage (MA) and Part D plans runs from October to December of each year, followed by an MA disenrollment period from January through February. In contrast, the General Enrollment Period (GEP) for delayed Part B enrollment runs from January to March of each year. Congress should align these disparate enrollment periods to create a Medicare enrollment season, allowing the federal government, community-based organizations, and others to more effectively educate beneficiaries about their Medicare enrollment options.

Expand equitable relief

Limited avenues for relief are available to those who make mistakes when enrolling in Medicare. Specifically, beneficiaries facing lifetime penalties and gaps in coverage can only remedy their situation if they can prove that an agent of the federal government misinformed them about enrollment rules. Yet many people turn to their employer or health plan—not a federal agency—when transitioning to Medicare. To provide adequate recourse for those who make honest enrollment mistakes, Congress should expand equitable relief to include misinformation from employers, health plans, and insurance brokers.

Reduce or eliminate the Part B lifetime late enrollment penalty

Erroneously delaying Medicare enrollment can have lifetime consequences—currently, a lifetime premium penalty of 10 percent is levied for every year a person should have been enrolled in Medicare Part B but was not. This penalty is designed to encourage enrollment by healthy individuals who otherwise might delay enrollment. Yet the penalty is also imposed on those who simply made a mistake. Congress should enact policies to reduce or eliminate lifetime premium penalties for beneficiaries who were misinformed or uninformed about Medicare enrollment rules.

Prohibit Medicare Advantage plans from dropping doctors mid-year without cause

Beneficiaries enrolled in MA plans should be able to count on stability in their plan networks and the knowledge that their doctors will be there when they need them. Congress should pass legislation to prohibit MA plans from dropping doctors without cause in the middle of the plan year and strengthen beneficiary notice on provider network changes.

Incorporate Medicare Advantage (MA) provider network information in the Plan Finder tool

Information about which health care providers are in network and out of network is vital for helping beneficiaries make smart decisions about their coverage. Yet this critical information is absent from Medicare’s primary online decision-making tool—Plan Finder. The federal government should incorporate accurate and timely MA provider network information in Plan Finder.

Create an individually tailored Annual Notice of Change for Medicare Advantage (MA) and Part D plans

Annual changes to MA and Part D plan coverage rules, cost-sharing amounts, and provider networks are commonplace. At the same time, comparing and contrasting plan options during the Medicare open enrollment period is a dizzying task for many. To help beneficiaries make informed decisions, the federal government should require that Medicare private health plans provide a tailored notice to beneficiaries, based on claims data, describing how a plan will change in the coming year.

Require all states to enter Part A buy-in agreements

Part A buy-in agreements are contracts between state Medicaid offices and the Social Security Administration that allow eligible individuals with very low incomes and limited assets to enroll in Medicare outside of standard enrollment periods. Not only are buy-in agreements helpful to beneficiaries who might otherwise face higher costs and gaps in coverage, they reduce state Medicaid costs, decrease costly reliance on emergency room care, and minimize future medical expenses by ensuring that those eligible for Medicare are enrolled in the program. Congress should require all states to enter into Part A buy-in agreements.

Enhance beneficiary education on quality and star ratings scores across all parts of Medicare

The star ratings programs are becoming an important tool to help Medicare beneficiaries identify high quality (and low quality) Medicare private health plans, nursing homes, hospitals, and more. Yet available evidence suggests that beneficiaries rarely reference these quality scores when making health care decisions. Congress should support a wide-reaching education campaign to help beneficiaries better understand what the star ratings scores mean and how to use them.