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New Bill Seeks to Improve Medicare Coverage and Enrollment

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Congress took steps this week to improve Medicare coverage and enrollment rules by introducing the “The Medicare Affordability and Enrollment Act of 2016.” If passed, the bill would create an out-of-pocket spending cap, reform the Medicare enrollment process by reducing penalties and gaps in coverage, and increase support for lower-income beneficiaries.

“Medicare has long been an ironclad guarantee to seniors of health care security and peace of mind in their later years,” said Senator Ron Wyden (D-OR), one of the original cosponsors of the bill. Today, the promise of Medicare falls short for too many who find their health costs becoming more and more unaffordable. Protecting and strengthening the Medicare guarantee is a vital task as the program prepares to enroll the next generation of older Americans, and these policies will put many seniors on a firm foundation for years to come.”

The bill seeks to address several key challenges that people with Medicare face: affordability for beneficiaries who have low-to-moderate income, but do not currently qualify for assistance; a complicated, outdated, and potentially costly enrollment process in which it is easy to make mistakes; and a long two-year wait for benefits for those who receive Social Security Disability benefits.

Key aspects of the bill include the following:

  • Set a maximum out-of-pocket cap for medical services under traditional Medicare, which exists today for Medicare Advantage and most commercial insurance plans
  • Significantly expand the number of low-income beneficiaries eligible for financial assistance to cover premiums and out-of-pocket costs
  • Eliminate the arbitrary two-year waiting period for people with disabilities to enroll in Medicare
  • Modernize the Medicare enrollment system to facilitate easier enrollment, begin coverage earlier and reduce arbitrary late-enrollment penalties that today are paid for a lifetime
  • Increase and extend permanent funding for low-income Medicare beneficiary outreach and education activities

The bill was introduced in the Senate by Finance Committee Ranking Member Ron Wyden, (D-OR). The bill’s Senate co-sponsors include Debbie Stabenow, (D-MI), and Michael Bennet, (D-CO), Bill Nelson, (D-FL), and Sherrod Brown, (D-OH).

A companion bill was introduced in the House by Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-NJ), Ways and Means Committee Ranking Member Sander Levin (D-MI), Energy and Commerce Health Subcommittee Ranking Member Gene Green (D-TX), and Ways and Means Health Subcommittee Ranking Member Jim McDermott (D-WA).

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