Close

Policy Work

The Medicare Rights Center’s policy agenda is driven by our experience serving people with Medicare and their families on our national helpline and through our educational programs. We pursue legislative and administrative solutions to protect, strengthen, and improve the Medicare program for current beneficiaries and generations to come.

Jump to section

Hot Topics

Policy Issues

Informed by the thousands of stories we hear on our national helpline each year, our policy and advocacy work is focused on helping people with Medicare access and afford their care. The following issues are particularly pressing as we seek to advance these goals.

The Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act

Currently, far too many people make honest mistakes when trying to understand and navigate the unduly complex Medicare Part B enrollment process. The consequences of such missteps are significant, including late enrollment penalties, higher out-of-pocket health care costs, gaps in coverage, and barriers to accessing needed services.

The bipartisan, bicameral Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (S. 1280/H.R. 2477), championed by Medicare Rights, would help prevent these costly errors—filling long-standing gaps in outreach and education, updating enrollment timelines to eliminate needless breaks in coverage, and informing policymaking on enrollment period alignment. Together, these changes would improve the health and financial well-being of current and future Medicare beneficiaries.

The Streamlining Part D Appeals Process Act

The Medicare Part D appeals process is an essential safety valve that allows older adults and people with disabilities to obtain needed medications. However, the current process is overly onerous and deeply flawed. Its inefficiencies can lead to delays in beneficiary access, abandonment of therapies, reduced adherence to treatment protocols, worse health outcomes, and higher costs.

The bipartisan, bicameral Streamlining Part D Appeals Process Act (S. 1861/H.R. 3924), supported by Medicare Rights, offers a commonsense solution: allow a refusal at the pharmacy counter to serve as the plan’s initial coverage determination. This one, simple change would give people with Medicare more timely information about their plan’s coverage decision and eliminate unnecessary steps within the system.

Improve Medicare Plan Finder

In the fall of 2019, the Centers for Medicare & Medicaid Services (CMS) unveiled significant updates to Medicare Plan Finder, the federal government’s primary enrollment assistance tool. The revised website includes a number of important changes that Medicare Rights has long supported, such as a streamlined design and a more intuitive presentation.

Based on our experience assisting people with Medicare and their families during Fall Open Enrollment and throughout the year, we know how challenging it can be for older adults and people with disabilities to evaluate their health care and prescription drug coverage options. Accordingly, while we appreciate CMS’s efforts to modernize Medicare Plan Finder, we are troubled by initial and persistent inaccuracies on the site that may undermine beneficiary decision-making.

To improve the tool’s functionality, Medicare Rights has provided feedback to CMS regarding opportunities to further strengthen this important resource. While some of our recommendations have been adopted, others remain unaddressed. Looking ahead, we will continue to encourage CMS to correct problems with the updated platform and enhance the user experience, so that people with Medicare have access to the accurate, actionable, and personalized information they need to make optimal coverage decisions.

Learn more about Medicare Rights’ observations and recommendations:

Make Prescription Drugs More Affordable

Medicare Rights supports efforts to meaningfully reduce drug prices and lower costs both for people with Medicare and for the program as a whole. Important strategies include imposing limits on beneficiary out-of-pocket spending, allowing Medicare to negotiate drug prices, and increasing pricing transparency and accountability throughout the supply chain. Changes to the current system must not undermine beneficiary protections or access to care.

In December 2019, the House of Representatives passed landmark prescription drug legislation, the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3). Medicare Rights is pleased to support this important bill, which would significantly improve health care and prescription drug affordability for people with Medicare. Work in the Senate is currently underway to craft a comprehensive drug pricing package.

Learn more about some of the Drug Pricing and Part D reforms the Medicare Rights Center supports:

Reduce Barriers to Medicare Low-Income Assistance Programs

Medicare Savings Programs and Part D’s Low-Income Subsidy (LIS) or “Extra Help”—can make care, including prescription drugs, more affordable for older adults and people with disabilities, but the programs’ complex, bureaucratic application processes and outdated eligibility thresholds unnecessarily limit participation.

Medicare Rights continues to urge lawmakers to modernize these policies to better reflect beneficiary financial realities, and to incorporate reforms made elsewhere in the health care system. This includes eliminating the asset limits for Medicare low-income assistance programs; allowing more people to access the benefits; aligning eligibility thresholds across programs; as well as integrating and simplifying administrative functions.

Learn more by reading Medicare Rights’ fact sheet.

Improving Access to Care for People with Medicare and Medicaid
There are currently more than 12 million Americans enrolled in both Medicare and Medicaid. These individuals, called dual-eligibles, experience high rates of chronic illness and represent a disproportionate share of national health care spending. As such, the federal government and states frequently consider and implement programs aimed at improving health care for dual-eligibles while reducing the costs associated with that care. 
 
Medicare Rights devotes significant energy to monitoring programs intended to serve people with Medicare and Medicaid. Nationally, we work in partnership to amplify the voices of dual-eligibles and help ensure that new programs work for this population. In New York, we lead the Coalition to Protect the Rights of New York’s Dually Eligible and engage regularly with state government and other stakeholders to shape and implement new programs, such as those intended to integrate coverage and care across Medicare and Medicaid.
 
Medicare Rights also pursues casework solutions for our dual-eligible clients, helping them access home health care, medicines, therapies, behavioral health services, and more.
 
The Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act

Currently, far too many people make honest mistakes when trying to understand and navigate the unduly complex Medicare Part B enrollment process. The consequences of such missteps are significant, including late enrollment penalties, higher out-of-pocket health care costs, gaps in coverage, and barriers to accessing needed services.

The bipartisan, bicameral Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (S. 1280/H.R. 2477), championed by Medicare Rights, would help prevent these costly errors—filling long-standing gaps in outreach and education, updating enrollment timelines to eliminate needless breaks in coverage, and informing policymaking on enrollment period alignment. Together, these changes would improve the health and financial well-being of current and future Medicare beneficiaries.

The Streamlining Part D Appeals Process Act

The Medicare Part D appeals process is an essential safety valve that allows older adults and people with disabilities to obtain needed medications. However, the current process is overly onerous and deeply flawed. Its inefficiencies can lead to delays in beneficiary access, abandonment of therapies, reduced adherence to treatment protocols, worse health outcomes, and higher costs.

The bipartisan, bicameral Streamlining Part D Appeals Process Act (S. 1861/H.R. 3924), supported by Medicare Rights, offers a commonsense solution: allow a refusal at the pharmacy counter to serve as the plan’s initial coverage determination. This one, simple change would give people with Medicare more timely information about their plan’s coverage decision and eliminate unnecessary steps within the system.

Improve Medicare Plan Finder

In the fall of 2019, the Centers for Medicare & Medicaid Services (CMS) unveiled significant updates to Medicare Plan Finder, the federal government’s primary enrollment assistance tool. The revised website includes a number of important changes that Medicare Rights has long supported, such as a streamlined design and a more intuitive presentation.

Based on our experience assisting people with Medicare and their families during Fall Open Enrollment and throughout the year, we know how challenging it can be for older adults and people with disabilities to evaluate their health care and prescription drug coverage options. Accordingly, while we appreciate CMS’s efforts to modernize Medicare Plan Finder, we are troubled by initial and persistent inaccuracies on the site that may undermine beneficiary decision-making.

To improve the tool’s functionality, Medicare Rights has provided feedback to CMS regarding opportunities to further strengthen this important resource. While some of our recommendations have been adopted, others remain unaddressed. Looking ahead, we will continue to encourage CMS to correct problems with the updated platform and enhance the user experience, so that people with Medicare have access to the accurate, actionable, and personalized information they need to make optimal coverage decisions.

Learn more about Medicare Rights’ observations and recommendations:

Make Prescription Drugs More Affordable

Medicare Rights supports efforts to meaningfully reduce drug prices and lower costs both for people with Medicare and for the program as a whole. Important strategies include imposing limits on beneficiary out-of-pocket spending, allowing Medicare to negotiate drug prices, and increasing pricing transparency and accountability throughout the supply chain. Changes to the current system must not undermine beneficiary protections or access to care.

In December 2019, the House of Representatives passed landmark prescription drug legislation, the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3). Medicare Rights is pleased to support this important bill, which would significantly improve health care and prescription drug affordability for people with Medicare. Work in the Senate is currently underway to craft a comprehensive drug pricing package.

Learn more about some of the Drug Pricing and Part D reforms the Medicare Rights Center supports:

Reduce Barriers to Medicare Low-Income Assistance Programs

Medicare Savings Programs and Part D’s Low-Income Subsidy (LIS) or “Extra Help”—can make care, including prescription drugs, more affordable for older adults and people with disabilities, but the programs’ complex, bureaucratic application processes and outdated eligibility thresholds unnecessarily limit participation.

Medicare Rights continues to urge lawmakers to modernize these policies to better reflect beneficiary financial realities, and to incorporate reforms made elsewhere in the health care system. This includes eliminating the asset limits for Medicare low-income assistance programs; allowing more people to access the benefits; aligning eligibility thresholds across programs; as well as integrating and simplifying administrative functions.

Improving Access to Care for People with Medicare and Medicaid
There are currently more than 12 million Americans enrolled in both Medicare and Medicaid. These individuals, called dual-eligibles, experience high rates of chronic illness and represent a disproportionate share of national health care spending. As such, the federal government and states frequently consider and implement programs aimed at improving health care for dual-eligibles while reducing the costs associated with that care. 
 
Medicare Rights devotes significant energy to monitoring programs intended to serve people with Medicare and Medicaid. Nationally, we work in partnership to amplify the voices of dual-eligibles and help ensure that new programs work for this population. In New York, we lead the Coalition to Protect the Rights of New York’s Dually Eligible and engage regularly with state government and other stakeholders to shape and implement new programs, such as those intended to integrate coverage and care across Medicare and Medicaid.
 
Medicare Rights also pursues casework solutions for our dual-eligible clients, helping them access home health care, medicines, therapies, behavioral health services, and more.
 
Policy Documents

Through public comments on administrative and regulatory changes, letters to policymakers, congressional testimony, and key reports, Medicare Rights advocates for systemic improvements to Medicare and other programs. Read these documents to learn more.

30 Policy Goals

Thinking ahead to Medicare's future, it’s important to modernize benefits and pursue changes that improve how people with Medicare navigate their coverage on a daily basis. Here are our evolving 30 policy goals for Medicare’s future.

Medicare Updates
Sign up for our weekly policy newsletter, Medicare Watch, to stay informed. Subscribers receive timely updates and alerts on issues important to older adults and people with disabilities. View recent articles in the latest news and updates.
Speak out

Take Action

Contacting your members of Congress is one of the best ways to enact positive change. Learn more about key legislation we’re following and weigh in today.

The BENES Act would direct the federal government to provide advance notice to individuals approaching Medicare eligibility about basic Medicare enrollment rules, filling a long-standing gap in education for older adults and people with disabilities and preventing costly enrollment mistakes.

  • Medicare Rights is urging lawmakers to simplify the Part D appeals process. These improvements are long overdue, and critical to ensuring people with Medicare have meaningful access to affordable prescription drugs.
Learn More

Policy Fact Sheets

Our fact sheet collections address a variety of Medicare issues and debates, highlighting the importance of the program now and in the future.

This brief gives a quick summary of Medicare’s strength, popularity, and status as a bulwark against unaffordable, low-quality health care. Highlights of the brief include facts about people with Medicare, the program’s financial future, and stories from the Medicare Rights national helpline.
“Means testing” the Medicare program is making higher income people pay more or get less by raising premiums or cutting benefits for people above a certain income level. Such proposals not only threaten to undermine the Medicare guarantee but also fail to recognize that older adults with higher incomes already pay more for Medicare during their working lives and/or after retirement.
Currently, all people with Medicare are entitled to the same set of basic benefits. Some policymakers support replacing Medicare’s defined benefit package with a fixed-dollar amount (often called a voucher) that beneficiaries would use to purchase health coverage through a private plan or Original Medicare. Converting Medicare to such a system, known as premium support, raises a number of beneficiary-related concerns.
Today, physicians may choose to privately contract with their Medicare patients, though very few do. Under such arrangements, providers can charge any amount they deem appropriate, rather than be bound by Medicare’s set fees and billing limits, so long as the patients agree. Some policymakers support broadening the conditions under which providers can privately contract with people with Medicare for the price of their services.
Some lawmakers support increasing the Medicare eligibility age from 65 to 67. This costly benefit cut is sometimes defended by arguing that as Americans live longer and delay retirement, most people will not need Medicare at age 65. But most Americans retire well before age 67—half of all men are retired by age 64 and half of all women by age 62.
Some policymakers support efforts to fundamentally restructure and severely cut Medicaid, including by transforming the program from a guaranteed benefit to a per capita cap or block grant system. Block grants and per capita caps are both designed to produce large federal savings over time by shrinking federal funding for state Medicaid programs.
Section 1115 waivers are statutorily required to promote the key objective of the Medicaid program: to furnish medical assistance to low-income individuals. Troublingly, in recent years CMS has approved state waivers that condition eligibility on compliance with burdensome employment and administrative requirements or otherwise restrict Medicaid coverage—seemingly in conflict with the program’s aim.
Under current law, the federal government matches state Medicaid spending based on a statutory formula, without a pre-set limit. If state spending increases, for example due to increased enrollment or unexpectedly high program costs, then federal spending increases as well. This open-ended financing structure allows federal funds to flow to states based on actual costs and needs as economic and other circumstances change.
For decades, Medicare and Medicaid have served as building blocks for health care and well-being for older adults and people with disabilities. The programs, with some overlap, serve different populations, provide different benefits, have different structures, and often face different political obstacles.
For more than 25 years, the State Health Insurance Assistance Program (SHIP) has helped Medicare beneficiaries, their families, and caregivers navigate Medicare’s complex coverage rules and enrollment processes. The individualized assistance provided by SHIPs has nearly tripled over the past 10 years, and with 10,000 people reaching Medicare eligibility age each day, demand is likely only to grow.
Working in Coalition

New York Advocacy

The Medicare Rights Center leads a number of coalitions designed to advocate for older adults, people disabilities, and people with limited incomes in New York.

The Coalition to Protect the Rights of New York’s Dually Eligible (CPRNYDE) is a diverse group of over 50 consumer-based interests, agencies, and perspectives working to shape the managed care programs that coordinate care for 760,000 older and disabled New Yorkers who are dually eligible for Medicare and Medicaid.

 

CPRNDYE, launched with support from Community Catalyst, seeks to improve the quality and affordability of care for New Yorkers dually eligible for Medicare and Medicaid. The coalition's membership engages in regular dialogue with state government and other stakeholders to improve programs intended to serve dual-eligibles. 

The New York State Medicare Savings Coalition, led by the Medicare Rights Center, is an alliance of over 150 community-based organizations, advocacy groups and government agencies in New York State. The Coalition is not intended for or open to employees of health insurance companies, health insurance agents or brokers, self-employed individuals, or individuals employed by private for-profit businesses. By bringing government officials and advocates together in dialogue, our meetings offer Coalition members the opportunity to review the latest information on implementing health care programs for people with limited incomes.

 

Coalition members stay connected through regular e-mail updates, conference calls, enrollment initiatives and advocacy projects. This ongoing exchange allows us to share knowledge about enrollment strategies and compare case scenarios.