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

Policy Recommendations for the Biden Administration

The Medicare Rights Center looks forward to working with the Biden administration to advance policies that protect and strengthen Medicare as well as the health and economic well-being of those who rely on its coverage. Read our recommended actions submitted for President Biden and his administration's consideration.
Hot Topics

Policy Issues

Informed by the thousands of stories we hear on our national helpline each year, our health equity-driven policy and advocacy agenda 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.

Combat COVID-19

The COVID-19 pandemic and its attendant economic fallout will have a lasting impact on people with Medicare and on the program itself. We urge Congress and the Biden administration to help people with Medicare maintain their health, safety, and independence during the public health emergency and beyond.

This includes easing and expediting Medicare enrollment; ensuring access to affordable COVID-19 care, treatment, and vaccines; providing economic relief for families, communities, and states; promoting health, safety, and quality of care in nursing homes; and increasing funding for Medicaid and other community living programs.

Learn more about Medicare Rights’ positions and recommendations:

Strengthen Medicare Coverage

Medicare provides health coverage and access to 60 million older adults and people with disabilities. While it is a lifeline for many, there are critical gaps in the benefit, such as Medicare’s lack of comprehensive coverage for hearing, vision, and oral health services, that must be addressed. Changes are also needed to improve access to long-term care, achieve mental health parity, and better support caregivers and the health care workforce.

Learn more about Medicare Rights’ positions and recommendations:

Improve Medicare Part B Enrollment

In December 2020, key provisions of the BENES Act were signed into law. The policies update Medicare enrollment rules for the first time in over 50 years—ending lengthy waits for coverage, expanding critical administrative flexibilities, and informing future policymaking on enrollment period alignment. These changes will take effect in 2023. 

To ensure these reforms are adopted in a thoughtful and timely manner, the Medicare Rights Center urges the Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration (SSA) to immediately launch a transparent implementation process that engages stakeholders and advances health equity goals. 

Learn more about Medicare Rights’ positions and recommendations:

Medicare Watch  |  
January 7, 2021  
Policy Document  |  
December 17, 2020  
Policy Document  |  
May 3, 2019  
Make Prescription Drugs More Affordable

Medicare Rights supports efforts to meaningfully reduce drug prices and lower costs for people with Medicare and the program as a whole. Important strategies to do so include imposing limits on beneficiary out-of-pocket spending, allowing Medicare to negotiate drug prices, and increasing price transparency and accountability throughout the supply chain. Any changes to the current system must strengthen beneficiary protections and access to care.

We urge the Biden administration to use administrative tools to advance these goals, and to work with Congress on comprehensive drug pricing reform. The Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3) should serve as the basis for future legislation.

Learn more about Medicare Rights’ positions and recommendations:

Ease Access to Medicare’s 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. However, the programs’ complex, bureaucratic application processes and outdated eligibility thresholds unnecessarily limit participation.

Medicare Rights urges policymakers to update these rules 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 about Medicare Rights’ positions and recommendations:

Modernize Medicare Part D Appeals

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.

We urge the Biden administration to pursue structural simplifications without delay, and to work with Congress to address systemic pitfalls. This includes legislation introduced in the 116th Congress, the bipartisan, bicameral Streamlining Part D Appeals Process Act (S. 1861/H.R. 3924). This commonsense bill would allow a refusal at the pharmacy counter to serve as the plan’s initial coverage determination—giving people with Medicare more timely information about their plan’s coverage decision and eliminating unnecessary steps within the system

Learn more about Medicare Rights’ positions and recommendations:

Integrate Care for People with Medicare and Medicaid

Distinct Medicare and Medicaid rules, funding streams, and service delivery systems can create barriers that increase costs and worsen outcomes for the 12 million people who are enrolled in both programs. This fragmentation is a perennial concern for state and federal policymakers, given the high health needs of dually eligible individuals and associated program costs.

More fully integrating care by removing systemic barriers for dually eligible individuals has the potential to improve enrollee health in a cost-effective way. Medicare Rights supports efforts that offer meaningful choice; address disparities in access to and quality of care; rely on active and informed consumer participation; include robust consumer protections and oversight; offer clear consumer and provider education about options for accessing integrated care; establish unified grievance and appeals processes; ensure seamless access to data; and provide person-centered care coordination and care management.

Learn more by reading Medicare Rights’ recommendations for New York integrated care products and toolkit for navigating integrated care in New York, as well as some of our recent comments:

Policy Document  |  
April 26, 2021  
Policy Document  |  
June 1, 2020  
Policy Document  |  
March 30, 2020  
Policy Document  |  
December 17, 2019  

Combat COVID-19

The COVID-19 pandemic and its attendant economic fallout will have a lasting impact on people with Medicare and on the program itself. We urge Congress and the Biden administration to help people with Medicare maintain their health, safety, and independence during the public health emergency and beyond.

This includes easing and expediting Medicare enrollment; ensuring access to affordable COVID-19 care, treatment, and vaccines; providing economic relief for families, communities, and states; promoting health, safety, and quality of care in nursing homes; and increasing funding for Medicaid and other community living programs.

Learn more about Medicare Rights’ positions and recommendations:

Strengthen Medicare Coverage

Medicare provides health coverage and access to 60 million older adults and people with disabilities. While it is a lifeline for many, there are critical gaps in the benefit, such as Medicare’s lack of comprehensive coverage for hearing, vision, and oral health services, that must be addressed. Changes are also needed to improve access to long-term care, achieve mental health parity, and better support caregivers and the health care workforce.

Learn more about Medicare Rights’ positions and recommendations:

Improve Medicare Part B Enrollment

In December 2020, key provisions of the BENES Act were signed into law. The policies update Medicare enrollment rules for the first time in over 50 years—ending lengthy waits for coverage, expanding critical administrative flexibilities, and informing future policymaking on enrollment period alignment. These changes will take effect in 2023. 

To ensure these reforms are adopted in a thoughtful and timely manner, the Medicare Rights Center urges the Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration (SSA) to immediately launch a transparent implementation process that engages stakeholders and advances health equity goals. 

Learn more about Medicare Rights’ positions and recommendations:

Medicare Watch  |  
January 7, 2021  
Policy Document  |  
December 17, 2020  
Policy Document  |  
May 3, 2019  
Make Prescription Drugs More Affordable

Medicare Rights supports efforts to meaningfully reduce drug prices and lower costs for people with Medicare and the program as a whole. Important strategies to do so include imposing limits on beneficiary out-of-pocket spending, allowing Medicare to negotiate drug prices, and increasing price transparency and accountability throughout the supply chain. Any changes to the current system must strengthen beneficiary protections and access to care.

We urge the Biden administration to use administrative tools to advance these goals, and to work with Congress on comprehensive drug pricing reform. The Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3) should serve as the basis for future legislation.

Learn more about Medicare Rights’ positions and recommendations:

Modernize Medicare Part D Appeals

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.

We urge the Biden administration to pursue structural simplifications without delay, and to work with Congress to address systemic pitfalls. This includes legislation introduced in the 116th Congress, the bipartisan, bicameral Streamlining Part D Appeals Process Act (S. 1861/H.R. 3924). This commonsense bill would allow a refusal at the pharmacy counter to serve as the plan’s initial coverage determination—giving people with Medicare more timely information about their plan’s coverage decision and eliminating unnecessary steps within the system

Learn more about Medicare Rights’ positions and recommendations:

Ease Access to Medicare’s 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. However, the programs’ complex, bureaucratic application processes and outdated eligibility thresholds unnecessarily limit participation.

Medicare Rights urges policymakers to update these rules 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 about Medicare Rights’ positions and recommendations:

Integrate Care for People with Medicare and Medicaid

Distinct Medicare and Medicaid rules, funding streams, and service delivery systems can create barriers that increase costs and worsen outcomes for the 12 million people who are enrolled in both programs. This fragmentation is a perennial concern for state and federal policymakers, given the high health needs of dually eligible individuals and associated program costs.

More fully integrating care by removing systemic barriers for dually eligible individuals has the potential to improve enrollee health in a cost-effective way. Medicare Rights supports efforts that offer meaningful choice; address disparities in access to and quality of care; rely on active and informed consumer participation; include robust consumer protections and oversight; offer clear consumer and provider education about options for accessing integrated care; establish unified grievance and appeals processes; ensure seamless access to data; and provide person-centered care coordination and care management.

Learn more by reading Medicare Rights’ recommendations for New York integrated care products and toolkit for navigating integrated care in New York, as well as some of our recent comments:

Policy Document  |  
April 26, 2021  
Policy Document  |  
June 1, 2020  
Policy Document  |  
March 30, 2020  
Policy Document  |  
December 17, 2019  

Combat COVID-19

The COVID-19 pandemic and its attendant economic fallout will have a lasting impact on people with Medicare and on the program itself. We urge Congress and the Biden administration to help people with Medicare maintain their health, safety, and independence during the public health emergency and beyond.

This includes easing and expediting Medicare enrollment; ensuring access to affordable COVID-19 care, treatment, and vaccines; providing economic relief for families, communities, and states; promoting health, safety, and quality of care in nursing homes; and increasing funding for Medicaid and other community living programs.

Learn more about Medicare Rights’ positions and recommendations:

Strengthen Medicare Coverage

Medicare provides health coverage and access to 60 million older adults and people with disabilities. While it is a lifeline for many, there are critical gaps in the benefit, such as Medicare’s lack of comprehensive coverage for hearing, vision, and oral health services, that must be addressed. Changes are also needed to improve access to long-term care, achieve mental health parity, and better support caregivers and the health care workforce.

Learn more about Medicare Rights’ positions and recommendations:

Improve Medicare Part B Enrollment

In December 2020, key provisions of the BENES Act were signed into law. The policies update Medicare enrollment rules for the first time in over 50 years—ending lengthy waits for coverage, expanding critical administrative flexibilities, and informing future policymaking on enrollment period alignment. These changes will take effect in 2023. 

To ensure these reforms are adopted in a thoughtful and timely manner, the Medicare Rights Center urges the Centers for Medicare & Medicaid Services (CMS) and the Social Security Administration (SSA) to immediately launch a transparent implementation process that engages stakeholders and advances health equity goals. 

Learn more about Medicare Rights’ positions and recommendations:

Medicare Watch  |  
January 7, 2021  
Policy Document  |  
December 17, 2020  
Policy Document  |  
May 3, 2019  
Make Prescription Drugs More Affordable

Medicare Rights supports efforts to meaningfully reduce drug prices and lower costs for people with Medicare and the program as a whole. Important strategies to do so include imposing limits on beneficiary out-of-pocket spending, allowing Medicare to negotiate drug prices, and increasing price transparency and accountability throughout the supply chain. Any changes to the current system must strengthen beneficiary protections and access to care.

We urge the Biden administration to use administrative tools to advance these goals, and to work with Congress on comprehensive drug pricing reform. The Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3) should serve as the basis for future legislation.

Learn more about Medicare Rights’ positions and recommendations:

Modernize Medicare Part D Appeals

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.

We urge the Biden administration to pursue structural simplifications without delay, and to work with Congress to address systemic pitfalls. This includes legislation introduced in the 116th Congress, the bipartisan, bicameral Streamlining Part D Appeals Process Act (S. 1861/H.R. 3924). This commonsense bill would allow a refusal at the pharmacy counter to serve as the plan’s initial coverage determination—giving people with Medicare more timely information about their plan’s coverage decision and eliminating unnecessary steps within the system

Learn more about Medicare Rights’ positions and recommendations:

Ease Access to Medicare’s 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. However, the programs’ complex, bureaucratic application processes and outdated eligibility thresholds unnecessarily limit participation.

Medicare Rights urges policymakers to update these rules 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 about Medicare Rights’ positions and recommendations:

Integrate Care for People with Medicare and Medicaid

Distinct Medicare and Medicaid rules, funding streams, and service delivery systems can create barriers that increase costs and worsen outcomes for the 12 million people who are enrolled in both programs. This fragmentation is a perennial concern for state and federal policymakers, given the high health needs of dually eligible individuals and associated program costs.

More fully integrating care by removing systemic barriers for dually eligible individuals has the potential to improve enrollee health in a cost-effective way. Medicare Rights supports efforts that offer meaningful choice; address disparities in access to and quality of care; rely on active and informed consumer participation; include robust consumer protections and oversight; offer clear consumer and provider education about options for accessing integrated care; establish unified grievance and appeals processes; ensure seamless access to data; and provide person-centered care coordination and care management.

Learn more by reading Medicare Rights’ recommendations for New York integrated care products and toolkit for navigating integrated care in New York, as well as some of our recent comments:

Policy Document  |  
April 26, 2021  
Policy Document  |  
June 1, 2020  
Policy Document  |  
March 30, 2020  
Policy Document  |  
December 17, 2019  
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.

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.

2021 Annual Awards Virtual Event

Join us for a special event on Monday, October 18, 2021 at 6 PM.