Medicare provides health coverage to over 60 million older adults and people with disabilities, paying for important medical care in hospital and outpatient settings. Nearly 12.5 million beneficiaries also rely on Medicaid, which helps with affordability through the Medicare Savings Programs (MSPs), and covers services Medicare does not, such as long-term services and supports. The Medicare Rights Center supports strengthening Medicare and Medicaid, modernizing benefits and financial assistance, and bolstering the workers and caregivers who deliver this vital care.
Medicare eligibility translates into meaningful gains in health equity. But the COVID-19 pandemic in particular has demonstrated that racial, ethnic, gender, LGBTQ+ status, disability status, and income disparities in health outcomes and access to care remain.
Medicare does not cover many of the essential services that older adults and people with disabilities need in order to live healthy lives. In addition to the direct impacts in terms of beneficiary well-being, gaps in access to these services can bring on or worsen other health concerns. Furthermore, this lack of coverage puts Medicare out-of-step with most private insurance and Medicaid which reflect a more modern understanding of patient needs and the interconnected nature of the human body.
Unlike most modern health insurance coverage, Original Medicare has no out-of-pocket maximum, exposing beneficiaries to limitless financial risk. While Medicare Advantage (MA) plans do include an out-of-pocket maximum in their benefit packages, the threshold is too high. This means people with high health care needs can be forced to make impossible choices between paying for rent, food, or their essential health care or medicines. Policies that cap out-of-pocket costs are already in place for the employer and individual markets, including Marketplace plans under the Affordable Care Act (ACA). People with Medicare must not be left behind.
Medicare benefits for skilled nursing facilities (SNFs) hinge on a complicated concept, the three-day rule. This rule requires beneficiaries to be hospital inpatients for three consecutive days before Medicare will cover SNF admittance. But Medicare beneficiaries needing hospital care often find themselves classified as “outpatients,” and/or in “Observation Status” rather than admitted as inpatients. Observation Status patients often receive care that is indistinguishable from the care provided to individuals who have been formally admitted as inpatients, and observation stays can last for several days. This penalizes patients who have no control over how they will be classified and makes the Medicare distinction between the two statuses illogical and punitive.
Current Medicare policies expose low- and moderate-income beneficiaries to excessive out-of-pocket costs. For those who qualify, the Medicare Savings Programs (MSPs) can be a lifeline, helping them pay premiums and, in some cases, cost sharing for Medicare coverage they would not otherwise be able to afford. But the application process in most states is complex and burdensome, and the eligibility requirements leave far too many people who need this assistance unable to get it.
While it is relatively easy for a Medicare beneficiary to enroll into and disenroll from a Medicare Advantage (MA) plan on an annual basis, there are limited windows of opportunity to join a Medigap plan. This means that people who want to switch from MA to traditional Medicare may not have the option for supplemental coverage they need, which may lock them into MA coverage. In order for Medicare beneficiaries to have true freedom of choice concerning their coverage options, Medigap plan access must be strengthened.
Far too many people with Medicare have trouble affording their health coverage and care. AARP recently released a report on
In late December, Congress passed an omnibus spending bill (P.L. 117-328) that funds the federal government through the current fiscal
As of January 1, more New Yorkers are eligible to enroll in a Medicare Savings Program (MSP). MSPs pay the
Medicare eligibility translates into meaningful gains in health equity. But the COVID-19 pandemic in particular has demonstrated that racial, ethnic, gender, LGBTQ+ status, disability status, and income disparities in health outcomes and access to care remain.
Medicare does not cover many of the essential services that older adults and people with disabilities need in order to live healthy lives. In addition to the direct impacts in terms of beneficiary well-being, gaps in access to these services can bring on or worsen other health concerns. Furthermore, this lack of coverage puts Medicare out-of-step with most private insurance and Medicaid which reflect a more modern understanding of patient needs and the interconnected nature of the human body.
Unlike most modern health insurance coverage, Original Medicare has no out-of-pocket maximum, exposing beneficiaries to limitless financial risk. While Medicare Advantage (MA) plans do include an out-of-pocket maximum in their benefit packages, the threshold is too high. This means people with high health care needs can be forced to make impossible choices between paying for rent, food, or their essential health care or medicines. Policies that cap out-of-pocket costs are already in place for the employer and individual markets, including Marketplace plans under the Affordable Care Act (ACA). People with Medicare must not be left behind.
Medicare benefits for skilled nursing facilities (SNFs) hinge on a complicated concept, the three-day rule. This rule requires beneficiaries to be hospital inpatients for three consecutive days before Medicare will cover SNF admittance. But Medicare beneficiaries needing hospital care often find themselves classified as “outpatients,” and/or in “Observation Status” rather than admitted as inpatients. Observation Status patients often receive care that is indistinguishable from the care provided to individuals who have been formally admitted as inpatients, and observation stays can last for several days. This penalizes patients who have no control over how they will be classified and makes the Medicare distinction between the two statuses illogical and punitive.
Current Medicare policies expose low- and moderate-income beneficiaries to excessive out-of-pocket costs. For those who qualify, the Medicare Savings Programs (MSPs) can be a lifeline, helping them pay premiums and, in some cases, cost sharing for Medicare coverage they would not otherwise be able to afford. But the application process in most states is complex and burdensome, and the eligibility requirements leave far too many people who need this assistance unable to get it.
While it is relatively easy for a Medicare beneficiary to enroll into and disenroll from a Medicare Advantage (MA) plan on an annual basis, there are limited windows of opportunity to join a Medigap plan. This means that people who want to switch from MA to traditional Medicare may not have the option for supplemental coverage they need, which may lock them into MA coverage. In order for Medicare beneficiaries to have true freedom of choice concerning their coverage options, Medigap plan access must be strengthened.
Far too many people with Medicare have trouble affording their health coverage and care. AARP recently released a report on
In late December, Congress passed an omnibus spending bill (P.L. 117-328) that funds the federal government through the current fiscal
As of January 1, more New Yorkers are eligible to enroll in a Medicare Savings Program (MSP). MSPs pay the
