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Coverage and Benefits

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.

Comments on the Conscience Proposed Rule

The Medicare Rights Center appreciates this opportunity to comment on the Safeguarding the Rights of Conscience as Protected by Federal Statutes proposed rule. We applaud this proposal by the Department of Health and Human Services (HHS) to rescind the most damaging aspects of the 2019 final rule Protecting Statutory Conscience Rights in Health Care; Delegations of Authority.

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Medicare Coverage Gaps: Care Inside the Home and DME in the Community

Medicare does not cover most long-term services and supports (LTSS) or durable medical equipment for use outside of the home. While home health should be more widely available, beneficiaries often find coverage inaccessible because of information gaps and onerous requirements, and the benefit is not integrated into other care and supports that people need in their homes. This results in patchworks of coverage that are difficult to manage, confusing and inefficient.

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Medicare and Health Equity

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.

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Filling Gaps in Medicare Coverage: Dental, Vision, and Hearing

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.

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Medicare Coverage Gaps: The Need to Curb Beneficiary Out-of-Pocket Spending

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.

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Medicare Hospital Outpatient and Observation Status: The Three-Day Stay Problem

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.

Read More »

Improving Medicare Savings Programs

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.

Read More »

Comments on the Conscience Proposed Rule

The Medicare Rights Center appreciates this opportunity to comment on the Safeguarding the Rights of Conscience as Protected by Federal Statutes proposed rule. We applaud this proposal by the Department of Health and Human Services (HHS) to rescind the most damaging aspects of the 2019 final rule Protecting Statutory Conscience Rights in Health Care; Delegations of Authority.

Medicare Coverage Gaps: Care Inside the Home and DME in the Community

Medicare does not cover most long-term services and supports (LTSS) or durable medical equipment for use outside of the home. While home health should be more widely available, beneficiaries often find coverage inaccessible because of information gaps and onerous requirements, and the benefit is not integrated into other care and supports that people need in their homes. This results in patchworks of coverage that are difficult to manage, confusing and inefficient.

Medicare and Health Equity

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.

Filling Gaps in Medicare Coverage: Dental, Vision, and Hearing

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.

Medicare Coverage Gaps: The Need to Curb Beneficiary Out-of-Pocket Spending

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 Hospital Outpatient and Observation Status: The Three-Day Stay Problem

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.

Improving Medicare Savings Programs

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.