30 Policy Goals for Medicare’s Future

#30MedicareGoals

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Category: Address Enrollment Pitfalls

Pass the BENES Act

Complex Medicare enrollment rules and lack of notification cause tens of thousands of older adults and people with disabilities to face lifetime penalties, coverage gaps, and other harmful consequences. The Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (S. 1280/H.R. 2477) would help people avoid making these costly errors by modernizing the Part B enrollment process. It would ensure that people approaching Medicare eligibility receive clear and timely information about Medicare Part B enrollment rules, simplify Part B enrollment periods, and improve transitions to Medicare by eliminating needless gaps in coverage.

Expand Special Enrollment Period (SEP) Rights

More people new to Medicare should have access to a Special Enrollment Period (SEP), allowing them to more easily enroll in Medicare after their existing coverage ends. Currently, federal law only grants a SEP to individuals with employer-sponsored group coverage and for eight months after that coverage ends. Making SEPs more widely available would help prevent enrollment errors that often result when people transition to Medicare from other, non-employer coverage. Medicare Rights supports making SEPs available to people with pre-Medicare coverage other than employer-sponsored group health plans, including COBRA, VA coverage, retiree insurance, and Marketplace plans.

Strengthen Equitable Relief

Limited avenues for relief are available to those who make mistakes when enrolling in Medicare. Specifically, beneficiaries facing lifetime penalties and gaps in coverage can only remedy their situation if they can prove that an agent of the federal government misinformed them about enrollment rules. Yet many people turn to their employer or health plan—not a federal agency—when transitioning to Medicare. To provide adequate recourse for those who make honest enrollment mistakes, Congress should expand equitable relief to include misinformation from non-federal sources, such as employers, employer-sponsored or individual market health plans, and insurance brokers.

Reduce or Eliminate the Part B Lifetime Late Enrollment Penalty

Erroneously delaying Medicare Part B can have significant consequences—including a lifetime premium penalty. Designed to encourage enrollment when first eligible, this late enrollment penalty is also imposed on those who simply make a mistake. For as long as they have Medicare, these individuals will pay the regular monthly Part B premium plus an additional 10 percent for each year they delayed signing up. While it is important that a penalty appropriately deter anyone who might actively seek to avoid Medicare enrollment, it must not punish those who make honest mistakes. Congress should enact policies to reduce or eliminate lifetime premium […]

Consolidate and Standardize Medicare Advantage and Part D Plans

Selecting a Medicare Advantage (MA) or Part D plan is a daunting task for many. Alarmingly, only 13 percent of Medicare beneficiaries opt to reevaluate their coverage options year to year—despite annual changes to premiums, plan coverage rules, and cost-sharing. This decision-making process is likely to become even more difficult, as plans adopt new flexibilities around uniformity and benefit design. Congress should enact legislation to consolidate MA and Part D plan choices and standardize options in order to facilitate informed beneficiary decision-making.

Improve Decision-Making Tools

Policymakers must ensure that people with Medicare have access to accurate, actionable, personalized information they need to make optimal coverage decisions, both initially and annually. This includes improving Medicare Plan Finder—the federal government’s primary enrollment tool—to be more accurate complete, and easy to use. Similarly, Medicare Advantage and Part D plans should be required to provide a tailored Annual Notice of Change to all enrollees. This notice should be based on claims data and clearly describe how the plan will change in the coming year.

Adequately Fund Medicare Outreach Programs

Medicare State Health Insurance Program (SHIP) counselors—most of whom are highly-trained volunteers—provide one-on-one, unbiased, personalized counseling to Medicare beneficiaries, helping them understand their rights and coverage options. And through the Medicare Improvements for Patients and Providers Act (MIPPA), SHIPs, Area Agencies on Aging, and Aging and Disability Resource Centers help low-income Medicare beneficiaries access programs that make their health care and prescription drugs affordable. Congress should adequately fund these programs and make MIPPA permanent in order to better meet current and future needs.