30 Policy Goals for Medicare’s Future

#30MedicareGoals

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Category: Expand and Improve Coverage

Provide Medicare Coverage for More Home Health and Long-term Care Services

Medicare (including Original Medicare and Medicare Advantage) does not cover many long-term services and supports. And it covers help with activities of daily living, like eating and bathing, only in very limited circumstances. Reflecting broad national trends, many callers to the Medicare Rights national helpline seek help paying for this care. Congress must modernize the Medicare program to meet this growing need by expanding coverage for services that allow beneficiaries to remain in their homes and for family caregiver supports, like respite care and adult day health care, and by filling existing coverage gaps, such as eliminating the requirement that […]

Strengthen Non-Medicare Home and Community-Based Services

Because Medicare generally does not cover many home and community-based services (HCBS) and long-term services and supports (LTSS), older adults and people with disabilities rely on a constellation of other programs to fully participate in their communities, including Medicaid and the Older American’s Act (OAA). Accordingly—while developing alternative, longer-term LTSS financing solutions—Congress must ensure these programs are up to the task. This includes best positioning Medicaid to serve beneficiaries in the least restrictive, most appropriate setting by expanding the Independence at Home demonstration, reauthorizing the Balancing Incentive Program, and making both the Money Follows the Person program and the HCBS […]

Support Family Caregivers and Strengthen the Health Care Workforce

The nation’s fragmented LTSS system means that people with Medicare who desire to age in the community often largely rely on unpaid family caregivers and undervalued home care workers to do so. Congress must better support these families and paid workers, including by creating federal paid family and medical leave that recognizes caring for relatives of all ages, adequately funding annually appropriated HCBS and caregiver support programs, and recruiting and retaining a robust home care workforce.

Address the Social Determinants of Health

Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. While comprehensively addressing the root causes of and health outcomes associated with social determinants of health is a complex, long-term endeavor, there are steps policymakers can take today to more holistically meet the needs of people with Medicare. We encourage policymakers to ensure that effective approaches are equally available to all beneficiaries.

Cover Oral Health Care

Despite the wealth of evidence that oral health is related to physical health, Medicare excludes routine dental care from coverage. While some Medicare Advantage plans may offer dental benefits, this coverage is often limited and can be inconsistent both across plans and from year to year. To address this unmet need, Congress must add a comprehensive oral health benefit to Part B. To best reflect the evidence base and align with the scope of current Medicare coverage, this benefit should be structured to include both medically necessary procedures as well as preventive care, and subject to the same cost sharing […]

Cover Vision and Hearing Care

Lack of hearing coverage can increase the risk of dementia and contribute to social isolation, which can in turn heighten one’s risk for depression and chronic illness. Similarly, uncorrected vision acuity loss can also cause other, significant health issues and adversely affect quality of life. Despite these troubling—and costly—consequences, Medicare does not cover many routine vision or hearing care needs. While some Medicare Advantage (MA) plans may offer supplementary vision or audiology coverage, quality and cost vary considerably from plan to plan. The absence of meaningful coverage for these basic health needs represents a stark gap in coverage for older […]

Provide Mental Health Parity in Medicare

Medicare is not fully subject to the federal law requiring equivalent coverage for mental and physical health conditions. As a result, unequal treatment remains. For instance, Medicare caps coverage for care at inpatient psychiatric hospitals at 190 days over a beneficiary’s lifetime. This same limit does not apply to inpatient psychiatric care received at non-specialized facilities, or for non-psychiatric care. Congress should eliminate this and other barriers to care, and ensure the full range of mental health services providers are eligible for Medicare reimbursement.

Expand Access to Telehealth

When thoughtfully designed and carefully implemented, telehealth can facilitate cost-effective care delivery. While administrative and legislative telehealth expansions tend to focus on increasing access within Medicare Advantage, we encourage policymakers to pursue parity with Original Medicare, so that all beneficiaries can access these services. Policymakers must also ensure robust consumer protections are in place before broadening telehealth options and require plans and providers to demonstrate how they intend to address inequalities in access to the internet and devices so that telehealth benefits are available to all enrollees.

Prohibit Medicare Advantage Plans from Dropping Doctors Mid-year without Cause

Beneficiaries enrolled in Medicare Advantage (MA) plans should be able to count on stability in their plan networks and the knowledge that their doctors will be there when they need them. Congress should pass legislation that prohibits MA plans from dropping doctors without cause in the middle of the plan year and strengthens beneficiary notice regarding provider network changes.