Your Weekly Medicare Consumer Advocacy Update
Protecting the Rights of People with Medicare Advantage
New Bill Introduced to Protect Rights of Medicare Advantage Beneficiaries
A new bill—the Medicare Advantage Participant Bill of Rights Act—was recently introduced in both the U.S. House and Senate. The bill aims to protect Medicare Advantage beneficiaries by limiting when and how a Medicare Advantage plan can make changes to its physician networks.
Many beneficiaries choose their Medicare Advantage plans specifically so their primary care physician and specialists are in-network. However, in the past year, some Medicare Advantage plans made drastic changes to their networks after the annual Medicare Fall Open Enrollment Period ended. The bill seeks to prevent this from happening in the future and to provide Medicare Advantage beneficiaries with more concrete supports if their doctor does leave the plan network.
The bill would prevent Medicare Advantage plans from dropping providers in the middle of the year without reason and require Medicare Advantage plans to finalize provider networks 60 days before the start of the Fall Open Enrollment Period. It also seeks to make it easier for beneficiaries to access and understand information and supports when a provider does leave the network.
Issue Brief Highlights Four Ways to Improve Programs for Low-Income People with Medicare
In a recent issue brief, Families USA examines four strategies to improve programs that help low-income people with Medicare pay for their health care costs. Half of the more than 50 million older adults and people with disabilities with Medicare have an annual income of less than $23,500. Oftentimes it can be difficult for those with limited incomes to pay monthly Medicare premiums, copayments and coinsurance.
The main programs that help people with limited income are Medicare Savings Programs and the Part D low-income subsidy, also known as Extra Help. These programs help provide some relief for household budgets that are often stretched thin.
With the goal of increasing what these programs cover and the number of people they reach, Families USA highlights the following strategies:
- Increase income eligibility standards
- Modernize asset limits
- Align eligibility criteria across programs
- Improve cost-sharing protections within existing programs
Volume 5, Issue 26
The Fall Open Enrollment Period is the time of year when Medicare beneficiaries can switch the way they receive their Medicare benefits. However, you generally cannot switch your Medicare Advantage plan or Part D prescription drug plan outside of Fall Open Enrollment, unless you qualify for a Special Enrollment Period (SEP). Some of the common ways to qualify for an SEP include, but are not limited to:
- When you move;
- If you are eligible for an assistance program such as Extra Help or a State Pharmaceutical Assistance Program (SPAP);
- When you lose or change employer or union (current or retiree) coverage; and
- If you choose to enroll in a five-star Part D or Medicare Advantage plan.
The length of your special enrollment period and when your new plan would start depend on your specific situation, so you should contact Medicare at 800-MEDICARE (800-633-4227) to see if you are eligible.
Recently, the U.S. House of Representatives held committee hearings on restructuring traditional Medicare. At first glance, proposals to “simplify” and “streamline” Medicare seem promising. Unfortunately, restructuring often means cutting critical resources. Some of the proposals being considered would increase out-of-pocket health care costs for over 70 percent of Medicare beneficiaries. They would also raise the cost of home health services, with copays up to $150. Yet, most people with Medicare simply cannot afford to pay more for health care.
Join the Medicare Rights Center and Campaign for America’s Future today in demanding that Congress not “simplify” Medicare by shifting costs onto seniors and people with disabilities.