Medicare Watch

Your Weekly Medicare Consumer Advocacy Update

Transitions to Medicare after the Affordable Care Act

September 12, 2013 Volume 4, Issue 36

Panel Discusses Transitions to Medicare for People with Insurance Provided through the ACA


Earlier this week, Medicare Rights joined colleagues from the Center for Medicare Advocacy, Inc. and the National Senior Citizens Law Center for a panel at the annual Home and Community Based Services Conference on the transition to Medicare for people who will gain new health care coverage through the Affordable Care Act (ACA)—including from the Health Insurance Marketplace to Medicare and from expanded Medicaid to Medicare.

Panelists reviewed beneficiary and policy considerations pertaining to the following transitions:

  • Individual Qualified Health Plan (QHP) à Medicare
  • Small Business Options Program (SHOP) plan à Medicare
  • Expanded Medicaid à Medicare
  • Expanded Medicaid à Medicare/Medicaid
  • Expanded Medicaid à Medicare + Medicare Savings Program (MSP) + Extra Help 

People newly eligible for Medicare transitioning from the Health Insurance Marketplace, both QHP and SHOP plans, must consider several factors to avoid gaps in health coverage and avoid late enrollment premium penalties. Among these factors is ensuring timely enrollment in Medicare and timely disenrollment from the Health Insurance Marketplace alongside assessing eligibility for low-income assistance programs, including Medicare Savings Programs (MSPs) and Extra Help. The federal government must ensure that beneficiaries are adequately educated about when and how to enroll in Medicare as well as about critical coordination of benefits rules.

For those transitioning from expanded Medicaid to Medicare, transitions are made more complicated by misaligned eligibility criteria for expanded Medicaid and traditional Medicaid. Based on income and asset tests, some may remain eligible for full Medicaid, others may be eligible for other types of cost sharing assistance, including MSPs and Extra Help, and some may only be eligible for Medicare. It is critical that federal and state governments actively enforce policies to automatically screen newly eligible Medicare beneficiaries for the health care assistance programs for which they might be eligible, and newly eligible Medicare beneficiaries must be vigilant about applying for these programs.

Poorly managed transitions from new ACA coverage options to Medicare may result in gaps in health coverage and significantly increased health care costs for newly eligible beneficiaries. Anticipating potential challenges for beneficiaries will help to lessen the likelihood of these burdens.

Read A Bridge to Health: Ensuring Seamless Transitions from Health Insurance Exchanges and Medicaid to Medicare.


Medicare Continues Its Slow Growth in Spending

In a recent article, Peter Orszag, the former director of the Office of Management and Budget under President Obama, discusses the continued slow growth in Medicare spending. Medicare spending per beneficiary has gone from 7.1 percent a year from 2000 to 2005 to 3.8 percent from 2007 to 2010. Over the past year total Medicare spending increased by only 3 percent. Many wonder whether the decline in spending is due to the economic downturn or other causes—the implication being that the decrease in spending will reverse once the economy improves or may continue the decline if attributed to other factors.

Mr. Orszag writes that the current economic recession has had “almost no effect” on Medicare spending. He says this is because Medicare beneficiaries have relatively small out-of-pocket costs, and their income is steady since it mostly comes from Social Security, which does not decrease due to a weak economy. However, according to a technical paper by researchers at the Congressional Budget Office (CBO), the slow growth in Medicare spending may be attributed to changes in the delivery of health care. The rate of hospital admissions per beneficiary has decreased, and more palliative care is occurring in hospices instead of hospitals, which are more expensive. The CBO suggests that these trends are due to a “heightened public focus on cost containment.” Many providers expect, in the future, for payments to be based more on the quality of their services rather than the quantity. According to Mr. Orszag, these expectations are having a significant impact.

How far can providers go to reduce costs without negatively impacting quality of care? According to a paper from Harvard University and Dartmouth College examining why Medicare spending is so different from region to region, the researchers found that the different ways doctors practice medicine, as opposed to patient demand, appears to explain the regional variation in Medicare spending. Through survey data, the paper found a significant correlation between the way doctors would treat hypothetical patients and the actual spending patterns across regions. According to the paper, if doctors who offer care beyond the medical guidelines were to instead follow the suggested guidelines, Medicare spending would decrease by 17 percent. Presumably, regions with higher Medicare spending would see a spending decrease.

Read the article. 

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Medicare Reminder

Whether you are allowed to buy a Medigap plan during Fall Open Enrollment (October 15-December 7 of each year) depends on your circumstances and your state’s specific rules on Medigap enrollment.

A Medigap plan is supplemental coverage designed to pay for out-of-pocket Original Medicare costs, such as deductibles and coinsurances. Medigap plans do not work with Medicare Advantage plans. You can only have a Medigap plan if you have Original Medicare.

Under federal law, you have the right to buy a Medigap plan at certain times. Federal law allows people 65 years or older to buy Medigaps; however, some states may extend that right to people who are under 65 years old and become eligible for Medicare due to disability, End-Stage Renal Disease or Lou-Gehrig’s Disease (ALS). For exact rules and protections in your state about Medigap enrollment periods, contact your State Health Insurance Assistance Program (SHIP) or State Department of Insurance.

Learn more about Medigap enrollment at



Today the Medicare Rights Center announced the release of the new, an overhaul of the organization’s website that will make it easier for beneficiaries, professionals, journalists and others to find answers to Medicare questions. With improved search, a new navigational structure and a modern design optimized for viewing on mobile devices, information about changes to Medicare and about Medicare Rights and its services are easier to find and are available to more people in more places.

In the last year, received a 105 percent increase in traffic from mobile devices over the previous year. With the launch of the new, the website is now optimized for easier viewing on mobile devices. Whether you are looking for information about Medicare changes, signing up for a newsletter, reading a policy report or looking for ways to get involved, you can do so with ease, regardless of how you access the website.

The new website is live today. Visit


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