Medicare matters.
Medicare is important to millions right now, and is being discussed as a basis for universal health care.
But before that can happen, we need to improve and protect the Medicare program we have. We need to keep it whole and working for all present and future beneficiaries.
Today, 62 million older people and people with disabilities have health care because of Medicare. Most Americans say Medicare works well. But it can be even better.
Medicare Platform
PRINCIPLES to Improve Medicare for all beneficiaries
now and in the future
1. Improve Consumer Protections and Quality Coverage
Cap out-of-pocket costs in traditional Medicare[1]
Require Medigap plans to be available to everyone in traditional Medicare, regardless of pre-existing conditions and age
Ensure parity between Medicare Advantage (MA) and traditional Medicare
Ensure all benefits in Medicare Advantage are also available in traditional Medicare, such as the waiver of 3-day prior hospital stay requirement for skilled nursing home care, coverage for home health aides, certain oral health, vision, and audiology services
Ensure payment in traditional Medicare is at least as much per enrollee as in Medicare Advantage[2]
Simplify enrollment in traditional Medicare, Part D and Medigap, and ease transitions from other insurances to Medicare
Improve consumer protections in Medicare Advantage
Standardize benefit packages[3]
Ensure parity between mental health and physical health coverage
Ensure the Medicare appeals system is cost-effective and fair for beneficiaries
Ensure access to timely, meaningful decision-making, and written determinations at all levels of appeal
Add a meaningful appeals process for hospice coverage[6]
2. Reduce Ongoing Barriers to Care
Eliminate the harm of so-called hospital “Observation Status” when a person is actually in the hospital
Eliminate the 3-day prior inpatient hospitalization requirement for skilled nursing facility coverage or, at least, count all time in the hospital towards the 3-day prior hospital requirement
Ensure access to home health coverage is actually available for all beneficiaries who meet coverage criteria; ensure access to legally authorized home health aides; resolve conflicts between payment models and coverage laws[7]
Ensure access to quality skilled nursing facility care
Require adequate staffing ratios, provider payments subject to a medical loss ratio, and adequate oversight and enforcement
Ensure beneficiaries with longer-term, chronic, and/or debilitating conditions have full access to skilled nursing, therapy and related care needed to maintain their conditions or slow decline, as is required by law
3. Improve Traditional Medicare
Ensure traditional Medicare is comprehensive, simple to navigate, and affordable
Add oral health, audiology, and vision coverage for all beneficiaries in traditional Medicare
Increase low-income protections and reduce cost-sharing
Add coverage for long-term care
As in HR 3,[8] ensure savings achieved through drug negotiations, or by other means, are reinvested into the Medicare program
We need to improve Medicare,
not privatize or cut it.
Renew it, strengthen it.
Then expand access for generations to come.
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[1] In 2016, the average person with Medicare coverage spent $5,460 out of their own pocket for health care (Kaiser Family Foundation, 2019).
[2] On average, MA plans are still being overpaid due, in part, to manipulation of risk adjusted payment and a broken quality bonus payment system; see, e.g., https://medicareadvocacy.org/medicare-advantage-continues-to-drive-up-medicare-costs, https://medicareadvocacy.org/support-traditional-medicare-by-leveling-the-playing-field-with-medicare-advantage/, http://www.medpac.gov/docs/default-source/reports/jun19_ch8_medpac_reporttocongress_sec.pdf.
[3] See, e.g., https://medicareadvocacy.org/center-comments-on-medicare-advantage-and-part-d-transformation-ideas/.
[4] See, e.g., discussion of reversing MA network adequacy changes in recent final Part C & D rule at: https://medicareadvocacy.org/final-rule-for-medicare-parts-c-and-d-includes-weakened-standards-for-medicare-advantage-networks/.
[5] See, comments to proposed Part C & D rule at: https://medicareadvocacy.org/wp-content/uploads/2020/04/CMA-CD-Comments-2020.pdf.
[6] For example, establish an expedited appeals process for hospice coverage issues similar to one currently in regulations for untimely discharges from skilled nursing facilities, home health and hospice – see 42 CFR §405.1200, et seq.
[7] For example, consider lifting or expanding the current statutory cap on outlier payments (claimed for individuals with significant resource needs) from 2.5% of total Medicare home health payments, and 10% of expenditures to any singular home health agency. These caps inappropriately limit access to necessary services under the guise of controlling fraud.
[8] H.R.3 - Elijah E. Cummings Lower Drug Costs Now Act (passed House of Representatives 12/12/19).
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