CMA Alert – December 20, 2018

1. Core Considerations for Medicare for Today & Tomorrow – A Medicare Platform for the New Congress
2. Texas Lawsuit Sabotage of the Affordable Health Care Act

Core Considerations for Medicare for Today & Tomorrow – A Medicare Platform for the New Congress

The Center for Medicare Advocacy works for a comprehensive Medicare program and quality health coverage and care for all people. To accomplish these goals for current and future beneficiaries in the changing health care environment, we seek to:

• Improve Medicare for current and future beneficiaries.
• Support the development of the best method possible to increase access to quality health coverage and care for the most people.

Medicare Platform to Improve Medicare for all beneficiaries, now and in the future:

1. Consumer Protections and Quality Coverage for All Medicare Beneficiaries (Including Parity Between Traditional Medicare and Medicare Advantage)

• Cap out-of-pocket costs in traditional Medicare
• Require Medigap plans to be available to all individuals in traditional Medicare, regardless of pre-existing conditions and age (“Guarantee Issue” and “Community Rating”)
• Ensure all benefits in Medicare Advantage are also available in traditional Medicare
  • For example, include all MA “supplemental benefits,” waiver of 3-day prior hospital stay requirement for SNF coverage, coverage for home health aides, coordinated care

• 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,
  • Strengthen network adequacy requirements
  • Strengthen plan oversight
  • Strengthen marketing protections

• Ensure the Medicare appeals system is cost-effective, accessible and fair

2. Reduce Ongoing Barriers to Care  

• Eliminate the harm of hospital “Observation Status”
• Home Health – Ensure access to 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
• Jimmo Implementation – 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

3. Improve Traditional Medicare  

• Add oral health, audiology, vision coverage
• Restructure Medicare to make it comprehensive, simpler and  affordable
• Increase Low-Income Protections in the Medicare Savings Program (at least on par with ACA subsidies)
• Long-term Care – Add coverage over time. For now, make incremental improvements (For example, repeal homebound requirement for home health coverage, repeal requirement that individual need skilled care and be homebound to qualify for home health aide coverage, repeal requirement that DME generally be needed in the home)

– top –

Texas Lawsuit Sabotage of the Affordable Health Care Act

The Center for Medicare Advocacy and the Medicare Rights Center recently issued a joint statement on the misguided decision of a federal court in Texas against the Affordable Care Act (ACA). If this decision stands, all of the ACA’s coverage and consumer protections will be null and void. People with pre-existing conditions and those who are older or have disabilities will be especially at risk. Consumers should know that decision has no immediate effect, the ACA is still the law of the land, and they continue to have access to all comprehensive benefits. ACA-compliant plans must not deny coverage or charge more to consumers based on health status, and must cover all of the “essential benefits” defined in the law.

Although the federal Open Enrollment period officially ended on December 15, the below states have opted to give consumers more time to enroll in an ACA-compliant plan for 2019 through their state-run marketplaces (coverage effectiveness dates vary):

• California: January 15, 2019
• Colorado: January 15, 2019
• Connecticut: January 15, 2019
• District of Columbia: January 31, 2019
• Massachusetts: January 23, 2019
• Minnesota: January 13, 2019
• New York: January 31, 2019
• Rhode Island: December 31, 2018
• Vermont: December 21, 2018 (grace period for people who were not able to get through to the exchange during the final days of open enrollment due to high call volume)
• Washington: December 20, 2018 (grace period for people who were not able to enroll before the end of open enrollment)

We will be closely following the Texas court case as we expect it to be appealed to the Fifth Circuit and to the Supreme Court. We also call on the Administration once again to defend the ACA as the health and well-being of millions of Americans depend on it.