- Finding a Way Into 2021
- COVID Relief and Omnibus Package: Overview of Medicare Provisions
- Affordable Care Act: Millions Have Benefited Despite Sabotage
- 2021 Medicare Reminders: Medicare Advantage Enrollees Can Still Make a Change, Possible Special Enrollment Periods, Medicare Cost-Sharing Rates for 2021
We began 2020 ready to advance access to Medicare and quality health care – working from our offices, and meeting with colleagues across the country. We enter 2021 working separately, connected remotely, with a heightened urgency to succeed brought about by the COVID pandemic and its disproportional impact on older people, people with disabilities, and people of color.
Tragically, as we left 2020 behind, the Capitol was stormed by mobs trying to undo the valid Presidential election. An election reviewed, and complaints dismissed, by dozens of courts.
The Center for Medicare Advocacy is a public interest law organization. We are proud to represent vulnerable people and advance their rights under the laws and Constitution. Good laws create and coalesce society, so we don’t break into individual silos and tribes. When just laws and ethics aren’t valued by leaders and respected by people, civil society breaks down – silos and tribes take hold. That is what we’ve witnessed.
Rep. John Lewis’s voice rings in our ears, reminding us to “find a way where there is no way.” The Center for Medicare Advocacy is determined to work together to build a path that leads to a more honorable and civil society, with health equity and justice.
January 7, 2021
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On December 21, 2020, Congress passed a COVID relief package as part of a larger omnibus spending package called the Consolidated Appropriations Act, 2021 (H.R. 133), signed into law on December 27, 2020. In addition to various public health measures aimed at combating the COVID-19 epidemic, and provisions addressing provider, workforce, rural health, Medicaid and other issues, the omnibus package included a number of provisions that relate directly to Medicare beneficiaries, discussed further below. Note that this Alert references some, but not all, of the Medicare-related changes in this package.
Summaries of the entire package include the following provided by the House Majority Leader: A division-by-division summary of the appropriations provisions is here. A division-by-division summary of the coronavirus relief provisions is here. A division-by-division of the authorizing matters is here.
Overview of Medicare Provisions
The House Ways & Means Committee majority staff issued a summary of the overall Coronavirus relief and omnibus agreement, which includes the following section related to Medicare beneficiaries (also see the minority staff summary here, discussed further below):
“Medicare Beneficiary Investments. The legislation makes important, overdue investments for Medicare to support access to health care for beneficiaries. Specifically, it:
- Simplifies and accelerates Medicare enrollment by mandating that Part B insurance begin the first of the month following an individual’s enrollment during both the later months of the beneficiary’s Initial Enrollment Period (IEP) and during the General Enrollment Period (GEP).
- Allows the federal government to create a Part A and B Special Enrollment Period (SEP) for exceptional circumstances like natural disasters.
- Extends funding for programs that help Medicare-eligible individuals and their families and caregivers determine the best way to access affordable, comprehensive health care.
- Lowers beneficiary costs by phasing in a waiver of coinsurance for certain colorectal cancer screening tests.
- Improves quality and safety in Medicare by: 1) extending funding for the National Quality Forum for an additional three years, 2) improving the Skilled Nursing Facility Value-Based Purchasing Program, 3) extending and expanding two demonstration programs that improve quality of care for vulnerable populations, 4) encouraging access to Alzheimer’s screening through physician education, and 5) providing intermediate remedies to improve quality in poor-performing hospices.
- Improves access to mental health care by permanently expanding Medicare coverage of mental health telehealth services.
- Provides eligibility for immunosuppressive drug coverage through Medicare to individuals post-kidney transplant who do not receive coverage through other insurance.
- Helps seniors and other individuals with the high cost of medical care by permanently lowering the Medicare Expense Deduction threshold to 7.5 percent of gross income.”
Key Enrollment Changes
Of note, as outlined in the first two bullets in the summary above, these changes included key provisions of the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act (S. 1280/H.R. 2477) – a bill championed by our colleagues at the Medicare Rights Center (MRC) and supported by many advocacy organizations, including the Center for Medicare Advocacy. We applaud MRC and their work to get these critical changes passed into law. As a result of these provisions, as noted in a press release by MRC, “millions of Americans will be able to avoid enrollment pitfalls of the current system and more easily connect with their earned Medicare benefits.”
MRC’s press release provides additional detail about these changes:
- “The bill eliminates the up to seven month-long wait for coverage that people can experience when they sign up for Medicare during the General Enrollment Period (GEP) or in the later months of their Initial Enrollment Period (IEP). Beginning in 2023, Medicare coverage will begin the month after enrollment.
- It reduces barriers to care by expanding Medicare’s authority to grant a Special Enrollment Period (SEP) for “exceptional circumstances.” A long-standing flexibility within Medicare Advantage and Part D, in 2023 this critical tool will be available to facilitate enrollments program-wide, enhancing beneficiary access and administrative consistency.
- To further maximize coverage continuity and ease transitions to Medicare, the bill directs the U.S. Department of Health and Human Services (HHS) to identify ways to align Medicare’s annual enrollment periods. HHS is to present these findings in a report to Congress by January 1, 2023.”
According to a summary of the package issued by the Ways & Means Committee minority staff entitled “House Republican Provisions in the 2020 Year-End Legislation”, additional Medicare-related changes include the following (see the summary for a full list):
- “Permitting occupational therapists to conduct the initial assessment visit and complete the comprehensive assessment with respect to certain rehabilitation services for home health agencies under the Medicare program (HR 3127). This section requires the Secretary of HHS, no later than January 1, 2022, to allow occupational therapists to conduct initial assessment visits and complete comprehensive assessments for certain home health services if the referral order by the physician does not include skilled nursing care but includes occupational therapy and physical therapy or speech language pathology.”
- “Continued coverage of certain temporary transitional home infusion therapy services (HR 6218). This section ensures continued coverage of home infusion therapy services for beneficiaries taking self-administered and biological drugs that are currently included under the temporary transitional home infusion therapy benefit when the permanent home infusion therapy benefit takes effect January 1, 2021.”
- “Transitional coverage and retroactive Medicare Part D coverage for certain low-income beneficiaries (HR 3029). This section permanently authorizes, beginning January 1, 2024, the Limited Income Newly Eligible Transition (LI NET) demonstration to provide immediate temporary Part D coverage for certain individuals with low-income subsidies (LIS) while their eligibility is processed.”
- “Improve access to skilled nursing facility (SNF) services for hemophilia patients (HR 5952). This section adds blood clotting factors and items and services related to their furnishing to the categories of high-cost, low-probability services that are excluded from the skilled nursing facility (SNF) per diem prospective payment system (PPS) and are separately payable. This change will allow SNF care to be an option instead of continued inpatient care for this limited population.”
- “Expanding access to mental health services furnished through telehealth (HR 1301). This section expands access to telehealth services in Medicare to allow beneficiaries to receive mental health services via telehealth, including from the beneficiary’s home. To be eligible to receive these services via telehealth, the beneficiary must have been seen in person at least once by the physician or non-physician practitioner during the six months period prior to the first telehealth service, with additional face-to-face requirements determined by the Secretary.”
Also, with respect to provisions addressed in the summary above, the minority staff summary clarifies that funding for State Health Insurance Assistance Programs, Area Agencies on Aging, Aging and Disability Resource Centers, and the National Center for Benefits and Outreach and Enrollment is extended for three years through September 30, 2023 (at $50 million in funding for each of fiscal years 2021, 2022, and 2023).
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A recent Washington Post article highlighted the importance of increased access to health insurance, made possible by the Affordable Care Act (ACA), during the catastrophic COVID-19 pandemic. Citing federal data, the article reports that about 8.2million people signed up for health plans for 2021, with 1.8 million of them new participants.
The high enrollment numbers come despite repeated attacks and sabotage of the ACA by the current administration. The Center for Medicare Advocacy (Center) has been tracking these attacks, which have included shortening the amount of time to enroll in a plan, slashing funding for enrollment assistance and outreach; and removing critical consumer assistance information from healthcare.gov. Additionally, the Trump administration joined in a lawsuit with several states, which could dismantle the entire ACA. The Center strongly opposed the meritless lawsuit, and submitted an amicus brief with AARP and Justice in Aging. The Center released a series of CMA Alerts cataloguing the grievous harms dismantling the ACA would have for Medicare beneficiaries. A decision from the Supreme Court is expected in 2021.
Reports have asserted that the incoming Biden administration may expand access to ACA insurance marketplaces beyond the open enrollment period to aid individuals who have lost their employer-based insurance during the economic crisis tied to the pandemic. Additionally, the incoming administration could restore funding for enrollment assistance and outreach to notify people of new enrollment opportunities.
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1. Medicare Advantage Open Enrollment Period (MA-OEP)
People who began 2021 enrolled in a private Medicare Advantage (MA) plan have an additional opportunity to switch MA plans or dis-enroll from an MA plan and return to traditional Medicare with a Part D plan during the first 3 months of the calendar year. This enrollment opportunity, called the Medicare Advantage Open Enrollment Period (MA-OEP), is not available to individuals who are in traditional Medicare and enrolled in a stand-alone Part D plan.
2. Special Enrollment Period (SEP)
In addition, there are certain rights to use a Special Enrollment Period (SEP) to change or get out of a plan in certain circumstances. There are a number of SEPs, including when someone receives inaccurate or misleading information from the Medicare Plan Finder, customer service representatives at 1-800-MEDICARE, or an MA or Part D plan (or its agents). For a full list of available SEPs, see, e.g., for MA SEPs: Medicare Managed Care Manual, Chapter 2 (2021 update available here) and Title 42, Code of Federal Regulations §422.62(b); for Part D SEPs see Medicare Prescription Drug Manual, Chapter 3 (2021 update available here) and Title 42, Code of Federal Regulations §423.38.
3. Medicare Cost-Sharing for 2021
Part A Monthly Premium (For those not automatically enrolled)
- 0-29 qualifying quarters of employment: $471
- 30-39 quarters: $259
- Deductible, Per Spell of Illness: $1,484
- Co-pay, Days 1 – 60: $0
- Co-pay, Days 61 – 90: $371/day
- Co-pay, Lifetime Reserve Days: $742/day
Skilled Nursing Facility
- Co-pay, Days 1 – 20: $0
- Co-pay, Days 21 – 100: $185.50
Standard Monthly Part B Premium
Part B Deductible
For the Parts B & D Income-Related Premium Amounts, see https://medicareadvocacy.org/medicare-cost-sharing-announced-for-2021/
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