Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

CMA Alert – March 12, 2020

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  1. Reminder: Medicare Advantage Enrollment Period Ends this Month; Ongoing Opportunity for Special Enrollment Period
  2. COVID-19 May Impact Medicare Coverage
  3. CMS Publishes Final Rule on Data Exchange
  4. Register Now – Upcoming CMA Events

Reminder: Medicare Advantage Enrollment Period Ends this Month; Ongoing Opportunity for Special Enrollment Period

Medicare Advantage Open Enrollment Period (MA-OEP)

Effective 2019, for the first 3 months of the calendar year there is a continuous open enrollment and disenrollment period relating to Medicare Advantage (MA) plans called the Medicare Advantage Open Enrollment Period, or MA-OEP. This opportunity is only available to individuals who are enrolled in an MA plan as of the first of the year. During this 3-month period an individual enrolled in an MA plan as of January 1st can make a one-time change to another MA plan, or they can elect traditional Medicare, including the option to pick up coverage under Part D.  Note that there is not a corresponding right for people in stand-alone Part D prescription drug plans (PDPs) to make changes during this time period.

Special Enrollment Periods (SEPs)

As discussed in previous Alerts, many people experienced problems with the revamped Medicare Plan Finder during last year’s annual enrollment period. While CMS continues to downplay such problems, affected individuals may have a right to a Special Enrollment Period (SEP) for special circumstances. As noted on Medicare.gov website here:

Note: If you believe you made the wrong plan choice because of inaccurate or misleading information, including using Plan Finder, call 1-800-MEDICARE and explain your situation. Call center representatives can help you throughout the year with options for making changes.

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COVID-19 May Impact Medicare Coverage

Coronavirus legislation signed by the President on March 5, 2020, would allow Medicare to expand the use of telemedicine in outbreak areas, potentially reducing infection risks. The Centers for Disease Control (CDC) has encouraged people who feel sick to first talk to doctors remotely to avoid filling waiting rooms.

The bill gives the Health and Human Services (HHS) Secretary the power to suspend rules that restrict access to remote care, or telehealth. Medicare coverage of telemedicine is currently limited mainly to residents of rural areas for treatments by specialists. The bill would allow waiver of restrictions for all beneficiaries in traditional Medicare.

While telemedicine cannot take the place of a sample for scientific testing, it can help doctors to screen patients. Telemedicine would also offer a way for Medicare beneficiaries in outbreak areas to take care of ongoing medical issues without having to expose themselves to someone who is sick.

The legislation requires a doctor to have an established, ongoing relationship with the patient (the patient would have to have seen a doctor at that facility for another reason at some point in the past three years) and communication must take place through a two-way interactive video and voice link.

Medicare Coverage and Payment Related to COVID-19 Fact-Sheet:

Articles addressing the legislation:

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CMS Publishes Final Rule on Data Exchange

This week, the Centers for Medicare & Medicaid Services (CMS) issued the Interoperability and Patient Access final rule. The final rule requires daily state-CMS exchange of data to identify who is enrolled in Medicare, and which party is liable for paying each beneficiary’s Parts A and B premiums. The final rule also requires daily state submission of files that identify whether a beneficiary is dually eligible for Medicaid and Medicare. Currently, states and CMS exchange these data as infrequently as weekly or monthly in 35 states. Both of these provisions require daily exchange by April 1, 2022.

The Center submitted comments to the proposed rule in June 2019 calling for the daily exchange of data. The Center applauds CMS for making this change; less frequent exchanges of data can lead to increased costs for beneficiaries if the state is not able to activate or terminate coverage in a timely manner. Daily submissions, and the ability for states to receive daily response files from CMS, spread state staff workload more evenly across the month, permit errors to be corrected more quickly, and connect new beneficiaries more quickly to benefits.

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Register Now – Upcoming CMA Events

Update on the 7th Annual National Voices of Medicare Summit and Senator Jay Rockefeller Lecture

Whither Medicare – From Promise to Privatization

April 30, 2020, 8:30 AM – 3:30 PM
Kaiser Family Foundation,
1330 G St NW, Washington, DC 20005

Single Seat Registration: $250

Note: We continue to monitor the impact of COVID-19. The situation is fluid, but
as of this time, there will be a program offered in some form on April 30, 2020 –
either in person, should circumstances permit, or online.

This event supports the Center’s work, so please, register now!

Against the increasing privatization of Medicare, voter focus on health care, and the ongoing talk about a Medicare for All, the 2020 Summit will focus on the promise, challenges to, and future of Medicare.

The Center for Medicare Advocacy’s 7th annual National Voices of Medicare Summit & Senator Jay Rockefeller Lecture will connect leading experts and advocates to discuss best practices, challenges and successes in efforts to improve access to quality health coverage and care. Against the increasing privatization of Medicare, voter focus on health care, and the ongoing talk about a Medicare for All, the 2020 Summit will focus on the promise, challenges to, and future of Medicare.

  • What was the original vision and promise of Medicare?
  • Is Medicare as a social insurance program a thing of the past?
  • Will Medicare be allowed to “wither on the vine,” as Newt Gingrich suggested?
  • Should Medicare be the model for universal coverage?
  • How can Medicare be improved for all people who qualify now, and may qualify in the future?

The Center for Medicare Advocacy is honored to welcome Wendell Potter as this year’s Sen. Jay Rockefeller Lecturer. 

Other confirmed speakers include: former Sen. Jay Rockefeller; former Sen. Chris Dodd; Ted Kennedy, Jr., Chair of the American Association of People with Disabilities; Tricia Neuman, Kaiser Family Foundation Senior Vice President; Clare Durrett, Associate Executive Director of Team Gleason; Judith Feder, Georgetown University professor of public policy and former dean of what is now Georgetown’s McCourt School of Public Policy; Peter Thomas, Principal, Powers, Pyles, Sutter & Verville, P.C; and health care journalists Susan Jaffe, Trudy Lieberman, and Mark Miller.

Register Today at: https://www.medicareadvocacy.org/summit/

Free Webinar: New Medicare Payment Systems – Obstacles to Accessing Covered Care

Thursday, March 26, 2020 1:00 PM – 2:00 PM EST

Presented in collaboration with California Health Advocates Senior Medicare Patrol by Center for Medicare Advocacy Associate Director, attorney Kathleen Holt and Center Senior Policy Attorney Toby S. Edelman, this webinar will:

  • Provide a brief overview of Medicare SNF and HHA Medicare coverage.
  • Examine new Medicare payment systems for SNF (Patient Driven Payment Model or PDPM) and for HHA (Patient Driven Groupings Model or PDGM).
  • Discuss the impact of PDPM and PDGM on access to Medicare covered services since implementation.
  • Review practice tips and tools to access Medicare covered services.

Register at https://register.gotowebinar.com/register/7158215826365982732

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