- Medicare Plan Finder Problems Emerge – At Least Three SHIP Programs Cautioning People to Delay Enrollment until Problems Resolved
- Dismantling the Affordable Care Act Would Harm Medicare and Medicare Beneficiaries: Spotlight on Closing the Part D Coverage Gap (“Donut Hole”)
- Long-Term Care Policy: Trump vs. Biden
The Medicare Annual Election Period (AEP), which lasts from October 15 until December 7, is a time during which Medicare beneficiaries can make changes to their Medicare Advantage and/or Part D prescription drug coverage for the following calendar year. The primary tool used to compare coverage options is the Medicare Plan Finder (MPF), which is produced by the Centers for Medicare & Medicaid Services (CMS) and available at www.medicare.gov.
Regrettably, with the AEP now in full swing, people assisting Medicare beneficiaries who are trying to navigate the MPF are reporting many unwelcomed issues with the MPF tool. Due to these emerging problems, this year at least one State Health Insurance Assistance Program (SHIP), Connecticut’s CHOICES program, is recommending that beneficiaries wait until the MPF issues are resolved and the information is complete before enrolling in Part D plans. It has been reported to the Center that New Hampshire and Massachusetts have also paused enrollments.
Current Plan Finder Problems
A message from the CHOICES program directed to Medicare beneficiaries receiving assistance from them states: “As of 10/19/20, we have been notified by the Centers for Medicare and Medicaid Services (CMS) and the Administration for Community Living (ACL) that there is incomplete information in the Medicare Plan Finder tool on Medicare.gov. We understand that CMS, as well as companies that offer these plans, are working to fix these issues.”
The message to beneficiaries continues: “Specifically:
- Not all plans are displaying full drug costs, including plans offered by Cigna-Healthspring and Express Scripts.
- Not all plans are displaying accurate pharmacy network information
- Beneficiaries entitled to Extra Help/LIS may not be able to view accurate cost-sharing.
Please understand that if you enroll in a plan at this time:
- We cannot guarantee that this plan is the lowest cost option for you.
- We cannot guarantee that you will be able to change plans due to incorrect cost information in the Medicare Plan Finder. However, in the past, beneficiaries who have enrolled in the wrong plan due to inaccurate information on the Plan Finder have been granted a Special Enrollment Period (SEP) to enroll in a new plan after Jan 1.”
In addition to the issues identified above, the MPF is showing “N/A” with respect to pricing for some plans. According to a message sent to SHIP programs by ACL, “If you see “N/A” on a plan card in the Medicare Plan Finder instead of pricing information it means that the plan has an error with their drug pricing data and Medicare has temporarily removed the information. This is not a problem with the Plan Finder but is an issue with the data that the plan sent over to CMS.” ACL also stated that the data problems concerning Cigna-Healthspring and Express Scripts is expected on 10/26.
MPF Problems During Last Year’s AEP
As described in of the several Center’s previous CMA Alerts, there were numerous problems with the Plan Finder during the last Annual Enrollment Period. A new, updated Plan Finder released in late August 2019 presented challenges prior to the AEP, and a number of functional problems arose during the enrollment period. These problems included: inaccurate information about covered drugs and costs, non-formulary drugs, dosage options, copays for individuals with the Part D Low Income Subsidy (LIS), problems creating a MyMedicare account and the listing of plan choices by premium rather than total cost. At the time, CMS leadership both downplayed the scope of problems identified, and did not adequately promote a Special Enrollment Period (SEP) available to beneficiaries who relied on inaccurate information in making their plan choices.
Conclusion
While CMS has made some improvements to the Plan Finder since last fall, it cannot repeat the failure to both adequately inform the public about the tool’s problems and promote avenues to address harm caused by Plan Finder errors. Further, given that the ongoing COVID-19 pandemic minimizes the availability of in-person counseling and assistance, and the fact that Plan Finder problems are preventing people from currently obtaining information they need in order to make informed choices, we urge CMS to extend the Annual Election Period past the December 7 end date.
While individuals enrolled in Medicare Advantage (MA) plans as of the first of the year have an additional opportunity to make plan changes from January to March during the Medicare Advantage Open Enrollment Period (MA-OEP), people with stand-alone Part D prescription drug plans do not have such an opportunity. CMS has provided numerous flexibilities to plans and providers during the ongoing public health emergency. It should employ the same approach to beneficiaries who are relying on information from the Medicare program that is flawed.
– top –
The Supreme Court will review the constitutionality of the Affordable Care Act (ACA) this term in California v. Texas, with oral argument scheduled for November 10, 2020. This ongoing litigation challenges the ACA’s individual mandate, but raises questions about the entire law’s survival, and could result in dismantling the entire ACA.
While the ACA’s changes to the individual insurance market and its expansion of Medicaid have been the focus of much media coverage, the law has affected every part of the health care system, including Medicare. The ACA is woven into Medicare, with over 165 provisions affecting the program. Many of these provisions help beneficiaries and strengthen Medicare’s financial well-being. Striking down the ACA would have disastrous ramifications for Medicare beneficiaries and the U.S. health care system as a whole. In a series of CMA Alerts leading up to the Supreme Court oral argument, the Center will highlight some of the harms undoing the ACA would bring to Medicare and Medicare beneficiaries.
Before the ACA, prescription drug coverage (Medicare Part D) required enrollees to pay the full cost of their drugs in the benefit’s coverage gap, commonly known as the “doughnut hole.” The doughnut hole was essentially a very large deductible that kicked in every year after beneficiaries’ drug costs exceeded an initial coverage limit. After reaching the initial coverage limit, enrollees who did not receive low-income subsidies had to pay 100% of their prescription drug costs until they spent enough to qualify for catastrophic coverage. Many Medicare beneficiaries struggled to afford their medications while they were in the doughnut hole. As a result, many reduced their medications (by splitting pills or skipping doses, for example), or stopped taking their medications altogether, impacting quality of life and health outcomes.
The ACA included a provision to phase out the coverage gap for both brand-name and generic drugs by 2020; the Bipartisan Budget Act of 2018 made additional changes to the coverage gap, closing the Part D coverage gap for brand-name drugs in 2019 instead of 2020. Closing the doughnut hole eased the medication affordability crisis for beneficiaries, with billions of dollars of savings in drug costs.
Undoing the ACA would jeopardize drug coverage for millions of Medicare beneficiaries. Reinstating the coverage gap would increase costs for Part D enrollees who have relatively high drug spending. Closing the “doughnut hole” was very popular with the public; according to Kaiser Family Foundation, in 2018, 81% of the public (79% of seniors) had a favorable view that “the [ACA] gradually closes the Medicare prescription drug ‘doughnut hole’ or ‘coverage gap’ so people on Medicare will no longer be required to pay the full cost of their medications when they reach the gap.”
The Center for Medicare Advocacy strongly opposes dismantling the ACA and the lawsuit that seeks to do so on unmerited grounds. The Center joined AARP and Justice in Aging in submitting an amicus brief in support of California and the other states defending the ACA against the lawsuit now at the Supreme Court. The brief highlights the ACA’s key protections for older adults and the devastating consequences that would ensue if the law is nullified.
Additional Resources:
- Kaiser Family Foundation, “Potential Impact of California v. Texas Decision on Key Provisions of the Affordable Care Act” (updated September 2020): https://www.kff.org/health-reform/issue-brief/potential-impact-of-california-v-texas-decision-on-key-provisions-of-the-affordable-care-act/#medicare
- Kaiser Family Foundation, “The Medicare Part D Coverage Gap: Costs and Consequences in 2007” (August 2008): https://www.kff.org/wp-content/uploads/2013/01/7811.pdf
- CMS Report, The Affordable Care Act: A Stronger Medicare Program (February 2013): http://www.cms.gov/apps/files/MedicareReport2012.pdf.
- Dena Bunis, Medicare “Doughnut Hole” Will Close in 2019, AARP (February 2018), https://www.aarp.org/health/medicareinsurance/info-2018/part-d-donut-holecloses-fd.html
- Center statement concerning the fate of the ACA in light of Supreme Court nomination hearings (October 2020): https://medicareadvocacy.org/supreme-court-nomination-could-have-devastating-consequences-for-the-affordable-care-act-and-medicare/
– top –
Long-Term Care Policy: Trump vs. Biden
For the Biden campaign, the Center looks at the Democratic Party’s 2020 platform,[1] the official campaign website,[2] and a position paper on long-term care issued by the campaign.[3] Identifying the Trump campaign’s position is more difficult,[4] since the Republican Party did not release a new platform in 2020,[5] the official campaign website does not include policy positions,[6] and the campaign’s six-page Second Term Agenda, “Fighting for You!,”[7] does not address long-term care. Therefore, the comparison below describes relevant policies implemented or proposed by the Trump Administration, before and during the coronavirus pandemic, as a guide to possible or likely actions on long-term care issues during a second term.
Issue | Trump Admin. (Pre-Pandemic) | Trump Admin. (During Pandemic) | Biden[8] |
Nursing home standards, before and during pandemic | Proposed revisions (July 2019) to some Requirements of Participation (2016), including rules for antipsychotic drugs, duties of facility’s grievance official, enhanced credentials for dieticians, frequency of facility-wide assessment[9] | Waiver of resident protections, including transfer/discharge; banning of all visitors (March 2020)[10] | Ensure effective point-of-care testing; ensure optimal PPE; ensure adequate staffing and training; enhance protections against inappropriate discharges Democratic Party platform: improve quality standards |
Staffing | Waiver of 75 hour nurse aide training requirement (March 2020)[11] | Ensure adequate staffing and training, citing recent study showing the correlation of high staffing with fewer COVID cases[12] Ensure staff have a choice to organize a union and collectively bargain; “give them pay, paid leave, career ladders, and other benefits they deserve.” Democratic Party platform: “improve nursing home staffing” | |
Infection prevention | Proposed rule reducing required on-site time for infection preventionists (July 2019)[13] | Require infectious disease expert in every nursing facility | |
Arbitration agreements | Promulgated final rule allowing pre-dispute arbitration agreements.[14] | Reinstate Obama-Biden ban on forced arbitration agreements | |
Surveying | Podcast (July 2019), CMS administrator describes President’s budget as asking Congress for risk-based survey model, i.e., less than annual surveyors, in order to focus on low performing nursing facilities[15] Proposed rule (July 2019) to add requirements for informal dispute resolution and to create “constructive waiver process” (i.e., give facilities automatic 35% reduction in civil money penalty if they do not appeal)[16] | Suspend standard surveys (Mar. – Jun. 2020); conduct only focused infection control surveys or immediate jeopardy surveys[17] | “Increase the frequency and scope of surveys and data collection” |
Enforcement | Multiple changes to surveyor guidance on enforcement, including: making per instance civil money penalties the default, rather than per day CMPs,[18] revising mandatory immediate imposition of remedies,[19] revisions to immediate jeopardy[20] | Suspend all enforcement, except for immediate jeopardy (March – June 2020)[21] | “Enhance oversight by CMS” “Restore levels of penalties needed to obtain compliance with quality standards” |
Limitations on provider liability | “Reject limitations on liability that make it impossible to ensure individuals harmed or killed due to nursing home negligence can hold providers accountable by pursuing legal remedies” |
___________________
[1] “2020 Democratic Party Platform,” https://www.demconvention.com/wp-content/uploads/2020/08/2020-07-31-Democratic-Party-Platform-For-Distribution.pdf.
[2] https://joebiden.com/.
[3] “Biden-Harris Plan to Make Nursing Homes and Long-term Care Facilities Safe,” https://joebiden.com/wp-content/uploads/2020/10/Nursing-Home-Policy.pdf.
[4] Chris Farrell, “2020 Election: Trump’s Second-Term Proposals For People 50+,” Forbes (Aug. 27, 2020), https://www.forbes.com/sites/nextavenue/2020/08/27/2020-election-trumps-second-term-proposals-for-people-50/#39fd37b1277a.
[5] Republican National Committee, “Resolution Regarding the Republican Party Platform,” https://prod-cdn-static.gop.com/docs/Resolution_Platform_2020.pdf.
[6] https://secure.winred.com/djt/2020-standing-with-president-trump/?utm_medium=ad&utm_source=dp_googlesearch&utm_campaign=20200427_
na_trumpgenerickws_djt_djtfund_ocpmypur_bh_audience0726_na_na_us_b_18-99_gsn_all_na_lp0424_fund_conversion_search_na_na_na&utm_content=fun&gclid=
CjwKCAjwiaX8BRBZEiwAQQxGx57ye8pLhVRykZv3I-lbfs86z3roVXR_5Ba4XcBwtuYAgoJ4uqnGqRoCzk8QAvD_BwE.
[7] Trump Campaign Announces President Trump’s 2nd Term Agenda: Fighting for You!, https://www.donaldjtrump.com/media/trump-campaign-announces-president-trumps-2nd-term-agenda-fighting-for-you/.
[8] Except as otherwise noted, positions are taken from “Biden-Harris Plan to Make Nursing Homes and Long-term Care Facilities Safe,” https://joebiden.com/wp-content/uploads/2020/10/Nursing-Home-Policy.pdf.
[9] Fed. Reg. (Jul. 2019).
[10] CMS, “Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities): CMS Flexibilities to Fight COVID-19” (Mar. 28, 2020), https://www.cms.gov/files/document/covid-long-term-care-facilities.pdf.
[11] Id.
[12] Jose F. Figueroa, et al, “Association of Nursing Home Ratings on Health Inspections, Quality of Care, and Nurse Staffing With COVID-19 Cases,” JAMA. 2020;324(aa):1103-1105, https://jamanetwork.com/journals/jama/fullarticle/2769437.
[13] CMS, “Medicare and Medicaid Programs: Requirements for Long-Term Care Facilities: Regulatory Provisions To Promote Efficiency, and Transparency,” CMS-3347-P. 84 Fed. Reg. 34737, 34746 (Jul. 18, 2019), https://www.govinfo.gov/content/pkg/FR-2019-07-18/pdf/2019-14946.pdf.
[14] CMS, “Medicare and Medicaid Programs; Revision of Requirements for Long term Care Facilities: Arbitration Agreements,” 84 Fed Reg. 34718 (Jul. 18, 2019), https://www.govinfo.gov/content/pkg/FR-2019-07-18/pdf/2019-14945.pdf.
[15] CMS, Episode 5: Nursing Home Strategy Part 1 – Strengthening Oversight (Jul. 31, 2019), https://www.cms.gov/podcast/episode-5-nursing-home-strategy-part-1-strengthening-oversight.
[16] CMS, “Medicare and Medicaid Programs: Requirements for Long-Term Care Facilities: Regulatory Provisions To Promote Efficiency, and Transparency,” CMS-3347-P. 84 Fed. Reg. 34737 (Jul. 18, 2019), https://www.govinfo.gov/content/pkg/FR-2019-07-18/pdf/2019-14946.pdf.
[17] CMS, “Prioritization of Survey Activities,” QSO-20-20-All (Mar. 20, 2020) https://www.cms.gov/files/document/qso-20-20-all.pdf; CMS, “Suspension of Survey Activities,” QSO-20-12-All (Mar. 4, 2020), https://www.cms.gov/files/document/qso-20-12-allpdf.pdf-1.
[18] CMS, “Revision of Civil Money Penalty (CMP) Policies and CMP Analytic Tool,” S&C: 17-37-NH (Jul. 7, 2017), https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-37.pdf.
[19] CMS, “Mandatory Immediate Imposition of Federal Remedies and Assessment Factors Used to Determine the Seriousness of Deficiencies for Nursing Homes,” SUC: 16-31-NH (Jul. 22, 2016, rev. 7.29.16), https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-16-31.pdf.
[20] CMS, “Revisions to Appendix Q, Guidance on Immediate Jeopardy,” QSO-19-09-ALL (Mar. 5, 2019), https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO19-09-ALL.pdf.
[21] CMS, “Prioritization of Survey Activities,” QSO-20-20-All (Mar. 20, 2020) https://www.cms.gov/files/document/qso-20-20-all.pdf; CMS, “Suspension of Survey Activities,” QSO-20-12-All (Mar. 4, 2020), https://www.cms.gov/files/document/qso-20-12-allpdf.pdf-1.