Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

CMA Alert – October 24, 2019

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  1. Medicare Enrollment and Medicare Advantage Updates
  2. CMS Administrator Seema Verma Testifies on Health Care Sabotage Before House Subcommittee
  3. Center Attorneys Participate in Oral Health Convening and Advocacy Day
  4. Nursing Home Compare’s Abuse Icon is Now Live
  5. Center for Medicare Advocacy Submits Comments Supporting Modification to ABN Instructions
  6. FREE WEBINAR: Register now for Coordination of Benefits – What Pays When? 

Medicare Enrollment and Medicare Advantage Updates

On October 22, the Center for Medicare Advocacy and the National Committee to Preserve Social Security and Medicare launched the second annual Medicare Fully Informed Project, with a variety of unbiased, accurate, up-to-date, and comprehensive information about the full range of Medicare coverage options. The Medicare Fully Informed Project includes an array of tools to guide Medicare beneficiaries, and those who assist them enroll and re-enroll in Medicare, in making the best individual enrollment choices.

Among these materials are a new Advocates’ Guide to MA Supplemental Benefits, focusing on Special Supplemental Benefits for the Chronically Ill (SSBCI), available for the first time in 2020. The Guide discusses eligibility, marketing and appeals relating to SSBCI, and highlights opportunities to change plans outside of the current enrollment period. The materials also include a one-page Consumer Guide that provides advice concerning how to assess SSBCI, including highlighting that such benefits will not be available to all plan enrollees.

Other Medicare Advantage Updates

  • Center Executive Director Judy Stein co-authored an op-ed with Congresswoman Rosa DeLauro, published in the New Haven Register and the Connecticut Post entitled “Medicare Advantage May Not Cover Your Doctor” which highlights Anthem’s recent termination of many doctors from one of its Connecticut plans.
  • CMS Mailing to Enrollees in Consistently Low Performing Plans – In a memo dated October 22, 2019, the Centers for Medicare & Medicaid Services (CMS) announced that in late October it “will again be issuing notices to individuals enrolled in plans with less than three stars for three consecutive years. The notice will alert beneficiaries to the sponsor or organization’s low rating and encourage them to review higher rated plan options during this annual election period (AEP). The notice also informs enrollees of an opportunity to contact CMS to request a special enrollment period (SEP) to move into a higher quality plan in 2020.”
  • The National Association of Insurance Commissioners (NAIC) expresses concerns about the Medicare Plan Finder – In a letter dated October 16, 2019, NAIC wrote to CMS Administrator Seema Verma to “support the concerns expressed by state regulators, consumer advocacy groups and industry representatives regarding the new Medicare Plan Finder.” NAIC noted that “examples of concerns, errors and omissions” include: “The cost comparison between Medicare Advantage (MA) and Medicare with a Medigap plan does not capture out of pocket costs – only premiums. This gives the false sense that Medigap is much more expensive overall than an MA plan.” and “The total yearly estimated cost for Original Medicare and a Medigap Plan (particularly Plan F) is unreasonably high.”
  • Kaiser Family Foundation releases report on Medicare Advantage in 2020 – https://www.kff.org/medicare/issue-brief/medicare-advantage-2020-spotlight-first-look/

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CMS Administrator Seema Verma Testifies on Health Care Sabotage Before House Subcommittee

Over the last several years, the Center for Medicare Advocacy (the Center) has written at length about the Trump Administration’s detrimental changes to the Affordable Care Act (ACA), Medicare, Medicaid, and other vital health care programs. On October 23, 2019, the House Committee on Energy & Commerce, Subcommittee on Oversight and Investigations, held a hearing to address the Administration’s health care sabotage. Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma was the sole witness before the Subcommittee.

In her written testimony, Administrator Verma defended the Administration’s health care efforts and touted those efforts as “putting patients first.” Administrator Verma argued that the Administration has lowered costs and improved access for patients, despite – among many other things – approving Medicaid work requirement waivers that have resulted in thousands losing coverage. Subcommittee Members questioned Administrator Verma about the Administration’s commitment to patients, given the Administration’s efforts to invalidate the ACA in Texas v. U.S. and promote junk plans. Administrator Verma indicated that the Administration is prepared to protect patient access to health care if the ACA is struck down, but failed to provide any details on how it would do so.

As noted in our jointly filed Amicus Curiae Brief in Texas v. U.S., invalidating the ACA will also negatively affect the financial health and efficiency of the Medicare and Medicaid programs, and most families. The ACA contains about 165 provisions that affect Medicare, touching on issues including preventive benefits, prescription drug costs and reimbursement for nursing home care. The Center asked the Fifth Circuit Court of Appeals to reverse the lower court’s decision and uphold the ACA.

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Center Attorneys Participate in Oral Health Convening and Advocacy Day

As part of the Center for Medicare Advocacy’s continued commitment to improving oral health for older adults and people with disabilities, and expanding Part B to include a comprehensive oral health benefit, Center attorneys are participating in oral health partnership meetings this week. The OPEN (Oral Health Progress & Equity Network, a national network of individuals and organizations that believe oral health is essential to overall health and wellbeing) convening is being held in Baltimore, MD. This event brings together groups focused on oral health equity, access, and coverage. Center attorneys are also participating in the OPEN Advocacy Day, in which groups will gather on the Hill for meetings to call for expanded oral health coverage, including adding a comprehensive oral health benefit in Part B of Medicare.

The Center joins our colleagues in supporting legislation that expands oral health coverage in Medicare. H.R. 4650, the “Medicare Dental Act of 2019.” This bill would be an important step toward providing comprehensive oral health coverage for all Medicare beneficiaries. It is critical to include such coverage in Part B, as this bill would do. We hope that the bill will continue to improve as it goes through the process, as outlined in the Center’s October 16, 2019 letter to the Energy & Commerce Committee.

The Center thanks the DentaQuest Partnership for its support of this work and its ongoing commitment to adding a comprehensive oral health benefit to Medicare.

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Nursing Home Compare’s Abuse Icon is Now Live

On October 23, 2019, the Centers for Medicare & Medicaid Services (CMS) began use of a new “abuse icon” on Nursing Home Compare. Consumers using the website will now be alerted when a nursing home has been cited for an abuse violation in the past year or over each of the past two years, depending on the level of harm. CMS is advising consumers who come across this new icon to “ask the administrator or other staff about what they’re doing to keep residents safe from abuse, neglect, mistreatment, or exploitation.”

While the Center for Medicare Advocacy and the Long Term Care Community Coalition thank CMS for helping consumers identify nursing homes with a history of abuse, our organizations remind consumers that the absence of an abuse icon on Nursing Home Compare does not necessarily indicate the absence of abuse. Federal reports over the last few decades have documented that state survey agencies (health inspectors) have missed problems and failed to cite violations. Moreover, violations indicating the existence of abuse or potential abuse may be cited under other federal tags, resulting in their exclusion from this initiative.

We urge nursing home consumers to continue using all the resources available when choosing a nursing home for themselves or a loved one.

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Center for Medicare Advocacy Submits Comments Supporting Modification to ABN Instructions

On October 21, 2019, The Center for Medicare Advocacy submitted comments in support of a Centers for Medicare & Medicaid Services (CMS) proposal to modify the instructions to the Advance Beneficiary Notice of Noncoverage (ABN).

The change would make it clear that providers may not bill dually eligible beneficiaries before their claim has gone through both Medicare and Medicaid. The Center strongly supports this modification, as the current language can cause confusion for dually eligible beneficiaries.

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FREE WEBINAR: Register Now for Coordination of Benefits – What Pays When?

Wednesday, November 6, 2019 3:00 PM – 4:00 PM EST

Part of our 2019-2020 webinar series, this webinar will explore issues relating to Medicare beneficiaries with coverage from other sources of insurance, including Medicaid, as well as other services for low income beneficiaries.

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