- You Can Choose Original Medicare: CMS Over-Emphasizes Private Medicare Advantage Plans in Open Enrollment Roll-Out
- CMS Extends Equitable Relief
- CMA Joins 30 Organizations in Amicus Brief in Support of Court Challenge to Trump ACA Sabotage
- And THIS Week in ACA Sabotage…
- Auto-Enrollment… And No Time to Switch
- More Repeal Disguised as Reform
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Social Security Disability Insurance (SSDI) Part 2 – Overview of Benefits for Those Who Qualify, and Best Practices for Applications
November 15, 2017
Official CMS Medicare Open Enrollment materials for 2018 tip the scales to encourage beneficiaries to choose a private Medicare plan over original Medicare coverage. This strategy is actually built into the CMS Office of Communications plan that states three objectives for Medicare Open Enrollment.
The first CMS communications objective is, “[i]nforming people with Medicare that Open Enrollment is the annual opportunity for them to review, compare and enroll in Medicare health and drug plans – with renewed emphasis on MA plans”. The second CMS communications objective is to, “[s]upport a competitive marketplace of privatized health plans by encouraging competition.” The third and final communications objective is to, “’[r]emind people with Medicare of the dates and deadline to review and compare: October 15 – December 7.”
The Key Messages of the CMS Communications Plan for 2018 Open Enrollment do not even address original Medicare. Further, the CMS Open Enrollment webpage makes no mention of original Medicare as a choice during Open Enrollment. https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-help-others/Medicare-Open-Enrollment.html.
While a CMS document, Medicare Open Enrollment: Review, Compare, Enroll, does list original Medicare as a coverage option, the section on Open Enrollment in the document does not include original Medicare as an option. It states, “[f]rom October 15 to December 7 you can join or switch a Medicare Prescription Drug Plan or join or switch a Medicare Advantage Plan.” Also in the same document, and in the Medicare & You 2018 Handbook, a chart comparing original Medicare to private Medicare Advantage provides misleading information to beneficiaries as they evaluate their Medicare choices. For example, addressing coverage for beneficiaries when they travel, the chart states that MA plans “don’t cover care you get outside of the U.S.” The fact is that MA plans typically do not cover any care, other than emergency care, outside of plan networks (which are usually limited to a county or a state) within the United States. Further, rather than noting a beneficiary with original Medicare can see most any provider in the U.S., the chart states, “[o]riginal Medicare generally doesn’t cover care outside the U.S.”
Additional information on the official CMS.gov website (https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-help-others/Open-Enrollment-Outreach-and-Media-Materials.html) includes Open Enrollment materials such as editable flyers, infographics and fact sheets. Here too, materials are geared toward private Medicare plans. All materials invite the reader to compare plans that change every year. The theme is “[o]pen to something better?” and “[o]pen to lower premiums, extra benefits?”, “[o]pen enrollment is here. This is your chance to look at all of your Medicare plan choices like prescription drug plans and Medicare Advantage plans from private insurers.” Again, traditional Medicare is not mentioned.
Original Medicare, which may be the best choice for most beneficiaries, is not being fairly represented by CMS and HHS during Open Enrollment. Beneficiary access to coverage, care, and true choice are in jeopardy as CMS strongly favors private insurers over the original Medicare program that serves so many, so well, and that continues to provide access to most health care providers nationwide.
CMS has extended "equitable relief" for certain Medicare-eligible people who have health coverage through the individual ACA Marketplace and would have faced penalties for not enrolling in Medicare Part B. The original deadline was September 30, 2017. It has been extended by one year and will now run until September 30, 2018.
People who don’t enroll in Part B when they are eligible often don’t realize that they will face late enrollment penalties for life. This can be a very expensive mistake. Equitable relief – enrollment without this penalty – has been offered to individuals enrolled in Medicare Part A and the ACA Marketplace. It has also been offered to beneficiaries enrolled in Part A and the Marketplace but later enrolled in Part B with a penalty. CMS has been offering equitable relief waivers and a Special Enrollment Period for these beneficiaries to sign up for Part B. We applaud CMS for this timely decision and are ready to work with them to make this as seamless as possible for beneficiaries.
Beneficiaries may apply for this relief by contacting their local Social Security Offices. Call Social Security at 1-800-772-1213 (TTY:1-800-325-0778) or go to SSA.gov to find local offices.
More information about equitable relief can be found at:
On October 12, 2017, the Center for Medicare Advocacy joined in an Amicus brief filed in support of plaintiffs in a lawsuit brought by 16 states and the District of Columbia, to challenge the Trump Administration’s decision to abruptly stop Cost-Sharing Reduction (CSR) payments to insurance companies offering plans in the Affordable Care Act’s Marketplace. CSR payments are mandated by law to reimburse insurers for subsidizing low-and middle-income consumers.
Refusal to make the CSR payments will cause individuals and families to face higher health insurance premiums and loss of coverage. It is yet another example of the Administration’s efforts to deliberately undermine and sabotage the Affordable Care Act. The Center was pleased to join in the Amicus brief with nearly 30 other organizations whose mission is to ensure access to quality health care for individuals and families. We thank Families USA and the National Health Law Project for leading this important work.
1. Auto-Enrollment… And No Time to Switch
Open enrollment starts next week but there are new reports that the Administration is up to more mischief-making and sabotage of the Affordable Care Act (ACA). It now appears that the Administration may auto-enroll millions of Americans into plans without conducting sufficient outreach to encourage them to shop around for a better deal. Consumer outreach has been standard practice in past years and is even more critical this year. We’ve already seen that rates have increased, sometimes by double digits. These rate hikes have been caused, at least in part, by the Administration’s refusal to fund the ACA’s Cost Sharing Reductions (CSR’s).
This year, consumers who haven’t chosen a different plan will be auto-enrolled and locked into a plan on December 16th. There will be no time to switch plans because open enrollment ends on December 15th. We urge the Administration to reach out to consumers and inform them about their health care options before they are auto enrolled. Health care decision-making can be complex; people need time to choose a plan that is right for them and their families.
This latest action, or inaction, comes from an Administration that has issued an Executive Order that would allow the sale of junk plans; refused to fund subsidies that help lower-income people afford health coverage; reduced the enrollment period; slashed funding for both advertising and enrollment assistance, refused to participate in enrollment events; and plans significant shut-downs of healthcare.gov during open enrollment. This is what Trumpcare is coming to mean.
We call on the Administration once again to stop the sabotage and protect the care of millions of Americans who need quality health coverage and care.
2. More Repeal Disguised as Reform
While a select minority of Representatives and Senators block the widely-supported Alexander-Murray bipartisan ACA stabilization proposal, partisan efforts to repeal the Affordable Care Act continue to rear their heads. Yesterday, House Ways and Means Committee Chairman Kevin Brady (R-Texas) and Senate Finance Committee Chairman Orrin Hatch (R-Utah) announced a proposal that would suspend the ACA’s individual and employer mandates through 2021, as well as make other harmful changes. This proposal, and the Administration’s proposed changes, would take coverage away from millions, sharply raise premiums, seriously destabilize the insurance market, and lead insurers to withdraw from the marketplaces – the exact opposite of what the Alexander-Murray bipartisan stabilization bill would achieve.
Policymakers of both parties should reject these harmful proposals, support the Alexander-Murray proposal, and demand that House and Senate leadership allow a vote on that legislation in its current form.