Medicare Advocacy in 2018 Regulatory Changes and Trends Lindsey Copeland Federal Policy Director lcopeland@medicarerights.org
Medicare Rights Center The Medicare Rights Center is a national not-forprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through Counseling and advocacy Educational programs Public policy initiatives Page 2
New and Proposed Rules that Impact People with Medicare Medicare: Loosening restrictions on Medicare Advantage plans Affordable Care Act: Expanding the availability of non- ACA compliant plans Medicaid: Giving states more control over program design and eligibility What trend do these regulatory changes have in common? Page 3
(De)regulatory Trend: MA Plan Flexibility Page 4
Meaningful Difference CMS is eliminating the requirement that MA plans offered by the same organization in the same county comply with unnecessary limits requiring differences among the organization s plans CMS expects that eliminating the meaningful difference requirement will improve the plan options available for beneficiaries. - CMS Fact Sheet on Final C&D Rule, April 2, 2018 Page 5
Plan Uniformity CMS has determined that plans can provide certain enrollees with access to different benefits and services This flexibility helps Medicare Advantage plans better manage health care services. - CMS Fact Sheet on Final 2019 Call Letter, April 2, 2018 Page 6
Supplemental Benefits Previously, CMS has not allowed an item or service to be eligible as a supplemental benefit if the primary purpose includes daily maintenance This expansion will effectively increase the number of allowable supplemental benefit options and provide patients with benefits and services that may improve their quality of life and health outcomes. - CMS Fact Sheet on Final 2019 Call Letter, April 2, 2018 Page 7
What Does This Mean for People with Medicare? Page 8
More Plans = More Choice = Higher Lower Enrollment Probability of Enrollment in Medicare Advantage by Number of Available Plans Page 9
Plan Choice Already Overwhelming Complex Page 10
Few Change Plans, Even When It Would Save them Money Page 11
Adjusted Switching Rate (%) The Exception? High-Need, High- Cost Beneficiaries 25 20 15 10 5 Traditional Medicare Medicare Advantage 0 Did not use nursing home care Used shortterm nursing home care Used longterm nursing home care Page 12
Most People with Medicare Covered by Traditional Medicare Medicare Enrollment Distribution, 2017 Medicare Advantag e 33% Traditional Medicare 67% Source: Kaiser Family Foundation, Traditional Medicare Medicare Advantage Page 13
Medicare Coverage is a Personal, Multi-Factorial Decision Page 14
Traditional Medicare Disadvantaged? Page 15
(De)regulatory Trend: ACA-Compliant Coverage Page 16
Regulatory Repeal & Replace Page 17
Short-Term Plans, Long-Term Damage Page 18
More Skimpy Plans Mean Higher Costs for Seniors Source: AARP Page 19
(De)regulatory Trend: State Medicaid Programs Page 20
Medicare and Medicaid
Medicaid s Role for People with Medicare
Medicaid Spending for Medicare Beneficiaries
A Threat to Medicaid is a Threat to Medicare Medicare beneficiaries who receive Medicaid are poorer than other Medicare beneficiaries, and many have intensive medical and longterm care needs as a result of old age, disability, and chronic illness. Medicare beneficiaries rely on Medicaid to cover expensive but necessary services, especially long-term care in the community and nursing homes, that are generally not available through Medicare or private insurance. They also depend on Medicaid to make Medicare affordable because Medicare s out-of-pocket costs can be high for those with low incomes. Page 24
Advocacy Opportunities Page 25
What Can Advocates Do? Page 26
What Can Advocates Do? Participate in the Regulatory Process Respond to state and federal agency requests for information, submit public comments, meet with policymakers Weigh in with your Lawmakers Through meetings, letters, and other outreach, educate local, state, and federal lawmakers about the issues Engage the Media Submit op-eds and letters to the editor, release press statements, host site visits, amplify your voice on Twitter, Facebook, etc. Activate your Network and Community Generate calls to congressional offices, organize a petition, attend in-state/district events Page 27
What Can Congress Do? Level the Playing Field. Expand services and coverage equally for all Medicare beneficiaries Simplify Medicare Enrollment and Empower Beneficiaries. Pass the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act! (S. 1909; H.R. 2575) Hold CMS Accountable. MA flexibilities must be implemented in a way that prioritizes people with Medicare, and that recognizes the expertise of the Aging and Disability Networks Fund In-person, Unbiased Medicare Counseling. Adequately fund the State Health Insurance Program (SHIPs) in FY19 Reauthorize the Medicaid Money Follows the Person Program. Extend and improve MFP by passing the EMPOWER Care Act (S. 2227, H.R. 5306) Page 28
Stay In Touch! Visit us at www.medicarerights.org Advocate at www.medicarerights.org/protect Call our helpline at 1-800-333-4114 Sign up for Medicare Watch Like us on Facebook Follow @lef_copeland & @medicarerights on Twitter Find me at lcopeland@medicarerights.org or 202-637-0961 Page 29