Medicare Platform: Core Considerations for Today & Tomorrow

The Center for Medicare Advocacy works for a comprehensive Medicare program and quality health coverage and care for all people. To accomplish these goals for current and future beneficiaries in the changing health care environment, we seek to:

• Improve Medicare for current and future beneficiaries.
• Support the development of the best method possible to increase access to quality health coverage and care for the most people.

Medicare Platform to Improve Medicare for all beneficiaries, now and in the future:
1. Consumer Protections and Quality Coverage for All Medicare Beneficiaries (Including Parity Between Traditional Medicare and Medicare Advantage)

• Cap out-of-pocket costs in traditional Medicare
• Require Medigap plans to be available to all individuals in traditional Medicare, regardless of pre-existing conditions and age (“Guarantee Issue” and “Community Rating”)
• Ensure all benefits in Medicare Advantage are also available in traditional Medicare
• For example, include all MA “supplemental benefits,” waiver of 3-day prior hospital stay requirement for SNF coverage, coverage for home health aides, coordinated care
• Simplify enrollment in traditional Medicare, Part D and Medigap, and ease transitions from other insurances to Medicare
• Improve consumer protections in Medicare Advantage
• Standardize benefit packages,
• Strengthen network adequacy requirements
• Strengthen plan oversight
• Strengthen marketing protections
• Ensure parity between mental health and physical health coverage
• Ensure the Medicare appeals system is cost-effective, accessible and fair

2. Reduce Ongoing Barriers to Care

• Eliminate the harm of hospital “Observation Status”
• Home Health – Ensure access to coverage is actually available for all beneficiaries who meet coverage criteria, ensure access to legally authorized home health aides, resolve conflicts between payment models and coverage laws
• Jimmo Implementation – Ensure beneficiaries with longer-term, chronic, and/or debilitating conditions have full access to skilled nursing, therapy and related care needed to maintain their conditions or slow decline

3. Improve Traditional Medicare

• Add oral health, audiology, vision coverage
• Restructure Medicare to make it comprehensive, simpler and affordable
• Increase Low-Income Protections in the Medicare Savings Program (at least on par with ACA subsidies)

Long-term Care – Add coverage over time. For now, make incremental improvements (For example, repeal homebound requirement for home health coverage, repeal requirement that individual need skilled care and be homebound to qualify for home health aide coverage, repeal requirement that DME generally be needed in the home)