PUBLISHED SAT, JUL 11 202010:15 AM EDT Sarah O’Brien@SARAHTGOBRIEN
KEY POINTS
·
Some Medicare provisions that were in the House-passed Heroes
Act might make it into the Senate’s version of a stimulus bill, expected in
late July.
·
One advocacy goal is to ensure that certain would-be
beneficiaries can access Medicare right away instead of having to wait for a
specific enrollment window.
·
Other goals include making sure people understand how COBRA
coverage interacts with Medicare, as well as increasing federal funding to
maintain services for the 12.2 million beneficiaries who also are enrolled in
Medicaid.
Changes
to Medicare that advocates have been seeking may end up in the next federal
coronavirus relief legislation, experts say.
The
Republican-controlled Senate is expected to unveil its version of the next
stimulus package in late July as the Covid-19 pandemic continues to slow economic recovery and unemployment remains high.
Senate
Majority Leader Mitch McConnell, R-Kentucky, indicated in public comments
Monday that the theme of the next relief legislation would be “liability
reform, kids in school, jobs and health care.”
While
specifics of the legislation are uncertain, consumer advocates hope to see
provisions that would improve access to Medicare, which provides health care
coverage to about 62.4 million beneficiaries — the majority of whom are age 65
or older and more likely to suffer complications from the coronavirus. The
program also covers younger individuals with disabilities and people with
end-stage renal disease.
“I
suspect there will be some Medicare provisions,” said Tricia Neuman, executive
director of the Medicare policy program at the Kaiser Family Foundation, a
nonprofit group focused on health care research and policy.
The
Democrat-dominated House already passed its version of the next round of
stimulus — called the Heroes Act —
but the Senate is not expected to consider it. Nevertheless, lawmakers in the
upper chamber could use parts of that bill for inclusion in whatever they
propose.
“Even
though the Heroes Act wasn’t bipartisan, some things in it may have a chance
because they are logical and bipartisan asks,” said Lindsey Copeland, federal
policy director for the Medicare Rights Center, an advocacy group.
Here are
the Medicare provisions Copeland says could make it into the next stimulus
package.
New enrollment window
Some
people miss the deadline for enrolling in basic Medicare — Part A
hospital coverage and/or Part B outpatient coverage — even if they are 65,
which otherwise would make them eligible.
Instead,
unless they meet an exception qualifying them for a
special enrollment period, they have to wait until Medicare’s annual
general open enrollment, which is Jan. 1 to March 31, with coverage starting
July 1. That delay could mean life-lasting late-enrollment penalties for not
signing up when they should have, as well as a potential gap in health care
coverage.
“We see
this more often than you’d think,” said Danielle Roberts, co-founder of Boomer
Benefits, a Medicare insurance agency.
It sort of adds insult to injury because you’re finally eligible
for Medicare, but because you missed a deadline, you can’t enroll. Tricia Neuman EXECUTIVE DIRECTOR OF THE
MEDICARE POLICY PROGRAM AT THE KAISER FAMILY FOUNDATION
This
category could include people who missed their initial enrollment period at age
65 without having acceptable health insurance (as deemed by the government) in
place of Medicare but didn’t realize it. Or it could be a person who didn’t
know they were eligible to enroll or were unable to sign up during the
pandemic.
“It sort
of adds insult to injury because you’re finally eligible for Medicare, but
because you missed a deadline, you can’t enroll,” Neuman said.
Copeland
said the hope is that the stimulus bill would establish a special enrollment
period for people who find themselves in that position so they can access
Medicare right away.
Late-enrollment
penalties for Part B are 10% of the standard premium for
each 12-month period you should have been enrolled. For Part D (prescription
drug coverage), the late-enrollment penalty is 1% of the base premium for each
full month you should have had that coverage.
Increased Medicaid funding
Roughly
12.2 million individuals enrolled in Medicare in 2018 were also enrolled in
Medicaid (which supports low-income beneficiaries), according to the Centers
for Medicare & Medicaid Services.
Now, with
job losses continuing and household incomes under pressure, sign-ups in
state-run Medicaid programs are likely to grow. States are hoping to get
additional federal funding to prop up Medicaid in the face of declining state
revenue and budget crunches.
“We
expect to see increased enrollments in Medicaid, and we’d want to stave off any
cuts to services,” Copeland said. “States are having a tough time with their
budgets right now, and Medicaid takes up a big piece of them.”
While
expanding Medicaid is typically a Democrat-supported proposal, Copeland said
that broad agreement at the state level could push the needle.
″“Support
may be more bipartisan than it was in the past,” she said.
Federal legislation
called the Families First Coronavirus Response
Act and signed into law in March, boosted the federal
contribution to Medicaid programs by by 6.2%. The Heroes Act included an
additional bump to 14%.
Meanwhile,
the National Governors Association has called on the federal government to
renew its declaration of a national public health emergency, which is slated to
end July 25. That expiration would end the 6.2% additional Medicaid funding now
in effect. The group also has asked that the rate go to 12%.
COBRA coverage
When
someone loses their job, they typically can keep their employer-sponsored
health coverage for 18 months (or up to three years in certain situations)
under a federal law known as COBRA. However, the ex-employee generally is
responsible for the full premium, and loses out on any company subsidy.
At the
same time, COBRA coverage is not considered acceptable insurance in place of
Medicare for those who are Medicare-eligible. This can cause issues in terms of
potential late fees if the person misses deadlines for signing up for
Medicare after losing their job. And, for complicated
reasons, it can lead to services not being covered and, instead, big
out-of-pocket costs for the patient.
The
Heroes Act called for the federal government to subsidize COBRA payments so
ex-workers could afford the coverage. In the Great Recession, Congress
authorized a 65% subsidy for people in that situation.
If the
Senate does “move forward with subsidizing COBRA premiums, it could push people
into that coverage when it might not be the best fit for them,” Copeland said.
“We’d want beneficiaries to have the information they need to make an informed
decision.”
She said
her group wants to be sure that outreach and education would be part of any
congressional mandate, so that Medicare beneficiaries avoid ending up in a bad
situation.
No comments:
Post a Comment