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30 Policy Goals for Medicare’s Future

Our policy goals are informed by more than 30 years of serving people with Medicare on our national helpline and through our educational programs. Thinking ahead to the next 30 years, it’s critically important to broadly modernize benefits in both Original Medicare and private Medicare plans. At the same time, it’s essential to pursue changes that improve how 60+ million people with Medicare navigate their coverage on a daily basis. In no particular order, here are our evolving 30 policy goals for Medicare’s future.

1

Make Prescription Drugs More Affordable

Access and Affordability
Medicare Rights supports efforts to meaningfully reduce drug prices and lower costs for both people with Medicare and the program as a whole. Potentially effective strategies include allowing Medicare to negotiate drug prices, increasing pricing transparency and accountability throughout the supply chain, and imposing limits on beneficiary out-of-pocket spending. Changes to the current system must be carefully considered and only adopted if they do not threaten to undermine beneficiary protections or access to medications, such as by weakening the protected classes or introducing additional, inappropriate utilization management strategies.

Make Prescription Drugs More Affordable

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2

Allow Open Enrollment, Guaranteed Issue, and Community Rating in Medigap for All People with Medicare

Access and Affordability
Though Medigaps help a growing number of people with Original Medicare afford needed care, not everyone is eligible to buy the plans, and most are only guaranteed the right to do so during very limited time frames. Congress must ensure that all beneficiaries have access to affordable, high-quality Medigap policies as well as the opportunity to re-evaluate their coverage choices as their needs change. This includes extending the same federal Medigap protections to beneficiaries under 65 as those provided to beneficiaries over 65 and providing for open enrollment, guaranteed issue, and community rating of Medigap for all people with Medicare.

Allow Open Enrollment, Guaranteed Issue, and Community Rating in Medigap for All People with Medicare

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3

Add a Standard Medicare Out-Of-Pocket Maximum for Beneficiary Cost Sharing

Access and Affordability
Original Medicare and Part D have no out-of-pocket maximums, exposing beneficiaries to limitless financial risk. While Medicare Advantage (MA) plans do include an out-of-pocket maximum in their benefit packages, this threshold is too high—permitting costs up to $6,700 in 2019. Congress should establish a standardized, affordable, out-of-pocket maximum for Original Medicare, MA, and Part D. To both lower costs for beneficiaries and the system, this change must be coupled with efforts address the underlying problem of high drug prices.

Add a Standard Medicare Out-Of-Pocket Maximum for Beneficiary Cost Sharing

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4

Eliminate the Observation Status Penalty

Access and Affordability
Medicare beneficiaries who need post-hospital care in a skilled nursing facility (SNF) may be forced to pay out-of-pocket for this care when the hospital chooses to assign them to “observation status” instead of admitting them as an inpatient. Congress should reevaluate the three-day hospital stay requirement, and all days in the hospital should count toward coverage for needed SNF care.

Eliminate the Observation Status Penalty

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5

Ease Access to Medicare Low-income Assistance Programs

Access and Affordability
Medicare’s low-income assistance programs (Medicare Savings Programs and Part D’s Extra Help) were established to help low-income seniors and people with disabilities afford needed medicines. But today, complex, bureaucratic application processes and outdated eligibility thresholds unnecessarily limit participation. These policies must be modernized to reflect financial realities and to align with reforms made elsewhere in the health care system. Accordingly, Congress should ease or eliminate the asset tests for Medicare low-income assistance programs; lower and align eligibility thresholds; and integrate the programs’ application processes, qualifying criteria, and administration.

Ease Access to Medicare Low-income Assistance Programs

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