Medicare Rights Urges Congress to Prioritize Critical Medicare Updates

This week, as Congress continued to discuss strategies to improve health coverage, Medicare Rights weighed in, urging them to prioritize critical Medicare updates.

The letter, signed by leading Medicare beneficiary advocacy organizations, calls on Congress and the Biden administration to “seize the opportunity to modernize the program, deliver on the promises to improve coverage and reduce prescription drug prices and out-of-pocket costs so that beneficiaries can afford what their doctors prescribe. The significant gaps in coverage must be addressed, specifically regarding oral health, hearing, and vision services. And barriers to low-income assistance–which is particularly important to older adults of color–must be eliminated.”

To achieve these goals, the letter recommends specific policy changes, including:

• Fill Harmful Gaps in Coverage by adding a comprehensive oral health benefit, as well as expanded hearing and vision coverage, to Part B.

• Reduce Prescription Drug Prices and Costs by allowing Medicare to negotiate drug prices; capping and smoothing beneficiary out-of-pocket costs; restructuring the Part D benefit to reduce Medicare’s liability and better align pricing incentives; and repealing safe harbors for pharmaceutical rebates, using those savings primarily for beneficiary improvements.  

• Streamline Part D Appeals by strengthening data collection, transparency, and oversight; requiring independent redeterminations; allowing tiering exceptions and raising the specialty tier threshold; and improving plan communications with enrollees, including at the pharmacy counter. 

• Improve Access to Medicare’s Low-income Programs by eliminating the unduly restrictive asset and eligibility tests for the Part D Low-Income Subsidy (LIS) and Medicare Savings Programs (MSPs), raising the income eligibility limit for the Qualified Medicare Beneficiary (QMB) program to 138% of poverty, and aligning enrollment standards and administrative functions across the programs.

• Make Coverage More Affordable by establishing a limit on beneficiary out-of-pocket costs, program-wide.

• Modernize Medigap Rules by expanding protections and purchase rights—including open enrollment, guaranteed issue, and community rating—to all people with Medicare.

• Expand Access to the Home Health Benefit by relaxing or eliminating the homebound and/or skilled care eligibility triggers and by removing the “at home” restriction for durable medical equipment. 

• Enhance Chronic Care by strengthening the Medicare Annual Wellness Visit; improving access to Medicare behavioral health services and the Medicare Diabetes Self-Management Training program; and by ensuring the availability of supplemental benefits for those in traditional Medicare.

These long-overdue, commonsense reforms would strengthen Medicare and promote beneficiary well-being. Join Medicare Rights in urging Congress to prioritize these improvements. Learn more and weigh in today. 

Read the letter.