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Celebrating 35 years of making Medicare more accessible, affordable, and equitable!

Casey Schwarz

Senior Counsel, Education & Federal Policy

CMS Releases Early Look at Medicare Beneficiary Survey Data

This week, Centers for Medicare & Medicaid Services (CMS) released an “early look” at the 2017 Medicare Current Beneficiary Survey (MCBS) results, including preliminary estimates about the Medicare population. The MCBS targets the Medicare population that resides in “the community” and does not include individuals who live in a nursing facility.

Middle-Income Older Adults Face Insufficient Resources for Housing and Health Care

This week, Health Affairs released a report finding that, increasingly, middle-income seniors will have not enough money to cover the cost of housing and healthcare. The authors project that by 2029, 14.4 million people over age 75 will be “middle income.” Around 60% of these older adults will have mobility limitations and 20% of whom will have high health care needs, but their incomes will put them at risk of not being able to afford health care or housing. Unfortunately, middle-income seniors are not served by the private seniors housing industry nor by the supportive housing available to lower income individuals. This means that 54% of these individuals will not have sufficient resources to pay for the level of care provided in senor housing.

Medicare Payments for Insulin Have Increased Dramatically, Report Finds

A recent Kaiser Family Foundation report highlights the dramatic increase in Medicare spending on insulin products from 2007 to 2017. When taking into account payments made by plans, beneficiaries, and the federal government, spending increased by 840% from $1.4 to $13.3 billion.

Although there are an increasing number of Part D enrollees and an increase in the percentage of enrollees who have diabetes—with one third (33%) of people with Medicare diagnosed with diabetes in 2016, up from 18% in 2000—these trends do not account for the steep growth in overall spending. Indeed, the study notes that the average total Medicare Part D spending per user on insulin products increased by 358% between 2007 and 2016 (from $862 to $3,949).

Department of Justice States Support for Total Invalidation of the Affordable Care Act

This week, the Department of Justice surprised observers by filing a short letter with the Fifth Circuit Court of Appeals indicating the Trump Administration’s agreement with a district court decision invalidating the entirety of the Affordable Care Act (ACA).

This new, more extreme position is a departure from previously stated Administration policy, which sought to strike some of the law while preserving its more popular provisions, like protections for people with pre-existing conditions, the ability for people under 26 to remain on a parent’s insurance, and prohibitions on charging older adults exorbitant amounts for coverage.

Medicare Rights Comments on 2020 Draft Rate Notice and Call Letter

Each year, the Centers for Medicare & Medicaid Services (CMS) releases a draft rate notice and call letter, which outlines rules and payment policies that will apply to Medicare Advantage plans in the upcoming plan year. Interested parties—including plans, beneficiaries, and advocates—can submit comments in response, which CMS takes into consideration when finalizing its proposal. The agency then releases a final rate notice and call letter in the spring, which contains information that plans use to submit their bids to offer Medicare Advantage and Part D plans.

Updated Federal Poverty Guidelines Announced

Each year, the Department of Health and Human Services (HHS) updates the federal poverty guidelines, which are then used to determine eligibility for programs including Medicaid, the Low Income Subsidy for Part D (LIS), and Medicare Savings Programs.

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Medicare Announces New Model to Test Changes to Part D Payments

This week, the Centers for Medicare & Medicaid Services (CMS) )—the agency that oversees the Medicare program—announced a new model to test changes to prescription drug payments and incentives. The CMS Center for Medicare and Medicaid Innovation (CMMI) will create a voluntary, five-year model in which Part D Plans (PDPs) and Medicare Advantage Prescription Drug Plans (MAPDs) may apply to participate.

According to CMS, the model is intended to test “new incentives for plans, patients, and providers to choose drugs with lower list prices in order to address rising federal reinsurance subsidy costs.”

Medicare Rights Responds to Proposed Changes for Medicare Advantage Plans in 2020

The Medicare Rights Center recently submitted comments in response to proposed rule changes from the Center for Medicare & Medicaid Services (CMS) pertaining to Medicare Parts C and D for 2020 and 2021. Many of the proposed rules implement changes that Congress made to the law that establishes Duals Special Needs Plans (D-SNPs). D-SNPs are special plans designed to serve the needs of people who are eligible for both Medicare and Medicaid, also known as “dual eligibles.”

CMS Proposes Changes to Protected-Class Drugs

Last week, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that would allow Part D and Medicare Advantage plans to use additional tools to reduce prescription drug prices. Some of these tools rely on weakening the protections for consumers who take certain medications in what are known as the “protected classes.”

CELEBRATING

YEARS

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