Over the past few months, the Medicare Rights Center has been actively engaged in considering and commenting on proposals from the Centers for Medicare & Medicaid Services (CMS) that could have significant effects on people who are enrolled in Medicare Advantage (MA) and Part D plans. Last week, CMS released both the Contract Year 2019 Final Rules for Medicare Advantage and Part D (Final Rules) and the 2019 Call Letter. CMS also released fact sheets for the Final Rule and the Call Letter. As we continue to analyze the Final Rules and Call Letter, as well as the impact of the recent two-year budget deal, here is a preview of the issue areas we intend to spotlight, which focus on regulatory trends, anticipated implementations, and practical changes that will impact people with Medicare and those who help them navigate coverage decisions.

Health care in the United States is very expensive, and many experts believe one thing contributing to that expense is the abundance of unnecessary or “low-value” health care services provided to patients. Policymakers typically believe that patients receive this unnecessary care because they expect or demand it. However, this month, the University of Michigan revealed new polling data that turns that assumption upside down.

The Kaiser Family Foundation recently released a report with new data on how much people with Medicare paid for health care in 2016 as a share of their total spending. These data show that Medicare households spend a higher proportion of their incomes on health care coverage, services, and drugs than non-Medicare households. This is important information when discussing what policies should be enacted to protect or improve Medicare’s affordability, especially for those with tight household budgets and fixed incomes.

Last week, Medicare Rights explored some of the looming risks to health coverage and affordability created by recent administrative efforts to undercut the Affordable Care Act (ACA). As we noted then, the Trump administration has proposed several new rules that would allow insurers to offer coverage that does not meet the standards set by the ACA. In addition, Congress has taken steps to undermine the ACA’s coverage by repealing the individual mandate in last year’s tax bill, despite evidence that doing so would cause millions to lose coverage. Together, these changes threaten to undermine the design and achievements of the ACA. Now the Urban Institute, a nonpartisan research organization, and Avalere, a nonpartisan health consulting firm, have released studies that add concrete numbers to these risks.

This week, economist Austin Frakt outlined the economic and health impacts associated with Medicaid’s lack of dental coverage for adults in many states. These associations range from an increased risk of cancer and heart disease, to complications for pregnancy, to social stigma and difficulty finding work.
While Medicaid requires dental coverage for children, coverage for adults is optional. Currently, there are 17 states that offer comprehensive adult dental benefits.
Medicaid’s lack of a comprehensive adult dental benefit in most states makes the health and well-being of people with Medicaid less robust. But Medicaid’s sparse dental coverage is still superior to the coverage Medicare offers most beneficiaries.

Congress is trying to pass a new budget this week that includes many important Medicare provisions. One of these provisions is a worrisome extension of past practices: increasing the amount some people must pay for their Medicare benefits.

This week, the Senate Special Committee on Aging held a hearing titled Turning 65: Navigating Critical Decisions to Age Well to examine issues that older adults face as they near retirement age. In Medicare, two decisions are especially important for those who are newly eligible: when to enroll and what coverage option to choose. As the hearing highlighted, these issues have attainable solutions, namely the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act and the State Health Insurance Assistance Program (SHIPs).

Last month, two health policy non-profits released detailed information and graphs about health spending in the U.S. The Peterson Center on Healthcare partnered with the Kaiser Family Foundation to create a Health System Tracker for health spending and other quality and cost trends in the health system.

In the past several years, the Center for Medicare & Medicaid Innovation (CMMI), part of the Centers for Medicare & Medicaid Services (CMS), has designed and implemented demonstration projects and models to try new ways of paying providers to deliver health care to people with Medicare. These tests of new designs attempt to see if there are ways providers can be paid that will increase the quality of care people receive while either keeping costs stable or, ideally, lowering them.

As Congress moves quickly to send a tax bill to the President before the end of the year, the Senate is now closer to passing their version of the bill. The Senate cleared key process hurdles this week, passing their bill out of committee and passing a Motion to Proceed that allows the bill to be introduced on the Senate floor. Now Senators have a maximum of 20 hours of debate, plus a series of quick votes on an unknown number of amendments that various Senators may offer, known as “vote-a-rama.”