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Denials and Appeals

Largely driven by prior authorization, MA and Part D coverage denials leave beneficiaries with only bad options: paying out-of-pocket, going without, or getting embroiled in a daunting and deeply flawed appeals process. Each path can lead to delayed care, abandoned therapies, worse health, and higher costs. Particularly egregious are improper coverage denials, which force people to make this choice unnecessarily. Changes are long overdue. Harmful denials must be curbed, and the appeals systems must be reformed to function as a safety valve—rather than as an inadequate substitute for sound plan decisions and robust federal oversight.

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Statement for the Record “Negotiating a Better Deal: Legislation to Lower the Cost of Prescription Drugs”

May 4, 2021

Immediate action is needed to transform the nation’s drug pricing system in ways that will lower prices, strengthen Medicare, and promote the well-being of those who rely on its coverage. H.R. 3 would significantly advance these goals, in part by authorizing Medicare to negotiate prices for certain drugs; imposing inflationary rebates; and restructuring Part D to cap beneficiary out-of-pocket costs at $2,000 per year, reduce the federal government’s liability, and better align pricing incentives.

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Reduce Barriers to Care

January 20, 2021

The Biden administration must reduce barriers to care by making coverage more available, accessible, and affordable. On our Helpline, we frequently hear from older adults and people with disabilities who live on modest or limited incomes and are struggling to access and afford their care. These financial challenges—which have in many cases been worsened by the coronavirus pandemic—along with rising health care and prescription drug costs, antiquated coverage rules, and burdensome program requirements can make it difficult for older adults and people with disabilities to obtain the care they need. The following reforms would help reduce these barriers to care by making Medicare stronger, easier to navigate, and more affordable.

Read More »

Summary of Policy Recommendations for the Biden Administration

December 17, 2020

The Medicare Rights Center (Medicare Rights) looks forward to working with the Biden administration to advance policies that protect and strengthen Medicare as well as the health and economic well-being of those who rely on its coverage. To facilitate this dialogue, we compiled a set of administrative actions for their consideration. We will also outline our legislative priorities for the 117th Congress.

Read More »

Statement for the Record “Negotiating a Better Deal: Legislation to Lower the Cost of Prescription Drugs”

May 4, 2021

Immediate action is needed to transform the nation’s drug pricing system in ways that will lower prices, strengthen Medicare, and promote the well-being of those who rely on its coverage. H.R. 3 would significantly advance these goals, in part by authorizing Medicare to negotiate prices for certain drugs; imposing inflationary rebates; and restructuring Part D to cap beneficiary out-of-pocket costs at $2,000 per year, reduce the federal government’s liability, and better align pricing incentives.

Reduce Barriers to Care

January 20, 2021

The Biden administration must reduce barriers to care by making coverage more available, accessible, and affordable. On our Helpline, we frequently hear from older adults and people with disabilities who live on modest or limited incomes and are struggling to access and afford their care. These financial challenges—which have in many cases been worsened by the coronavirus pandemic—along with rising health care and prescription drug costs, antiquated coverage rules, and burdensome program requirements can make it difficult for older adults and people with disabilities to obtain the care they need. The following reforms would help reduce these barriers to care by making Medicare stronger, easier to navigate, and more affordable.

Summary of Policy Recommendations for the Biden Administration

December 17, 2020

The Medicare Rights Center (Medicare Rights) looks forward to working with the Biden administration to advance policies that protect and strengthen Medicare as well as the health and economic well-being of those who rely on its coverage. To facilitate this dialogue, we compiled a set of administrative actions for their consideration. We will also outline our legislative priorities for the 117th Congress.

CELEBRATING

YEARS

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Help us honor 35 years of making Medicare more affordable, accessible, and equitable. Sign up to receive special alerts with ways to support our 35 years of service to older adults and people with disabilities. Learn more at www.medicarerights.org/35.