Category: Uncategorized

Congress should act to protect seniors from higher health costs

Whether at town halls, in meetings, through letters or emails, the top concern we hear from hardworking Americans is that health care costs are too high. Many families rely on their health insurance to cover their medical needs, only to be hit with high deductibles, surprise emergency room bills, and unaffordable prescription drug costs. This is especially true for our nation’s seniors. This fall, Congress has an opportunity to fix this for many seniors with a simple, bipartisan solution: eliminating the Health Insurance Tax (HIT).

For Medicare Advantage beneficiaries who live on fixed incomes, the out-of-pocket cost protections they have in their coverage are vital. But, unless Congress acts, these beneficiaries risk facing the possibility of higher health care costs or fewer benefits due to the HIT. The HIT is a multi-billion-dollar tax on annual premiums that was first levied in 2014 and increases every year by the rate of growth in premiums. Over 25 percent of the HIT falls on Medicare Advantage and Part D plans, resulting in higher costs and possible reductions to supplemental benefits shouldered by seniors and other beneficiaries who depend on their coverage to meet their health care needs and keep health care affordable.

Today, over 22 million Medicare beneficiaries are covered by Medicare Advantage, and almost half live on less than $24,000 a year. They are looking to Congress for solutions that will lower health care costs. Uzella Scoville is a Medicare Advantage beneficiary from Cincinnatus, N.Y., who is concerned about the mounting health care costs she faces every day. Uzella suffers from Central Pain Syndrome after a stroke paralyzed the right side of her body a few years ago. With the tax looming, any increase in her health care costs would be devastating for her and other beneficiaries living on razor thin margins.

Many beneficiaries with Medicare Advantage and Part D coverage are low- to modest-income individuals, and over 20 percent of enrollees are also eligible for Medicaid. The threat of the HIT could impact not only the cost of health care, but also the availability of supplemental benefits like dental, vision, and hearing as well as newly-allowable benefits like pest control, transportation services, and post-hospital meal delivery, among others.

Another beneficiary, Carolyn Lee of Rome, N.Y., has spinal stenosis and is ardently opposed to changes in her Medicare Advantage plan. Carolyn shares, “I absolutely love my Medicare Advantage plan. My prescriptions are covered very, very well, I seldom pay more than $5 to $8…Any time I go to my primary care doctor my copay is only $5 and I would not like to see that change.”

The value beneficiaries derive from the Medicare Advantage’s affordability and high-quality care advances what we ought to strive for across the health care system. Unfortunately, if reenacted, the HIT would leave beneficiaries like Uzella and Carolyn making the choice between their health coverage and paying for other necessities like gas, groceries, and utility bills. We can spare beneficiaries from these painful decisions by passing the Jobs and Premium Protection Act that would repeal the HIT for good.

We cannot leave seniors with more worry and more financial insecurity. Permanently ending the HIT would protect some of the most vulnerable in our communities and reduce rising health care costs for many Americans. Nearly 40 percent of New Yorkers and 34 percent of Americans on Medicare are enrolled in Medicare Advantage. Without a repeal of the HIT someone will be left paying more for their care.

Hardworking Americans need to be heard. Their ask of us, as policymakers, is to reduce their health care costs. Congress needs to listen and act now to reduce health care costs, not increase them.

Repealing the HIT is the best way Congress can deliver on lowering health care costs for beneficiaries who rely on Medicare Advantage and Part D prescription drug coverage to sustain their health. Let’s listen to Uzella and Carolyn and provide them with the security in their health coverage that they deserve.

Brindisi represents the 22nd District of New York. Schwartz is a former representative from Pennsylvania and is CEO & President of Better Medicare Alliance.

Better Medicare Alliance Advocacy Update – September 2019

Note from Congresswoman Schwartz

Hello BMA advocates!

Have you heard the news?  The Centers for Medicare and Medicaid Services (CMS) recently published information on Medicare Advantage plan premiums and offerings for 2020 enrollment. CMS found that the Medicare Advantage average monthly premium is expected to decrease by 14% next year, hitting the lowest premium cost in 13 years!

This is great news for seniors and individuals with disabilities enrolled in Medicare Advantage plans nationwide! In a time of premium increases in other markets, premiums in Medicare Advantage will remain low, while plan choices and benefits continue to expand.

In 2020, enrollment in Medicare Advantage is expected to reach 40% of all Medicare-eligible individuals to a total of over 24 million people.  This growth is a testament to the value Medicare Advantage provides, offering high-quality care at affordable costs.

At BMA, we recognize the importance of making sure beneficiaries are equipped with comprehensive, accurate information about their Medicare coverage options to inform enrollment decisions in a way that best meets their health and financial needs.  We believe all Medicare beneficiaries should be active choosers of their care.   As the annual Open Enrollment Period approaches, we encourage you to familiarize yourself with available tools and resources designed to make comparing your options easier.

Recently, CMS updated the Medicare Plan Finder, an online tool where you can explore and compare plans available in your area.  BMA actively participated in the revision process, citing your experiences and concerns in the recommendations we offered to CMS to improve the Plan Finder. We are happy to report that the new Plan Finder tool is much more user friendly.  If you have a MyMedicare account, you can now pull directly from your claims data to build an accurate drug list. Validated users also have access to 24/7 web chat assistance to help with both technical and enrollment questions.

In addition to the Plan Finder, you will likely soon be receiving the 2020 Medicare & You Handbook, which is updated annually to assist beneficiaries with enrollment decisions. Using the Handbook, you can learn more about Medicare coverage options, the Open Enrollment Process, and what services are covered under Medicare. Your feedback on the Handbook offered in the last few years has helped BMA propose changes to improve the Handbook. We are currently viewing the Handbook and are pleased to see how our recommendations were implemented by CMS.

Finally, are you looking for a quick reference to get some easy and understandable information on your Medicare options before Open Enrollment?  We suggest our BMA Open Enrollment Guide. The BMA Guide provides a comprehensive overview of key differences between Original Medicare and Medicare Advantage to help you make an informed choice during the enrollment period. We update this guide regularly, so check back to find our most recent edition prior to Open Enrollment.

If you utilize any of these resources to gather information and compare Medicare choices this fall, we’d love to hear your feedback. Send our team an email at community@bettermedicarealliance.org to help us improve them in ways that meet your needs.

Thank you for your advocacy for Medicare Advantage and our efforts here at BMA!

Sincerely,

Allyson Y. Schwartz
President & CEO, Better Medicare Alliance

HIT Update

With members back in Washington following the August recess, BMA continues to advocate for suspension of the Health Insurance Tax (HIT).  The HIT, which could increase health care costs or reduce access to supplemental benefits for seniors on Medicare Advantage, was recently reviewed by a Task Force of the Senate Finance Committee.  BMA advocates took the opportunity to make their voices heard by members of the Task Force, sending more than 1,015 letters urging members to #StoptheHITonSeniors.

The Committee Task Force was charged with identifying long-term solutions for six unique health taxes.  In its recent report, the Task Force did not come to a consensus on how to address the tax provisions, but one thing was made very clear: none of the participating parties advocated for continuation of the HIT.

Senators Cory Gardner (R-CO) and Jeanne Shaheen (D-NH), who have led efforts to delay and/or repeal the HIT in the Senate, urged their colleagues to take immediate action to prevent higher costs from being passed down to consumers.  BMA recognizes their advocacy on behalf of Medicare Advantage beneficiaries, and encourages advocates residing in Colorado or New Hampshire to join us on Twitter to thank Senator Shaheen and Senator Gardner for their support of the coverage seniors choose.

Don’t live in Colorado or New Hampshire?  It is still critically important that we keep up the pressure on Congress to delay or repeal the HIT. If you are concerned about the tax impacting your coverage, we encourage you to speak out. Call or write your members of Congress – whether for the first time, or to reach out again. Write a letter to the editor and make sure other Medicare beneficiaries in your area understand the HIT and how it could impact their lives. Visit our website for more information on the HIT to help you effectively address this issue with lawmakers.

Featured Advocacy Action

At BMA, we value your stories and experiences with Medicare Advantage to help support our outreach to members of Congress and their staff.  We know beneficiaries enrolled in Medicare Advantage represent a diverse group of seniors and individuals with disabilities from across the country, and we work hard to demonstrate how Medicare Advantage offers the quality care you need.  Your feedback— in your own words– makes the difference.  That’s why we’ve been collecting stories from advocates nationwide.

We are extremely close to having collected wonderful advocate stories from all fifty states, but we need your help to make sure every state is included. If you live in the following states, head to medicaremyway.com to share your Medicare Advantage story today!

Alaska

Delaware

Hawaii

Minnesota

New Hampshire

Nebraska

North Dakota

Vermont

West Virginia

Wyoming

Our Top Advocates

  • Judith C. (Carmel, CA)
  • Luther A. (Fillmore, CA)
  • Maryann V. (San Bernardino, CA)

BMA Ambassadors work directly with BMA to further engage in advocacy activities, like hosting events, recruiting new members, and contacting Congress.

The Better Medicare Alliance Ambassador Facebook Group is a self-selected committee of the Better Medicare Alliance’s most engaged senior advocates dedicated to strengthening health care for seniors and people with disabilities who are enrolled in Medicare Advantage.

 

BMA Educates Hill Staff on Demographic Trends in Medicare Advantage

Better Medicare Alliance (BMA) hosted a briefing for Congressional staff on Thursday, July 11, 2019. The event, titled Medicare Advantage: Enrollment & Demographic Trends, unveiled new data showing the critical role Medicare Advantage plays in shielding beneficiaries from high out-of-pocket costs. Findings also showed that Medicare Advantage serves an increasingly diverse population with complex care needs.

Anne Tumlinson, CEO at Anne Tumlinson Innovations, presented key findings from her new report sponsored by BMA, entitled Medicare Advantage Provides Key Financial Protections to Low and Modest Income Populations. The analysis found while there are many similarities between the populations enrolled in Medicare Advantage and Traditional Medicare in terms of age, gender, and prevalence of chronic conditions, Medicare Advantage plans enroll a higher number of beneficiaries with incomes below $24,000 (or 200% of the federal poverty level). In addition, the analysis showed that Medicare Advantage beneficiaries have significantly lower premium and out-of-pocket costs and are less likely to be cost-burdened than their peers in Traditional Medicare.

“There are a growing number of families in this country that are suffering from problems with the health care delivery system. It’s not meeting their needs. Medicare Advantage is an exciting part of the toolkit to solve those delivery system problems,” noted Tumlinson.

Two of BMA’s Medicare Advantage Champions in Congress addressed the attendees, highlighted the value of Medicare Advantage to their constituents, and emphasized the importance of continued bipartisan support for Medicare Advantage. Representatives Tony Cárdenas (D-CA) and Jimmy Gomez (D-CA) stressed the importance of improving understanding of Medicare choices and increasing access to high-quality care offered by Medicare Advantage.

“Seniors deserve the dignity of knowing they can see the doctor when they need to. That’s the dignity of Medicare Advantage. This is an example of what Medicare should be about,” noted Representative Cárdenas as he urged Congressional staff to learn more about Medicare Advantage.

The briefing included a panel discussion moderated by Allyson Y. Schwartz, BMA President & CEO. The panelists were Autumn Campbell, Director of Public Policy and Advocacy at the National Association of Area Agencies on Aging, Gary Puckrein, Ph.D., President & CEO of the National Minority Quality Forum, and Lucy Theilheimer, Chief Strategy and Impact Officer at Meals on Wheels. They discussed the role of strategic partnerships between Medicare Advantage and community partners to address social risk factors and address disparities based on race, ethnicity and gender. All three organizations are part of BMA’s coalition of Allies.

The event was widely attended, with almost 100 Congressional staffers and other interested parties joining to learn more about consumer cost protections and the diverse population of in Medicare Advantage. Participants represented 46 House and Senate offices, a testament to widespread Congressional support for Medicare Advantage.

To view the briefing please click here.

Administration Withdraws Proposed Rebate Rule

Seniors nationwide struggle to pay the out-of-pocket costs for their life-saving medications. As prescription drug prices continue to rise, efforts to protect seniors and keep drug costs down have become a priority for members of Congress and the Administration.

In April, the Administration issued a proposed rule to eliminate drug rebates in Medicare, known as the Rebate Rule. This rule intended to change the way in which pharmacy benefit managers (PBMs) negotiate lower drug prices with manufacturers and how plans use the rebated funds.

Currently, rebates are a vital tool used by health plans to lower Part D premiums for beneficiaries. These rebates are negotiated with drug manufacturers by Pharmacy Benefit Managers and used to reduce out-of-pocket costs for all Part D beneficiaries. The Administration wanted to redirect the rebates to be used only for those beneficiaries with high price specialty drugs. It was acknowledged that this would result in increased premiums and out-of-pocket costs, and in some cases, fewer supplemental benefits, for beneficiaries in Medicare Advantage.

Analysis by Department of Health and Human Services, as well as another by the Congressional Budget Office projected that the proposed rule, would increase beneficiary premiums, would cost the federal government hundreds of millions of dollars a year and would likely not reduce prescription drug prices. With this proposed rule set to jeopardize the affordable prescription drug coverage provided in Medicare Advantage, Better Medicare Alliance (BMA) advocates rallied to keep prescription drugs affordable for all beneficiaries who rely on this coverage for essential medications.

Our community of advocates sent 2,962 letters to the Senate Finance Committee urging them to oppose the proposed rule and 1,229 advocates watched the Committee hearing on rebates to learn more about the role of Pharmacy Benefit Managers. Additionally, 2,710 advocates joined the Keep Our Prescription Drugs Affordable Task Force to stay informed on changes that impact MA-PD plans and prescription drug pricing.

Thanks to these efforts, as well as those of BMA ally organizations which also advocated to protect MA-PD plans, the Administration announced on July 11, 2019, that it is withdrawing the proposed rule!

BMA applauded this decision and is pleased to see our advocacy make a difference in protecting low premiums for you and the millions of beneficiaries in MA-PD plans. BMA shares the Administration and Congress’s interest in reducing prescription drug costs for consumers. Working with the Administration and Congress, we will continue to seek solutions to achieve this goal. And, we will support efforts to reduce prices while ensuring that these actions protect the high-quality, affordable prescription drug coverage and health care provided in MA-PD plans.

Proposed Changes to Drug Rebates Could Harm Medicare Prescription Drug Coverage

Better Medicare Alliance advocates for the 22 million Americans who rely on Medicare Advantage for its affordability, simplicity, care coordination and enhanced supplemental benefits. Across the country rising costs of prescription drugs are a growing concern, as more and more individuals and families find it difficult to afford medications they need. Yet Medicare Advantage Prescription Drug plans (MA-PD) have been able to offer stable premiums to beneficiaries since the program’s inception.

Medicare Advantage-Part D plans work to deliver value for seniors and for taxpayers by negotiating lower prices directly with pharmaceutical companies. They do this by working with Pharmacy Benefits Managers (PBMs), such as CVS Caremark or Express Scripts, who negotiate lower drug prices with pharmaceutical companies through the use of rebates. Rebates are a vital tool used by health plans and PBMs to negotiate lower drug prices with drug manufacturers. Without this tool MA-PD enrollees could face increased premiums, higher out-of-pocket costs and reduced supplemental benefits.

Recently, the Administration proposed eliminating current rebates provided to PBM’s associated with Medicare Part D plans. The Senate Finance Committee hearing “Drug Pricing in America: A Prescription for Change, Part III” on April 9, 2019, provided lawmakers an opportunity to learn more about the role of PBM’s and better assess the impact of the Administration’s proposed changes to Part D prescription drug coverage.

Top executives from Cigna Corporation, CVS Caremark, Humana Inc., OptumRx, and Prime Therapeutics LLC answered questions about their efforts to curb the rising costs of prescription drugs, relationships with manufacturers, and the extent to which rebates impact list prices.

In summary remarks, Senator Sherrod Brown (D-OH) clarified “PBM’s do not set drug prices. The Administration rule will not change that fact.”
Better Medicare Alliance is opposed to the Administration’s proposal because it could jeopardize affordable prescription drug coverage and raise costs in Medicare Advantage plans.
Here’s why:

  • Rebates are important negotiating tool to compel drug manufacturers to keep prescription drug coverage affordable for seniors.
  • Part D rebates have been used to stabilize and drive prescription drug costs down.
  • Eliminating rebates could destabilize Medicare Part D premiums and cause an increase in costs to enrollees.
  • The proposed rule risks creating instability for seniors on Medicare.
  • Studies show that rebates have reduced costs in Medicare Part D by nearly $35 billion in the last four years and had they been eliminated last year Part D premiums would have risen by 52 percent in 2018 alone.
  • Eliminating current rebates would negatively affect nearly 16 million people on Medicare Part D.
  • This proposal could reduce access to supplemental benefits in Medicare Advantage Part D plans, such as dental, vision, and hearing coverage.
  • According to experts, zero premium MA-PD plans could experience a 28% reduction in resources available to finance supplemental benefits. This could translate to an average annual $228 decrease in funding available per beneficiary for these plans to provide supplemental benefits. Individuals in rural areas would be the most negatively impacted by this proposal.
  • This proposal fails to address the root cause of high prescription drug costs. If we’re serious about addressing the real problem, we need to start with list prices that are set by drug manufacturers.

Better Medicare Alliance supports the goal to curb rising prescription drug costs, but the potential harm to seniors and individuals with disabilities this proposal could cause suggests there should be another way to achieve this goal. We urge the Administration to work with stakeholders like Better Medicare Alliance to identify solutions that minimize the negative consequences to beneficiaries in integrated MA-PD plans and address the root causes of high prescription drug prices for consumers.

Upcoming Health Insurance Tax Could Increase Costs for Seniors

The rising costs of health care remain a great concern to seniors and disabled individuals across the United States. As the new Congress begins its work following the government shutdown, Members face a decision on a multi-billion-dollar tax on health insurance coverage that would impact the costs and benefits under Medicare Advantage.

As part of the Patient Protection and Affordable Care Act (ACA), an annual tax was imposed on health insurance premiums called the Health Insurance Tax (HIT). The HIT is a tax that applies to individual policies, small group plans, employers who are not self-insured, Medicaid managed care, Medicare Part D, and Medicare Advantage. If you are enrolled in Medicare Advantage or a Medicare Part D plan, the HIT could have a significant impact on you.

The HIT would likely result in increases in plan premium costs, less cost sharing reductions for beneficiaries, fewer supplemental benefits provided under plans, or a combination of all three. The HIT has been suspended in previous years, but it is scheduled to return in 2020. If it allowed to go into effect, annual plan premiums could increase by $241 for the average beneficiary and approximately $500 for the average couple on Medicare Advantage. Research shows that over 25% of the financial burden of the HIT is carried by Medicare Advantage and Medicare Part D enrollees.

We know beneficiaries value their Medicare Advantage coverage for the high-quality, affordable care it provides. More than half of all Medicare Advantage beneficiaries live on less than $30,000 a year and most live on fixed incomes. Protecting seniors and individuals on disabilities in Medicare Advantage from cost increases should be a high priority for policymakers.
Suspending the HIT for 2020 is one of the most direct ways for Congress to provide financial relief for seniors and disabled individuals who rely on Medicare Advantage plans to maintain access to quality health care and prescription drug coverage.

Two bills have been introduced that would delay the HIT Tax for 2020 and 2021. In the Senate, S. 172 is sponsored by Senators Cory Gardner (R–CO), Jeanne Shaheen (D-NH), John Barrasso (R-WY), Doug Jones (D-AL), Tim Scott (R-SC), and Kyrsten Sinema (D-AZ). A companion bill, H.R. 1398 has been introduced by Representatives Ami Bera (D-CA), Josh Gottheimer (D-NJ), Jackie Walorski (R-IN), and Kenny Marchant (R-TX) in the House of Representatives.

Better Medicare Alliance supports bipartisan efforts to protect Medicare Advantage beneficiaries from rising health care costs. We have voiced our strong support for delaying or repealing the HIT. We will continue to advocate for this action and will continue to monitor legislative progress towards that goal Demonstrating support for Medicare Advantage by requesting a suspension of the HIT for 2020 is critically important. We encourage you to contact your member of Congress and Senators and urge them to co-sponsor these bills. To do so, sign our petition today!

Want Better Retirement? Better Health Care? Learn How to Become a Senior Advocate

Are you concerned about prescription drug prices in Medicare? Perhaps you have a chronic condition and you are worried about how Medicare will cover your bills?

We are less than two months away from a midterm election and a new Congress. It is now more important than ever to make sure your voice is heard in Washington. Last year, Better Medicare Alliance (BMA) senior advocates sent 10,000 letters, made phone calls and signed petitions to successfully advocate Congress to ensure chronically ill Medicare beneficiaries have access to the high-quality care through passage of the CHRONIC Care Act.
Let’s build on that success! Better Medicare Alliance has created four voluntary senior advocate task forces. Our task forces are smaller groups of senior advocates that are passionate about certain issues that impact people enrolled in Medicare Advantage. When you sign up to join one of our tasks forces you will gain access to special resources on the part of Medicare Advantage you’re most passionate about.

Join one (or more) of the following task force:

Chronic Disease Task Force
Join our chronic disease task force to protect critical Medicare Advantage chronic disease care and work directly with Better Medicare Alliance to ensure seniors with chronic disease continue to receive high-quality, affordable health care through Medicare Advantage. Medicare Advantage has been at the forefront of developing and incentivizing ground-breaking ways to prevent, diagnose and treat chronic diseases such as diabetes, hypertension and heart disease.

Keep Our Prescription Drugs Affordable (KOPDA) Task Force
Prescription drug prices are on the rise affecting millions of seniors on Medicare Advantage, many of whom struggle to pay the out-of-pocket costs for their life-saving medications. Better Medicare Alliance understands the negative impact high drug prices have on beneficiaries and supports developing policies that make prescription drugs more affordable for everyone. Join our Keep Our Prescription Drugs Affordable Task Force to ensure seniors on Medicare Advantage have access to affordable and effective prescription medicines.

Medicare Advantage Retiree Plans Task Force
Join our Medicare Advantage Retiree Plans Task Force to protect Medicare Advantage plans provided to retirees by their former employers. Over four million retirees across the country are enrolled in a Medicare Advantage health plan sponsored by a former employer. These seniors depend on high-quality, affordable care, and continued funding for these plans.

Medicare My Way Task Force
Join our Medicare My Way Task Force to work directly with Better Medicare Alliance to advise the government on how to improve Medicare and advocate for what services you think your Medicare Advantage plans should cover, including supplemental benefits.

What happens next?

If you join our task forces, participation is free and completely volunteer-based – we just ask for 1-2 hours of your time each month. As an organization with over 115+ Allies we want to represent the voice of Medicare Advantage seniors around the nation.

The most important goal of our task force is education. Education is key for advocating for Medicare Advantage. We will provide you with legislative updates and talking points, so you can better advocate for each issue.

Some of the activities you will be asked to participate in when you join a task force include surveys, petitions, calls to other seniors, calls to offices of members of congress, and drafting letters and op-eds about positive experiences.

What about Drug Prices in Medicare?

Prescription drug prices are a concern to almost everyone and that concern has captured the attention of policymakers. This is certainly true, many Medicare enrollees who have seen high out-of-pocket costs, particularly for specialty drugs.

The first step in tackling the question of how to keep drug costs down is to know how drug pricing works. Here’s a start:

Drug prices start with pharmaceutical companies. Pharmaceutical companies set prices for their products independently and can increase them at will. This often results in high out-of-pocket costs for consumers, as well as increased costs throughout the entire system.

Medicare Advantage-Part D (MAPD) plans and standalone Part D Prescription Drug Plans (PDPs)work to deliver value for seniors and for taxpayers by negotiating lower prices directly with pharmaceutical companies. They are able to do this by working with Pharmacy Benefits Managers (PBMs), such as CVS Caremark or Express Scripts, who are able to negotiate lower drug prices with pharmaceutical companies through the use of rebates.

Rebates are a vital tool used by health plans to lower drug premiums for their beneficiariess. Without the use of rebates, health plans would have no leverage to negotiate lower drug prices with pharmaceutical companies, resulting in increased premiums for health plan enrollees.Consumers are also able to change plans each year to better meet specific financial and health needs to help manage the prescription drug costs, should their medical or financial needs change over time.

The prescription drug supply chain needs comprehensive reform to protect seniors and those with disabilities on Medicare from high prices, abrupt increases, as well as rising drug costs in both routine medications and specialty prescription drugs. As beneficiaries, you can contact your representatives to motivate legislative change and you can share your stories to better build a case when we advocate for the stability of drug prices for our 400,000 advocates.