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We work closely with over 1 million senior advocates to provide information about what Better Medicare Alliance is up to and how you can get involved. Make sure to check back here for regular updates on all things Medicare Advantage!

Have questions? Email us at community@bettermedicarealliance.org. We look forward to hearing from you!

Open Enrollment Guide 2021

Download Open Enrollment Guide 2021

Better Medicare Alliance Open Enrollment Guide 2021
When Is Open Enrollment?
  • Open Enrollment for Medicare takes place each year from October 15 to December 7.

What Can I Do During The Open Enrollment Period? During Open Enrollment, you can: 

  • Switch from a Medicare Advantage plan to a different Medicare Advantage plan.
  • Switch from a Medicare Advantage plan that does not offer drug coverage to a Medicare Advantage plan that offers drug coverage.
  • Switch from a Medicare Advantage plan that offers drug coverage to a Medicare Advantage plan that does not offer drug coverage.

Consumer Sentiments on Medicare Advantage

Medicare Advantage plans continue to provide value, according to the results of a new poll.

Ninety-four percent of beneficiaries are satisfied with their Medicare Advantage coverage, according to the poll of 2,000 beneficiaries conducted Morning Consult and released by Washington, D.C.-based Better Medicare Alliance, a coalition of Medicare Advantage supporters of more than 400,000 beneficiaries and over 140 ally organizations led by Allyson Y. Schwartz, a former member of the U.S. House of Representatives from Pennsylvania.

Better Medicare Alliance commissions a poll annually to gauge seniors’ views on Medicare issues.

“Our previous polling pegged this number at 92%—so it’s remarkable that enrollees’ satisfaction rate has climbed even higher,” says Schwartz, Better Medicare Alliance president, and CEO. “What’s more, 93% of respondents are satisfied with their network of doctors, physicians, and specialists in their Medicare Advantage plan and nearly two-thirds [62%] go so far as to say that Medicare Advantage is a ‘better choice’ for seniors’ needs that traditional Medicare.”

Healthcare executives want to have their finger on the pulse of the Medicare marketplace so they know how to best respond to emerging trends, according to Schwartz.

“With this poll, we’re providing a timely snapshot of seniors’ views and it confirms what we’ve long known: they like their Medicare Advantage coverage and want to see it protected and strengthened by policymakers in Washington and health care plans and providers,” she says.

Other findings

The poll also found that nearly half of seniors on Medicare (45%) still did not know about Medicare Advantage when first enrolling in coverage, and 32% said they would have liked to have more upfront information about this option.

“These results show improvement from previous polling which has placed the share of seniors unaware of Medicare Advantage as high as 65% but it shows us that there is still work to be done,” Schwartz says. “Every beneficiary deserves complete, unbiased information about their Medicare options so that they can make an informed decision based on their unique healthcare needs.

“With half of Medicare Advantage beneficiaries enrolled in $0 premium plans; 97% having access to dental, vision, hearing, or fitness benefits unavailable in traditional Medicare; and beneficiaries experiencing lower out-of-pocket costs, it is clear that seniors are responding,” Schwartz says. “As policy makers continue discussions on healthcare policy in Washington, we must protect what works. Medicare Advantage is exactly that.”

Seniors with Complex Health Care Needs Deserve to Know Their Choices

Imagine being so burdened by health care costs that you were forced to empty your life savings or started receiving calls from debt collectors.

This is not some hypothetical scenario from ages past, it is the painful experience for 36 percent and 27 percent, respectively, of seriously ill Traditional Medicare beneficiaries today, according to new research from Harvard University and the Commonwealth Fund.

When President Lyndon B. Johnson signed Medicare into law in 1965, he inspired Americans with a promise that “No longer will illness crush and destroy the savings that they [seniors] have so carefully put away over a lifetime so that they might enjoy dignity in their later years.”

Yet, given this report’s findings that Traditional Medicare beneficiaries over the age of 85 spend an average of $10,307 annually on out of pocket costs and 23 percent of the sickest enrollees are unable to pay for basic necessities, it is clear this decades-long promise is threatened.

Medicare’s Traditional fee-for-service model is simply not living up to the vision that President Johnson and Congress made to protect older Americans’ health and financial security. This legacy and, most importantly, today’s seniors deserve better.

For us – as a former lawmaker who fought to expand affordable health coverage and a physician of more than 30 years working to address health disparities in the Hispanic community – it also highlights the importance of empowering Medicare enrollees to know their options.

For many beneficiaries, Medicare Advantage – which offers extra benefits and important cost protections, including an annual limit on out-of-pocket expenses unavailable in Traditional Medicare, could be the right choice.

Consider that half of Medicare Advantage enrollees are in $0 premium plans, whereas the average Traditional Medicare enrollee spends a whopping $2,294 on premiums alone each year.

What’s more, 58 percent of Medicare Advantage plans provide dental, vision, hearing and fitness benefits – none of which are covered under Traditional Medicare – meaning enrollees are getting more coverage at a lower cost.

In addition, there is increasing evidence that care coordination and case management available in Medicare Advantage achieves better outcomes for beneficiaries with multiple chronic conditions; complex patients who are able to receive care in the home, transportation, or meal delivery to improve their health and well-being

The problem? As many as 45 percent of seniors are unaware they have a choice in how they receive their Medicare coverage.

That means Medicare eligible beneficiaries on fixed incomes with serious health care needs are defaulting into a program that places no limit on their out-of-pocket expenses and leaves them to shoulder too much of the cost burden, not knowing that there is another way. This is flat wrong.

Better Medicare Alliance has been working to ensure that information about Medicare Advantage is clear, complete, and understandable to seniors. We’ve already seen success.

For example, the 2020 “Medicare & You” handbook includes upfront, easy-to-read information about the choice between Traditional Medicare and Medicare Advantage right on page six, instead of pages later in the more-than-100 page booklet.

When beneficiaries find their way to Medicare Advantage, they like what they find. It’s no surprise then, that Medicare Advantage enrollment has grown significantly in recent years and is projected to reach 40 percent of the people eligible for Medicare, a record of 24.4 million people, next year. The Hispanic community plays an outsized role in this trend with 57 percent of Hispanic Medicare eligible beneficiaries choosing Medicare Advantage.

One reason is that Medicare Advantage beneficiaries report an average of $1,276 less in total health care spending each year than their Traditional Medicare counterparts. Consider what this savings could mean to the widower with diabetes, the retiree battling cancer, the grandmother facing dementia, or the elderly neighbor recovering from a stroke.

For millions of our nation’s seniors facing such challenges, it is Medicare Advantage that is best honoring Medicare’s original solemn pledge to protect their health and personal finances.

As Medicare’s annual open enrollment season heads into its last few weeks, Washington must ensure that today’s beneficiaries – and those yet to come – know the value of each of their choices.

Allyson Y. Schwartz is the president and CEO of the Better Medicare Alliance. She represented Pennsylvania in the House as a Democrat from 2005 to 2015.

Elena Rios, MD, MSPH is the president and CEO of the National Hispanic Medical Association.

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.

 

Better Medicare Alliance Advocacy Update – July 2019

Note from Congresswoman Schwartz

Hello BMA Advocates!

Since 1966, Medicare has provided critical health and economic security for America’s seniors and their families. As we reflect on Medicare’s success in recognition of the program’s 54th anniversary, we also see new opportunities and challenges in meeting the needs and expectations of today’s Medicare beneficiaries. With 10,000 new seniors becoming eligible for Medicare every day, this new generation of older adults have different needs than those of 50 years ago when the main concern was coverage for hospital costs for acute illness. Given the advancements in treatments and cures, we are living longer, and many seniors are healthier than ever.

Yet, many are also living with complex chronic conditions and managing their medical and non-clinical needs is more important than ever. Fortunately, Medicare has changed over the decades to meet these needs. Part D coverage for prescription drugs was one of those changes, as was the option of Medicare Advantage, which is uniquely designed to care for seniors today. Attention to care coordination, preventive services and early intervention offered by Medicare Advantage are effective steps to help those living with chronic diseases manage their care and life healthier lives. With innovative solutions and a focus on value-based care, Better Medicare Alliance (BMA) believes Medicare Advantage is the future of Medicare and offers a model for the nation.

In July, thought leaders, plans, providers and community partners in health care from across the country convened in Washington for BMA’s 2019 Medicare Advantage Summit. Over two days, we discussed the future of Medicare and highlighted the unique capacity of Medicare Advantage to meet the needs of older adults and people with disabilities. With outstanding speakers, including Secretary Alex Azar of Health and Human Services, Administrator Seema Verma of the Centers for Medicare and Medicaid Services, Adam Boehler of the Center for Medicare and Medicaid Innovation, Bruce Broussard, CEO of Humana, and Larry Merlo, CEO Of CVS Health, participants explored opportunities to improve patient care, remove barriers to care, and reduce health disparities. Over 250 individuals attended the Summit, with more than 36% traveling from out of state to take part in this one of a kind opportunity to learn more about Medicare Advantage.

BMA Summit Photos

With the help of this community, BMA has been educating members and cultivating strong bipartisan support for Medicare Advantage in Congress. In July, BMA hosted an educational briefing for Congressional staff, unveiling new data that show the critical role Medicare Advantage plays in serving an increasingly diverse population of beneficiaries and shielding low and modest-income individuals from high-out-of-pocket costs. The briefing, entitled Medicare Advantage: Enrollment and Demographic Trends, included a presentation by Anne Tumlinson of Anne Tumlinson Innovations and a panel discussion with three BMA ally organizations: Meals on Wheels, National Association of Area Agencies on Aging and the National Minority Quality Forum. BMA Medicare Advantage Champions Representatives Tony Cardenas (D-CA) and Jimmy Gomez (D-CA) also addressed the crowd, urging Congressional staff to learn more about Medicare Advantage. We are excited to report that the event was widely attended, with nearly 100 Congressional staffers joining to learn more about demographic trends and consumer cost protections in Medicare Advantage.

BMA Congressional briefing

In April, we reached out to you about a proposal to eliminate drug rebates in Medicare, which would have raised the cost of premiums for seniors on Medicare Advantage. Seniors like you spoke out to protect Medicare Advantage beneficiaries, sending nearly 3,000 letters to Congress opposing the proposal and calling on lawmakers to tell the Administration to protect affordable prescription drug coverage for all beneficiaries. In July, we saw your hard work pay off, as the Administration withdrew the proposal after listening to groups like BMA and our senior advocates. This victory on behalf of Medicare Advantage beneficiaries proves how critical your voice is to protect high-quality, affordable health coverage available with Medicare Advantage.

Thank you for speaking out to support and improve Medicare Advantage!

Sincerely,

Allyson Y. Schwartz
President & CEO

Active Choosers Participate in BMA Medicare Academy Month

By Daniella Chambers, BMA Advocacy Manager

Throughout July, seniors and beneficiaries with disabilities across the country competed to expand their knowledge of Medicare Advantage as part of Medicare Academy Month. This educational series provided Medicare-eligible seniors the chance to learn more about their Medicare choices, and gave BMA advocates and ambassadors an opportunity to learn new information through participation in weekly activities and quizzes.

Participation in Medicare Academy Month was phenomenal! Over 73,000 advocates tuned in to the series to learn more about Medicare Advantage by viewing graphics and short videos on Facebook and over 150 advocates competed for prizes by completing weekly quizzes.

With all points totaled, BMA congratulates the following advocates for their success in learning more about Medicare Advantage during Medicare Academy Month:

Thank you to everyone who participated throughout the month of July! Your dedication to learning more about Medicare Advantage and enhancing your role as an active chooser is so encouraging and much appreciated.

Looking to share what you learned with others? You can access resources from Medicare Academy Month online any time. Visit our website for more information.

Continued Advocacy During August Recess

During the month of August, members of Congress head out of Washington to return to their home districts. Many will be meeting with their constituents. Recess provides great opportunities for you to make sure your members understand and support Medicare Advantage by connecting with them locally!

To find events in your area, check out Town Hall Project, a web resource dedicated to helping you locate upcoming events with your elected officials. Want more information on Medicare Advantage to prepare for your discussions? Visit our website, where you can find our advocacy toolkit and other resources.

If you attend a townhall or event with your members during the August recess, we would love to hear about your experience! Contact us by email at community@bettermedicarealliance.org and we will connect for more information about the event and the feedback you received.

Join Our Task Forces

* Join our Medicare My Way Task Force

* Join our Medicare Advantage Retiree Plans Task Force

* Join the Keep Our Prescription Drugs Affordable Task Force

* Join the Protect Our Care Task Force

* Join our Chronic Disease Task Force

Featured Action: Share Your Story

BMA is proud to be a leading source for information on beneficiary experience in Medicare Advantage. Through your stories, comments, and letters, you help us understand what works well and where we as a community can advocate for improvements. This information is critical as we work to shape the future of Medicare today and in the days to come.

Our Top Advocates

  • Jose D. (Hialeah, FL)
  • Susan B. (Jefferson, TX)
  • Sharon R. (Fort Worth, TX)

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.