Coalition’s plan to shift Medicare enrollment responsibilities from SSA to HHS and initiate earlier beneficiary engagement draws praise from America’s Physician Groups, Consumer Action, Blue Cross Blue Shield Association
Washington, D.C. – Better Medicare Alliance (BMA), the leading research and advocacy organization supporting Medicare Advantage, unveiled a new white paper today with a set of comprehensive recommendations to reimagine Medicare enrollment, empowering beneficiaries to make better sense of their options and become active choosers in their health coverage.
The coalition’s five-pronged plan, entitled “Empowering Beneficiaries and Modernizing Medicare Enrollment” was developed in consultation with a wide array of stakeholders and beneficiary advocates, addressing key challenges in the current enrollment process and offering bold recommendations for reform, including shifting all Medicare enrollment responsibilities from the Social Security Administration (SSA) to Department of Health and Human Services (HHS).
“The limitations of our current Medicare enrollment process do a disservice to our nation’s seniors, too often leaving new entrants uncertain and unable to make decisions that would benefit their health and well-being. Nearly half of all Medicare beneficiaries don’t know about Medicare Advantage at their first open enrollment, possibly defaulting into a fee-for-service system that may not best suit their health needs and financial circumstances. Countless others face punishing fines for missing enrollment deadlines of which they were simply unaware,” said Allyson Y. Schwartz, President and CEO of the Better Medicare Alliance. “Even as changes have been made to improve the information available to beneficiaries, confusion and difficulty remain. With over 10,000 people turning 65 years every day in our country, we can do better. Through simple steps like beginning outreach to beneficiaries on their 64th birthday, deploying a standardized training and certification program for State Health Insurance Program (SHIP) counselors across all states, providing information to employers and employees, translating Medicare resources to meet the needs of our increasingly diverse senior population, and moving enrollment responsibilities to HHS, our white paper presents a vision for a modernized enrollment process that empowers beneficiaries with the information to make the right coverage choice at the right time for their unique health care needs.”
The Problem: Medicare beneficiaries face a confusing enrollment process that is further complicated by the lack of a single government entity responsible for the entire Medicare enrollment process and the difficulty in being able to fully compare coverage options. While the Centers for Medicare and Medicaid Services (CMS) administers the Medicare program, individuals must apply for Medicare through the Social Security Administration (SSA). Making the wrong enrollment choice or not acting at all has consequences that can include financial penalties or higher costs, as well as the loss of coverage or continuity of care.
Nearly half of all seniors on Medicare were unaware of the option of Medicare Advantage during their first open enrollment, according to a 2019 Morning Consult poll. Seniors who do not make a coverage determination default into Traditional Medicare where they may face high out-of-pocket costs.
A study published in Health Affairs found that 53 percent of seriously ill Traditional Medicare beneficiaries “reported having a serious problem paying a medical bill of any kind.” Likewise, analysis from ATI Advisory found that 37.8% of Traditional Medicare beneficiaries between 100-199 percent of the Federal Poverty Line report being cost-burdened by the cost of health coverage, more than double the percentage of Medicare Advantage beneficiaries who report the same challenge.
The Solution: Better Medicare Alliance’s white paper offers a five-part plan to redesign the Medicare enrollment process:
- Designate HHS as Solely Responsible for Medicare Enrollment: Congress should designate HHS as solely responsible for the entirety of the Medicare program, encompassing both administration and enrollment.
- Standardize and Modernize Educational Materials for Current and Prospective Beneficiaries: CMS should ensure that all materials provided by the Agency or organizations affiliated with the Medicare program are appropriately branded as official resources. Unaffiliated entities seeking to market themselves as Medicare educators should be required to meet specified requirements and undergo CMS review. Materials that meet the new CMS requirements would be able to include a seal of approval indicating that it meets CMS’ standards of accuracy and completeness.
- Redesign, Simplify, and Tailor the Notice of Medicare Benefits: CMS should continue to revise and update the Medicare & You handbook to ensure that different language, health, and socioeconomic needs are met and that materials are fully accessible and understandable to the increasingly diverse senior population. CMS should also prioritize translating the handbook and the online tool, Medicare Plan Finder, into additional languages to meet the needs of today’s Medicare population.
- Initiate Beneficiary Engagement and Education at Age 64: Congress should extend the timeline for beneficiary engagement and education to begin at age 64. Upon a future beneficiary’s 64th birthday, CMS should issue an official notice regarding upcoming Medicare eligibility that directs them to the appropriate tools and resources to begin the education process. Additionally, materials should be provided to public and private employers to offer standardized and current information to workers upon the employee turning age 64.
- Modernize a Single Comprehensive Tool to Compare all Coverage Options: CMS should build off the work already done on the Medicare Plan Finder tool to modernize this resource into a single comprehensive tool that allows beneficiaries to evaluate Traditional Medicare, Medicare Advantage, and Medigap options in their area to facilitate informed decision making. This tool should incorporate filters to allow beneficiaries to tailor their search based on their unique circumstances such as income or chronic condition, and take into account factors such as out-of-pocket costs, provider network, supplemental benefits, programs for specific conditions or disease states, and quality ratings.
Health care leaders and consumer advocates praised Better Medicare Alliance’s recommendations, including:
“Driving down health care costs and improving health outcomes starts with clearing away the confusion to give beneficiaries actionable, understandable information about their health coverage options,” said Don Crane, President and CEO of America’s Physician Groups. “On behalf of our more than 300 medical groups, independent practice associations, and integrated healthcare systems across the nation, we applaud these recommendations to fundamentally redesign the Medicare enrollment process and urge action from CMS and consideration by Congress to implement these solutions.”
“Every day, Americans experience firsthand the challenges and confusion that comes with enrolling in Medicare, from when to enroll to understanding what’s covered,” said Justine Handelman, Senior Vice President, Office of Policy and Representation for the Blue Cross Blue Shield Association. “Enrolling in Medicare should be a simple and easy process, which leaves beneficiaries with the peace of mind that they can get the care they need when they need it. That’s why we commend Better Medicare Alliance’s common-sense recommendations and support their enactment.”
“As an organization committed to empowering underrepresented consumers nationwide, Consumer Action is proud to support these recommendations to bring needed clarity to the Medicare enrollment process,” said Ken McEldowney, Executive Director of Consumer Action. “Seniors on fixed incomes deserve to be able to get the best bargain for their health coverage possible and should not be subjected to costly penalties stemming from the confusion of the current system. We thank Better Medicare Alliance for offering a way forward that puts the consumer first.”
Read the full whitepaper HERE.