Highlighting Medicare Rights’ National Helpline Trends In March, the Medicare Rights Center released its annual helpline trends report outlining ongoing challenges facing people with Medicare, heard through nearly 17,000 calls to the National Consumer Helpline. The report, Medicare Trends and Recommendations: An Analysis of 2016 Call Data from the Medicare Rights Center National Helpline, reexamines the top three recurring issues heard on the helpline in prior years. Part B enrollment confusion, Medicare Advantage plan denials, and prescription drug costs continue to pose problems for people with Medicare. Samantha Morales, associate director of client services, and Julie Carter, federal policy associate, who authored the report, illustrate these trends with client stories. The stories and data highlight how helpline
counseling informs Medicare Rights’ work with partners, policymakers, and the Centers for Medicare & Medicaid Services (CMS) to address persistent issues and create change. Medicare Rights helpline counselors responded to over 1,000 questions about Medicare Part B enrollment in 2016. One client, Ms. B, was undergoing cancer treatment when she was left without health insurance due to misinformation from her employer about coordination of benefits with COBRA and Medicare. To help prevent enrollment mistakes like Ms. B’s, Medicare Rights developed the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act, bipartisan legislation which would modernize and simplify
the Part B enrollment process. Hearing the real life struggles of people with Medicare firsthand helps Medicare Rights prioritize clients’ concerns in our policy work. Similar to previous years, coverage- and denials-related calls were most common, representing 34% of all helpline calls in 2016. Many people with Medicare Advantage (MA) plans are denied coverage for receiving care from out-ofnetwork providers. Some live in rural areas far from in-network doctors, and others face long wait times. Questions related to Medicare affordability are also frequent, representing 20% of 2016 calls. “Specialty tier” prescription drugs in particular present challenges, as current regulations exclude them from
cost reductions. Medicare Rights urges a change to these rules that unfairly penalize people who need specialty drugs. We are listening to client needs, and we will continue our efforts to improve consumer education surrounding MA plans and to support health care affordability. Although Part B enrollment, Medicare Advantage plan networks, and prescription drug affordability remain persistent issues, Medicare Rights continues to work on behalf of its clients—and all people with Medicare—to address them. Its dedicated helpline staff and volunteers assist clients one at a time, while the policy team takes what they learn from the helpline to the nation’s capital to incite change for people with Medicare.
Trump Plan to Lower Drug Prices Could Increase Costs for Some Patients When President Trump unveiled his plan to lower prescription drug prices in a Rose Garden speech last month, he said he would inject more competition into the market by bolstering negotiating powers under Medicare. But experts analyzing the plan warn of a possible side effect: The proposal could significantly increase outof-pocket costs for some of the sickest people on Medicare. At the heart of the president’s plan is a proposal to switch some expensive drugs from one part of Medicare to another part — moving them from Part B, the medical benefit created in the original 1965 Medicare law, to Part D, the outpatient drug benefit added by Congress in 2003. Under Part D, the government contracts with private health insurance companies to manage the benefit and negotiate discounts with drugmakers. There is no such negotiation for
the drugs covered by Part B, which are administered by infusion or injection in doctors’ offices or hospital outpatient departments. But Medicare beneficiaries typically pay a larger share of the costs for Part D drugs. Many beneficiaries have supplemental insurance, such as a Medigap policy, to help pay their share of the bill for drugs covered under Part B. Medigap policies are not allowed to cover Part D expenses. AARP, the lobby for older Americans, and advocates for cancer patients are already expressing concerns. The problems are not inevitable, they say, but will be difficult to solve. “People may see a lot higher out-of-pocket costs if a drug moves from Part B to Part D,” said David M. Certner, the legislative policy director of AARP.
Under Part B, beneficiaries are generally responsible for 20 percent of the Medicare-approved charges for drugs and doctors’ services, but the most popular Medigap policies cover the beneficiary’s share. By contrast, in Part D, beneficiaries may be responsible for 30 percent of the cost of some drugs, or more, depending on the terms of coverage set by their drug plan. Another potential problem is that nine million Medicare beneficiaries who are enrolled in Part B do not have drug coverage under Part D. The White House has not said how their drug bills would be paid. Administration officials and Republicans in Congress often describe Part D — proposed by President George W. Bush and pushed through Congress by Republicans — as a success that shows the value of competition.
Benefits are delivered entirely by competing private health plans. “President Trump has called on us to merge Medicare Part B into Part D, where negotiation has been so successful on so many drugs,” said Alex M. Azar II, the secretary of health and human services. Dr. Steven B. Miller, the chief medical officer of Express Scripts, one of the nation’s largest pharmacy benefit managers, said he was confident that his company could save money for beneficiaries and the government if it could manage drugs now covered by Part B of Medicare. “Part D has been under budget every year, and member satisfaction is extraordinarily high,” Dr. Miller said. “It’s a very successful program. That’s why people are excited about moving drugs into Part D.” ...Read More
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