MEDICARE: RISKS & OPPORTUNITIES for 2019 _____________________________________ David Lipschutz, Associate Director/Senior Policy Attorney Center for Medicare Advocacy Health Action 2019 Conference January 25, 2019 Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org

The Center for Medicare Advocacy is a national non-profit law organization, founded in 1986, that works to advance access to comprehensive Medicare and quality health care _____________________________________________________ Headquartered in CT and Washington, DC With additional attorneys around the country Staffed by attorneys, advocates, nurses, and technical experts Education, legal analysis, writing and assistance Systemic change – Policy & Litigation Based on our experience with the problems of real people Medicare appeals Medicare/Medicaid Third Party Liability Projects Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org

Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org MEDICARE SNAPSHOT 60 million enrollees Roughly 2/3 of Medicare beneficiaries are in traditional Medicare 8 in 10 beneficiaries in traditional Medicare (81%) had some type of supplemental insurance, including employer-sponsored insurance (30%), Medigap (29%), and Medicaid (22%) Nearly 1 in 5 beneficiaries (19%)—6.1 million beneficiaries overall—had no source of supplemental coverage in 2016 (Kaiser Family Foundation) Over 1/3 of Medicare beneficiaries are enrolled in private Medicare Advantage (MA) plans Pros – one-stop shopping, some extra benefits, required oop cap Cons – limited networks, gatekeeper/prior auth, access to care (?) Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org

Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org FAVORING MA Policy Changes and CMS Efforts Favoring MA Law, regulations and policy Erosion of Medigap coverage, expansion of MA coverage (without corresponding expansion in trad. Medicare) New deregulatory efforts and MA “flexibilities” that make things more, not less, complex for beneficiaries CMS materials – including Medicare & You, online tools, outreach and enrollment materials (including email campaign) Overplay the pluses of MA and downplay any minuses in a manner that is highly misleading, at best Annual election period materials minimize or altogether omit reference to trad. Medicare as an option Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org

PROGRAMMATIC CONSIDERATIONS Limited data about beneficiary experiences in MA Mixed health and quality outcomes After ACA, costs more in line with trad. Medicare but still paid more, on average, due to quality bonuses, questionable risk adjustment practices New England Journal of Medicine article (Nov. 2018) “[w]ithout much fanfare, Medicare has evolved into a program that provides benefits that are more generous to beneficiaries in [MA] plans than to their counterparts in traditional Medicare.” Assuming MA enrollment continues to grow, “the Medicare of tomorrow could look much different than it does today – more like a marketplace of private plans, with a backup public plan, and less like a national insurance program.”   Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org

COVERAGE EXPANSION PROPOSALS Medicare For All, Medicare Buy-In Is it “Medicare”? Does it keep current system in place, including MA? Does it keep current coverage or expand coverage? Does it lead to any unintended consequences? Our position – improve Medicare now Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org

Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org IMPROVE MEDICARE Create parity between MA and trad. Medicare Expand Medigap rights Add out-of-pocket limit to trad. Medicare Ensure all benefits in MA available in trad. Medicare Address barriers to care Observation status, access to home health care, DME, etc. Improve low-income protections Ease transitions from other insurance Expand coverage Oral health, vision, hearing, long-term care Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org

Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org RESOURCES CMA Weekly Alert re: NEJM article re: Medicare Advantage (November 2018): https://www.medicareadvocacy.org/important-health-policy-article-published-in-new-england-journal-of-medicine-medicare-advantage-checkup/ CMA Weekly Alert re: Tipping the Scales Towards MA Plans (March 2018): http://www.medicareadvocacy.org/tipping-the-scales-toward-medicare-advantage/ CMA “Special Report: Recent Changes in Law, Regulations and Guidance Relating to Medicare Advantage and the Prescription Drug Benefit Program”(September 2018), available at: http://www.medicareadvocacy.org/special-report-recent-changes-in-law-regulations-and-guidance-relating-to-medicare-advantage-and-the-prescription-drug-benefit-program/ CMA Weekly Alert “As Medicare Enrollment Period Draws to a Close, MA Steering Continues – Advocates & Members of Congress Write Letters of Concern to CMS” (October 2018): http://www.medicareadvocacy.org/as-medicare-enrollment-period-draws-to-a-close-ma-steering-continues-advocates-members-of-congress-write-letters-of-concern-to-cms/ CMA and National Committee to Preserve Social Security and Medicare (NCPSSM) – Medicare Fully Informed Project: https://www.medicareadvocacy.org/medicare-fully-informed-project/ Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org

Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org RESOURCES (cont’d) CMA Medicare Platform for a New Congress (December 2018): https://www.medicareadvocacy.org/core-considerations-for-medicare-for-today-tomorrow-a-medicare-platform-for-the-new-congress/ Kaiser Family Foundation - Medicare-for-All and Public Plan Buy-In Proposals: Overview and Key Issues (October 2018): https://www.kff.org/medicare/issue-brief/medicare-for-all-and-public-plan-buy-in-proposals-overview-and-key-issues/ Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org

For further information, or to receive the Center’s free weekly electronic newsletter, CMA Alert, update emails and webinar announcements, contact: Communications@MedicareAdvocacy.org Or visit MedicareAdvocacy.org ___________ (860) 456-7790 (CT) (202) 293-5760 (DC) Copyright © Center for Medicare Advocacy - MedicareAdvocacy.org