Medicare Modernization (Parts C and D)

State of Play:  With Democrats taking control of the House of Representatives in the 116th Congress, Medicare for All will likely be a more prominent debate; but Democrats overall are not unified in supporting the policy.  The Trump administration began discussing the disadvantages of Medicare-for-All just after the November elections.  The administration continues to tout private-sector successes in the Medicare program.  According to the Centers for Medicare and Medicaid Services (CMS), the average Medicare Advantage (MA) monthly premium decreases by $1.81 to $28 while the average monthly premium for a basic Medicare Part D prescription drug plan falls by $1.08 to $32.50 for the 2019 calendar year.  The average number of MA plan choices per county has increased by five to about 34, with MA enrollment increasing to 22.6 million, about 36 percent of Medicare beneficiaries. 

HLC Position:   HLC continues to advocate for the Medicare program’s modernization through tools that have been developed and used successfully in the private sector and adopted for use by the MA and Part D programs.  HLC also supports continued steps to make the consumer-focused MA program, with its emphasis on coordinated care and disease prevention and management, the preferred alternative for Medicare beneficiaries.  These types of thoughtful, beneficiary-centered changes are a better path to cost reduction than the arbitrary cuts that would have been imposed by IPAB if the board had not been repealed.   

HLC Recent Activity:

  • On December 31, HLC submitted comments on Centers for Medicare and Medicaid Services (CMS) Medicare Advantage and Part D flexibility proposed rule, providing recommendations for telehealth, dual eligible special needs plans, quality star rating system, and risk adjustment data validation provisions.
  • On December 31, HLC wrote the Department of Health and Human Services (HHS) Secretary Alex Azar and CMS Administrator Seema Verma expressing concerns about the International Pricing Index model for Part B drugs proposed rule.
  • On December 11, HLC’s executive committee met with HHS Deputy Secretary Eric Hargan to discuss regulatory efforts on the risk adjustment rules (RAD-V), to ensure that consumers in the insurance market can have a robust choice of plans without facing pricing instability.
  • In December, HLC signed onto a coalition letter with the National Osteoporosis Foundation in support of Medicare Part D’s noninterference clause, rejecting calls in Part D drug negotiations.
  • On October 26, HLC President Mary Grealy released a statement on the International Pricing Index model for Part B drugs, stating increasing competition, not importing price controls, is key to bolstering affordability of medicines.
  • HLC has finalized the high-need beneficiary playbook for improving care for high-need, high-cost patients and has begun distribution to congressional offices and other health policy thought leaders and staff. This playbook includes recommendations to improve access to Medicare Advantage, which can provide more care coordination and better outcomes.
  • On September 10, HLC signed onto a letter with the Diabetes Advocacy Alliance (DAA) providing comments related to the CMS CY 2019 Physician Fee Schedule Proposed rule.
  • On August 30, HLC presented Medicare Today’s annual survey results to participants on the National Osteoporosis Foundation’s Protect Part D Working Group conference call.
  • On August 15, HLC’s Medicare Today coalition released the annual nationwide survey by Morning Consult of Americans age 65 and older. The survey found that 85 percent of beneficiaries are satisfied with their Medicare Part D prescription drug coverage, with over eight out of 10 saying their Part D plans provide good value.
  • On August 10, HLC posted a blog highlighting the reduced premiums for the Medicare Part D prescription drug program that CMS announced for 2019 and pointing out the need to address the impending Medicare “Part D cliff.”
  • On July 25, HLC highlighted on its blog a recent Avalere Health study that shows Medicare Advantage beneficiaries experience better health outcomes at a lower cost than those beneficiaries in Medicare fee-for-service.
  • On July 23, HLC joined other Better Medicare Alliance members in sending a letter to Representatives Mike Kelly (R-PA) and Ron Kind (D-WI) in support of their legislation, the “Improving Seniors Access to Quality Benefits Act,” which calls for a study of the impact of the benchmark cap on Medicare Advantage plans.
  • In HLC’s July 13 response to Health and Human Services’ request for information regarding drug pricing, the letter suggested broader exceptions to fraud-and-abuse laws to allow manufacturers’ participation in value-based arrangements in Medicare.
  • On June 1, HLC joined other healthcare organizations on a letter to the Centers for Medicare and Medicaid Innovation (CMMI) asking for expeditious attention in implementing the Medicare Access and CHIP Reauthorization Act (MACRA), regarding physician participation in risk-bearing advanced alternative payment models (APMs).
  • In June, Medicare Today released an infographic and video about the out-of-pocket cliff coming in 2020 in Medicare Part D.
  • HLC updated its “red tape” list of suggested regulatory reforms, including the relief of burdens on Medicare providers and beneficiaries. HLC met with the Department of Health and Human Services (HHS) to share this list and provided it to the House Ways and Means Committee, the Senate Health, Education, Labor, and Pensions (HELP) Committee, and members of Congress.
  • During regional advocacy meetings, HLC educates members of Congress on the importance of not reducing MA rates.
  • HLC is a member of the National Osteoporosis Foundation’s Protect Part D Working Group.