Doug meets with Congressman MacArthur
There were several issues discussed this year at the conference and in meetings with our local Congress representatives. Two of the most important issues were also topics last year at the conference:
- Stabilize the Individual Market – the individual market makes up a small percentage of overall Americans (~6%), but the effects of this market can have detrimental impacts on the Group Market (170 million people covered). One of the key solutions is to allow states to be eligible for funding for new hybrid high-risk pools/reinsurance. The new pools would not issue coverage but would be available as a reinsurance mechanism to insure risk about certain levels for high-risk individuals who were enrolled after going longer than 60 days without coverage. This is critical because "82% of health case costs are driven by just 13% of Americans" with very high claims costs (Katy Spangler, Spangler Strategies). This reinsurance would allow for the premiums to not be impacted as severely by these high claimant individuals.
- Preserve the Employer Exclusion – As Congress tries to find money to support proposed legislations, one of the proposals is to cap or eliminate the tax deductions associated with employer-sponsored benefits. THIS WOULD BE DETRIMENTAL TO THE STABILITY OF THE GROUP MARKET (~170 million people covered) and would negatively affect middle-class Americans who currently benefit from this provision. The infographics below provide more information on the impacts of this proposed change.
Meeting with the House Ways & Means Committee
As a member of the Medicare Advisory Group of NAHU, Justin Lubenow had the opportunity to meet with the Ways & Means Committee. Three of the key Medicare topics we discussed were:
- Making Cobra Credible Coverage – Medicare-eligible individuals who sign up for Cobra don’t generally understand that Cobra is not considered credible coverage. This has significant impacts on Part B effective dates and Penalties when the Cobra coverage runs out. We worked closely with two Congressman in 2016 to get bi-partisan support of a bill that will improve the treatment of the “Cobra trap” . Unfortunately, before this bill could pass one of the Congressman lost his seat. I am excited to announce that we were able to work to get a new bill drafted just last week to amend title XVIII of the Social Security Act to provide for a special enrollment period under Medicare for individuals enrolled in COBRA continuation coverage, and for other purposes. This time we have four sponsors (two Republicans and two Democrats) and we are hopeful this bill could get passed this year!
- Allow Brokers to Support Medicare Advantage Clients - currently CMS (Centers for Medicare and Medicaid Services) regulates Medicare Advantage and Part D Prescription Plans preventing the carriers to speak with an agent/broker on behalf of a client. This is different from Medicare Supplements (and basically all other types of insurance) which allow an agent to speak to the carrier on behalf of the client. We are actively working on getting a bill put together that would fix this so that agents can properly support our clients with their Medicare Advantage and Part D Plans.
- Hospital Observation Status- There is an important provision with Medicare Part A Benefits that is creating unexpected bills for some Medicare Beneficiaries. Most people understand that Medicare Part A covers Hospital expenses… but Part A also covers Short-Term Skilled Facility Care, up to 100 days (20 days fully covered by Part A, Days 21-100 have a copay, which most Medigap Plans pay.) There is a nuance to qualify for the Short-Term Skilled Facility Care benefit. In order to qualify for this benefit, you must have been “Admitted” to the hospital for at least 3 days, and enter the Medicare-approved Skilled Nursing Facility within 30 days after leaving the hospital. For most people that get hospitalized for three days and need Short-Term Skilled Care, this is not a problem since they have been “Admitted” to the hospital. The people that are impacted are those that were never “Admitted” and kept in an “Observation” status, and then transferred to a Skilled Nursing Facility. These people are given a notice explaining that they will be responsible for the bills at the Skilled Nursing care, but most people are in too much pain/stress to really understand this information at the time. These people end up getting bills for thousands and thousands of dollars that are not covered by Medicare (or Medigap). This is a hot topic that we are continuing to work on with Congress and we hope to have a better solution drafted later this year so Medicare Beneficiaries don't keep getting stuck with these huge bills for skilled nursing care.
We will continue to lobby on behalf of protecting Healthcare benefits for Group Insurance, Individual Insurance, and Medicare Beneficiaries.
If you have any questions or would like more information about Medicare, or Medicare Plans, you can give us a call at the numbers below.