The Government Wants To Make Medicare Benefits Available

Scalise Acknowledges Gop Plan To Change Social Security Medicare

BySteve Benen

The latest New York Times/Siena College poll asked respondents about the major issues facing the country. The volunteered responses highlighted familiar problems and challenges: the economy, inflation, the health of our democracy, abortion rights and so on. The future of programs such as Social Security and Medicare did not make the list.

That might be a mistake.

President Joe Biden recently warned the public that Social Security and Medicare would end up on the chopping block if Republicans make gains in this years midterm elections, and as regular readers know, plenty of prominent GOP voices from Wisconsin Sen. Ron Johnson to New Hampshires Don Bolduc to Rep. Buddy Carter of Georgia have bolstered Bidens claims.

It was against this backdrop that a member of the House Republican leadership broached the same subject yesterday morning. Bloomberg reported:

Representative Steve Scalise, the number two House Republican, defended his partys approach to Medicare and Social Security, which has become a campaign issue ahead of US midterm elections in November. Its a mis-characterization to say the GOP plans to cut the programs, Scalise said on Fox News Sunday.

For now, lets put aside the question of which party cared more about the future of Social Security a debate Republicans obviously cant win. Lets instead consider the two key elements of the broader debate.

Services Medicare Doesnt Cover

• Most long-term care. Medicare only pays for medically necessary care provided in a nursing home.
• Custodial care, if its the only kind of care you need. Custodial care can include help with walking, getting in and out of bed, dressing, bathing, toileting, shopping, eating, and taking medicine.
• More than 100 days of skilled nursing home care during a benefit period following a hospital stay. The Medicare Part A benefit period begins the first day you receive a Medicare-covered service and ends when you have been out of the hospital or a skilled nursing home for 60 days in a row.
• Homemaker services.
• Most dental care and dentures.
• Health care while traveling outside the United States, except under limited circumstances.
• Cosmetic surgery and routine foot care.
• Routine eye care, eyeglasses , and hearing aids.

Am I Eligible For Medicare

To receive Medicare, you must be eligible for Social Security benefits.

Part A Eligibility

Most people age 65 or older are eligible for Medicare Part A based on their own employment, or their spouse’s employment. Most people have enough Social Security credits to get Part A for free. Others must purchase it.

You are eligible for Medicare Part A if you meet one of the following criteria:

• You are eligible for Social Security or Railroad Retirement benefits, even if you do not receive those benefits.
• You are entitled to Social Security benefits based on a spouse’s, or divorced spouse’s work record, and that spouse is at least 62 years old.
• You have worked long enough in a federal, state, or local government job to be eligible for Medicare.

If you are under 65, you are eligible for Medicare Part A if you meet one of the following criteria:

• You have received Social Security disability benefits for 24 months.
• You have received Social Security benefits as a disabled widow, divorced disabled widow, or a disabled child for 24 months.
• You have worked long enough in a federal, state, or local government job and meet the requirements of the Social Security disability program.
• You have permanent kidney failure that requires maintenance dialysis or a kidney transplant.
• You are diagnosed with ALS or Lou Gehrig’s disease.

Part B Eligibility

If you are eligible for Part A, you can enroll in Medicare Part B which has a monthly premium.

Will I Need To Prove My Age?

Automatic Enrollment

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The Impasse Before And After The 2000 Presidential Election

In the wake of the bipartisan commission’s deliberations, Senator Breaux and Representative Thomas joined Senator Bill Frist on a series of proposals to include a prescription drug benefit as essentially an inducement for beneficiaries to shift from the traditional fee-for-service program to a private health plan. More liberal and moderate members of Congress introduced proposals for an independent outpatient prescription drug benefit in the Medicare program.

In addition, in his 1999 State of the Union address, President Clinton proposed his own plan for a voluntary outpatient prescription drug benefit available to all Medicare beneficiaries. A new Part D drug benefit premium would be established, providing subsidies for low-income beneficiaries with incomes below 150 percent of poverty. This plan introduced the idea of combining modest benefits for most if not all beneficiaries with stop-loss protection for the relatively few enrollees with catastrophic costs. Medicare would cover 50 percent of an enrollee’s first $5,000 in annual drug spending and 100 percent of any additional expenses .

Another reason for the deadlock was that the amount proposed in the president’s budget was only one-tenth of what the Congressional Budget Office projected that the Medicare population would spend on prescription drugs during that period. Heading into the 2002 election, Democrats reasoned that no benefit was better than an inadequate benefit.

What Does Original Medicare Cover

Original Medicare consists of Medicare Part A and Part B.

Medicare Part A generally covers inpatient hospital care, nursing facility care, nursing home care, hospice care and home healthcare.

Medicare Part B offers coverage for medically necessary and preventive care services. Essential medical services diagnose and treat health problems. It can include durable medical equipment , mental healthcare or ambulance services. Preventive care services are health treatments that prevent illness or detect problems early, like flu shots or cancer screenings.

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Keeping Your Coverage If You Move

If you are moving to another county or state, make sure your Medicare plan will still be in effect after you move.

If you have original Medicare, federal rules usually allow you to keep your Medicare supplement policy. There are exceptions to this if you have a Medicare Select plan or if you have a plan that includes added benefits, such as vision coverage or discounts that were available only where you bought the plan.

If you have a Medicare Advantage plan, ask the plan whether its available in your new ZIP code. If the plan isnt available, youll have to get a new one. You can switch to another Medicare Advantage plan in your new area or to original Medicare.

Cms Releases Analysis On 2022 Medicare Part B Premium Reexamination

Today, the Centers for Medicare & Medicaid Services released areportthat recommends cost savings from lower-than-expected Medicare Part B spending be passed along to people with Medicare Part B coverage in the calculation of the 2023 Part B premium. Earlier this year, Department of Health and Human Services Secretary Xavier Becerra instructedCMS to reassess the 2022 Part B premium amount in response to a price reduction for Aduhelm, a monoclonal antibody directed against amyloid for use in treating Alzheimers disease. Given the information available today, it is expected that the 2023 premium will be lower than 2022. The final determination will be made later this fall.

At the Secretarys direction, CMS reassessed the Medicare Part B premium and recommends that the identified savings be incorporated into the Medicare Part B premium for 2023, said CMS Administrator Chiquita Brooks-LaSure. Due to changes in the cost of Aduhelm and coverage since the premium was established, CMS recommends that the lower-than-anticipated spending in 2022 be incorporated into the 2023 Part B premium determination. The Biden-Harris Administration remains committed to lowering health care costs for beneficiaries by increasing price transparency, lowering the cost of prescription drugs, and connecting people to savings programs.

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How Much Do Medicare Part A And Part B Premiums Cost

Most people dont have to pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years while they were working.

Theres also no premium for Part A if:

• Youre receiving Social Security.
• Youve received disability benefits for at least 24 months.

There is a monthly premium for Part B, which is deducted from your Social Security or, for those who receive them, from their Railroad Retirement Board benefits. For 2022, the standard premium for Part B coverage is $170.10 – or higher, depending on your income.1

The Medicare Prescription Drug Improvement And Modernization Act Of 2003

At several points, participants close to the conference committee negotiations believed that another opportunity for reform would be missed. On November 15, however, the conferees reached agreement on a new version of H.R. 1, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The 678-page conference report included many of the features that had come to be widely accepted in earlier proposals, such as the discount card, additional assistance for low-income beneficiaries, a substantial gap in benefits for individuals with high drug costs , and the use of private pharmacy benefit managers in lieu of direct governmental regulation. Yet the bill reflected concession more than compromise, with the final provisions on some of the most controversial issues watered down so as to become almost meaningless to their proponents. This deepened rather than resolved cleavages that pitted Democrats against Republicans and, at times, Republicans against Republicans .

The final product included the following major provisions :

Here’s another bit of insanity: The bill pays private insurance companies to take elderly patients. You know how one of the tenets of conservative philosophy is that private companies can always deliver a product better and cheaper? So why does the Medicare bill offer billions in subsidies to private insurers to induce them into the market? That’s not competition that’s corporate welfare.

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Cobra Coverage From An Employer Plan

Federal and state law allows people who leave their jobs to continue their employer-sponsored health coverage for a period of time. Be aware of the following:

• You have an eight-month period after your employment ends to enroll in Medicare. If you dont enroll during that eight-month window, you might have to pay a penalty when you enroll.
• If youre in your Medicare initial enrollment period, you must enroll in Medicare during that time to avoid a possible penalty.
• If you dont buy a Medicare supplement policy during your open enrollment period, youll be able to buy some Medicare supplement plans within 63 days of losing your COBRA coverage.

Talk to your employer about COBRA and Medicare eligibility.

Ask If Your Doctor Accepts Assignment

Assignment is an agreement between doctors and other health care providers and Medicare. Doctors who accept assignment charge only what Medicare will pay them for a service. You must pay any deductibles, coinsurance, and copayments that you owe.

Doctors who dont accept assignment may charge more than the Medicare-approved amount. You are responsible for the higher charges. You also might have to pay the full cost of the service at the doctors office, and then wait to be reimbursed by Medicare.

Use your Medicare Summary Notice to review the charges. You get a Medicare Summary Notice each quarter. If you were overcharged and werent reimbursed, follow the instructions on the notice to report the overcharge to Medicare. The notice will also show you any deadlines to complain or appeal charges and denied services. If you are in original Medicare, you can also look at your Medicare claims online at MyMedicare.gov.

Medicare has a directory of doctors, hospitals, and suppliers that work with Medicare. The Physician Compare directory also shows which providers accepted assignment on Medicare claims.

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Medicare And Turning Age 65

When you or your dependent turns age 65 you are required to enroll in Medicare. Learn more about Medicare and what you have to do to keep your PEBB benefits.

Note: If you or your spouse or state-registered domestic partner is enrolled in Medicaid, please contact us, as this may affect your PEBB retiree health plan coverage.

Prescription Drug Policies In The Nixon Administration

Following submission of the task force’s report, Secretary Finch appointed a review committee headed by John Dunlop of Harvard University, the former chair of President Nixon’s health transition team who had been appointed secretary of labor. The committee convened in April and submitted its report on July 23, 1969. With only one dissenting voice from a representative of the pharmaceutical manufacturers, the committee endorsed a number of the task force’s recommendations. In particular, the Secretary of Health, Education, and Welfare should recommend an Administration decision for an out-of-hospital drug insurance program under Medicare .

The proposed regulations were very similar to those recommended by the task force in 1969. Such a policy stemming from a Republican administration came as a surprise, however, and illustrated how concerned policymakers were about rising medical costs. Weinberger’s announcement touched the pharmaceutical industry’s most sensitive nerves, endorsing generic substitutes for brand-name products and limits on reimbursement. Despite vigorous industry opposition, state laws were already changing to allow pharmacists to substitute cheaper, generic drugs for brand-name products. Now the federal government was adopting similar methods.

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The Long Wait For New Benefits

More than a decade passed before there was another major effort to introduce prescription drug coverage under Medicare. Even though the Democrats controlled both the legislative and executive branches of government in the wake of the Watergate scandal and the election of President Jimmy Carter in 1976, the energy crisis, a weak economy, and rising inflation precluded costly new initiatives . Inflation and growing unemployment were threatening the solvency of Social Security, and Congress responded by raising payroll taxes in 1977. Richard Himelfarb observed that

the economic troubles of this period transformed the politics of federal programs serving the elderly. Whereas the 1960s and early 1970s had been marked by significant expansion of federal aid to the aged, the late 1970s and 1980s constituted an era of scarcity in which public officials struggled to maintain the gains of an earlier era. In short, from the Carter years onward, legislators would face no more easy votes on programs affecting the elderly.

The End Of The Political Deadlock

The congressional elections in November 2002 produced a political alignment not seen since the 1950s: Republicans were now in charge of the White House, the House of Representatives, and the Senate. In addition, two of the Republicans most interested in Medicare reformthe new Senate Majority Leader, Bill Frist , and the House Ways and Means Committee chair, Bill Thomaswere in a position to give the issue priority and exert considerable control over the legislative process. It became increasingly likely, therefore, that Congress and President Bush would agree to add outpatient prescription drug benefits to Medicare and that Republican leaders would make every effort to link those benefits to broader restructuring of the Medicare program .

In February 2003 President Bush made a major shift in strategy and decided not to propose detailed legislation but instead to offer only the general structure of a Medicare reform, incorporating prescription drug coverage in an effort to increase Medicare’s reliance on private health plans. In doing so, Bush followed the advice of his congressional liaisons and Republican legislators who said they wanted to draft their own reform plan .

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The Enactment Of Medicare In 1965

The limited scope of the original Medicare benefits reflects the beating that President Harry Truman took at the hands of the American Medical Association after he introduced proposals for national health insurance between 1945 and 1948 and again after his election in 1948. The AMA launched a very well-funded and bitter attack on socialized medicine to defeat Truman and his congressional allies even after the Democrats regained control of the House of Representatives and the Senate in 1949 .

In 1951 the idea of a health insurance program for the elderly was initially proposed by Oscar Ewing, head of the Federal Security Administration. Between 1958 and 1965, the House Ways and Means Committee and the Senate Finance Committee held annual hearings on proposals to offer hospital insurance for the elderly. The hearings provided a battleground for pressure groups with deeply differing ideological views of the role of the federal government in any aspect of medical care . When the 1964 election produced a landslide victory for President Lyndon Johnson and the largest Democratic majorities in both houses of Congress since the 1936 election, the enactment of new medical assistance for the aged was no longer in doubt. This major shift in legislative power and President Johnson’s activist social policy agenda led to the prompt enactment of Medicare in the spring of 1965.

Prescription Drug Coverage In The Health Security Act

The next opportunity to add an outpatient prescription drug benefit in the Medicare program came in 1993 as part of the health security act proposed by President Bill Clinton . Adding a Medicare drug benefit was good policy and good politics: It would be extraordinarily difficult to guarantee comprehensive health benefits, including drugs, to all Americans under age 65 and not to do the same for senior citizens and the disabled, whose needs were generally higher. A new drug benefit might also rally the support of Medicare beneficiaries for the Clinton plan, or at least neutralize potential opposition, given that the plan called for savings in other parts of Medicare as a way to help pay for coverage of uninsured persons under age 65.

The proposed expansion of the Medicare program would include an outpatient prescription drug and biologics benefit as well as a guaranteed national benefits package for those under the age of 65. The Medicare drug benefit would become part of Part B, adding $11 per month to the premium. Beneficiaries would pay a $250 annual deductible and 20 percent of the cost of each prescription up to an annual maximum of $1,000. Low-income beneficiaries would receive assistance with cost sharing.

In the report describing the health security act, the Clinton administration made clear its strategy to contain the cost of the prescription drug benefit:

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