As the October 15 Medicare open enrollment period approaches, the Centers for Medicare and Medicaid Services (CMS) have announced a number of changes in Medicare procedures and coverage for calendar year 2021.
“More changes will be announced after this November’s election,” says Ensurem CEO Dave Rich, “some of them possibly substantial. To help seniors plan ahead, we’ve been carefully following the major candidates’ healthcare platforms and proposals.”
As to the current changes, Rich, whose company is a growing online multicarrier insurance brokerage firm, notes that for the first time, all Medicare-eligible patients suffering from end-stage renal disease will be allowed to enroll in Medicare Advantage plans.
Other changes include modification of data score targets to reflect disruption caused by the COVID-19 pandemic; a credit for Medicare Advantage providers serving certain rural areas; and expansion of the list of circumstances that could trigger a special enrollment period.
Looking ahead, Rich notes that Democratic presidential candidate Joe Biden’s campaign announced a somewhat detailed healthcare plan in July. Key proposals in the plan call for the federal government to:
- Lower Medicare age to 60. This would make roughly 20 million more people eligible for Medicare and would be funded by regular tax revenues.
- Install a government-run public option. The option would be available to anyone, including the uninsured, beneficiaries in the ACA exchange, and people dissatisfied with their employer-sponsored coverage.
- Boost the Affordable Care Act. The plan would reduce deductibles and co-pays for subsidized beneficiaries, as well as reduce the share of income subsidized households pay for coverage.
- Stop surprise billing. Biden says he would bar providers from charging out-of-network rates in situations where the patient has no choice of provider, such as emergency surgery and ambulance transport.
- Control prescription drug prices. Biden plans to repeal the exception that allows drug companies to avoid negotiating with Medicare over drug prices.
President Donald Trump’s proposed 2021 budget, announced in February, contains about $500 million in net Medicare spending reductions over 10 years, most of which would come from reducing payments to healthcare providers. In May, the Trump Administration and the Centers for Medicare and Medicaid Services announced finalized requirements designed to:
- Increase access to telehealth for services in Medicare Advantage plans;
- Expand the range of supplemental benefits for beneficiaries with a Medicare Advantage plan who have chronic diseases;
- Provide support for more Medicare Advantage options for patients living in rural areas; and
- Expand access to Medicare Advantage for patients with end-stage renal disease.
Regardless of the election’s results, says Rich, new Medicare enrollees in 2021 and beyond will face an increasingly broad array of choices. To help them evaluate those choices and make the best decision, Ensurem is developing artificial intelligence products that enable online product shopping and comparison.
These capabilities, Rich emphasizes, are designed to aid and supplement human expertise, not replace it. “Our technology,” he says, “is backed by a fully licensed and contracted contact center staffed with expert agents who can assist those requiring help beyond our online tools. By the end of the year, in fact, Ensurem will have nearly doubled its stable of in-house agents.”
Ensurem, headquartered in Clearwater, Fla., is a leading technology and product distribution company serving the massive U.S. senior market. For more information, visit Ensurem.com.