RISE summarizes the latest news involving Medicare, Medicare Advantage, and the Affordable Care Act.

Study: Unsatisfied with care access, rural enrollees in MA switch to traditional Medicare

More than one out of every 10 seniors enrolled in a Medicare Advantage (MA) who also lived in a rural area, switched to traditional Medicare during 2010-2016, according to a study published this week in Health Affairs from researchers at Drexel University’s Dornsife School of Public Health.

The switch was driven primarily due to low satisfaction with care access, researchers said in an announcement. By contrast, only 1.7 percent of rural traditional Medicare enrollees made the switch to Medicare Advantage during this period.

The findings, among the first to look at rates of switching between the two options among rural versus nonrural enrollees, found a similar, yet more muted, effect among nonrural enrollees, with 2.2 percent of traditional Medicare enrollees and 5 percent of MA enrollees making the switch.

Researchers said switching was most common among MA enrollees who experienced higher costs, such as hospitalization or long-term facility stay. Among those requiring more expensive services, rural enrollees were about twice as likely to switch from MA to traditional Medicare as nonrural enrollees (16.8 percent versus 8.3 percent), suggesting that limited provider options in rural areas were a major factor leading consumers to change their coverage plan.

“We studied 11 factors that might make someone switch their health insurance and found that much of this transfer from Medicare Advantage to traditional Medicare among rural residents came from limited provider availability. However, care quality or out-of-pocket costs played a limited role,” lead author Sungchul Park, Ph.D., an assistant professor in the Dornsife School of Public Health, said in the announcement. “It’s not that rural patients were sicker than nonrural patients, they might just have a much tougher time than their counterparts did when it came to finding an approved medical provider.”

Park said it is important to develop policies that provides incentives to the health care workforce to practice in rural areas. For example, loan repayment or forgiveness programs may attract needed health care professionals to areas of shortages. Also, the federal government could consider changing MA network adequacy standards for rural areas to make sure that there are enough providers included. Finally, offering a rural payment add-on for MA plans that operate in rural areas may improve access to high-quality MA plans among rural enrollees.

Eshoo: Make Medicare reimbursement for telehealth services permanent

Rep. Anna Eshoo (D-Calif.) told the Committee on Energy and Commerce during her opening statement at a hearing this week on the future of telehealth that she supports making Medicare reimbursement for telehealth services permanent. Eshoo, who serves as chair of the Subcommittee on Health and a member of the Subcommittee on Communications and Technology, said that she approved of the Department of Health & Human Services’ decision to waive many outdated rules and payment policies surrounding telehealth coverage in traditional Medicare during the public health emergency. More than 10 million Medicare beneficiaries were able to use telehealth from mid-March through early July 2020 because of those waivers. Once the public health emergency has lifted, the temporary policy changes will come to an end unless Congress takes action to make them permanent.

“I know telehealth isn’t the silver bullet for the deeper problems that exist in our health care system, but it does show promise for high-quality, innovative care if we intentionally create legislation that fits our nation’s needs. Now that Medicare beneficiaries and Americans are receiving this important benefit, we need to find a way to continue affordable telehealth access for seniors and other Americans,” she said.  

Although most of the witness testimony supported the permanent expansion of telehealth benefits, Frederic Riccardi, president of the Medicare Rights Center, urged restraint. He said the “beneficiary experience has been mixed. Some callers to our national helpline have reported greater access to care, while others are being left behind.”

Frank Pallone Jr., (D-N.J.), chair of the Committee on Energy and Commerce, agreed. In his opening statement, he said that although there are tangible benefits to telehealth, particularly during the pandemic, it’s important that the committee continue to investigate the impact of these changes on the health care system before enacting permanent policies.

Click here to listen to the hearing and read all written witness testimony.

Feds issue guidance to remove barriers to COVID-19 diagnostic testing, vaccinations

The Centers for Medicare & Medicaid Services (CMS), together with the Department of Labor and the Department of the Treasury, late last month issued guidance removing barriers to COVID-19 diagnostic testing and vaccinations and strengthening requirements that plans and issuers cover diagnostic testing without cost sharing.

This guidance states that private group health plans and issuers cannot use medical screening criteria to deny coverage for COVID-19 diagnostic tests for individuals with health coverage who are asymptomatic, and who have no known or suspected exposure to COVID-19. The testing must be covered without cost sharing, prior authorization, or other medical management requirements imposed by the plan or issuer. For example, covered individuals wanting to ensure they are COVID-19 negative prior to visiting a family member would be able to be tested without paying cost sharing. The guidance also includes information for providers on how to get reimbursed for COVID-19 diagnostic testing or for administering the COVID-19 vaccine to those who are uninsured.

CMS said the announcement should clarify the circumstances in which group health plans and issuers offering group or individual health insurance coverage must cover COVID-19 diagnostic tests without cost sharing, prior authorization, or other medical management requirements to include tests for asymptomatic individuals without known or suspected exposure to COVID-19. In addition, the guidance confirms that plans and issuers must cover point-of-care COVID-19 diagnostic tests and COVID-19 diagnostic tests administered at state or locally administered testing sites.

CMS: More than 200K Americans signed up for ACA insurance during special enrollment period

CMS announced that more than 206,000 Americans signed up for health insurance plans during the first two weeks (Feb. 15-Feb. 28) of the 2021 Marketplace Special Enrollment Period. The CMS report refers to the 36 marketplace states that use the HealthCare.gov platform for the 2021 coverage year. The special enrollment period was opened to all Americans in response to the COVID-19 public health emergency. If the pace keeps up, this special enrollment period could make a meaningful dent in the number of people uninsured, Larry Levitt, executive vice president of Kaiser Family Foundation, told the Associated Press. “The enrollment numbers so far are stronger than I would have expected,” he told the medial outlet. 

COVID relief package could bring major changes to the ACA

The $1.9 trillion coronavirus relief package, which passed the House on Saturday and is about to be debated on the Senate floor, contains big changes in the Affordable Care Act (ACA) , NBC News reports. The reforms include temporarily expanding subsidies to purchase insurance and making them available to people of all incomes. The plan would cap the maximum premium anyone is expected to pay at 8.5 percent of their income. Those with lower incomes would see a boost in tax credits. People who make less than 150 percent of the federal poverty line ($19,320 for an individual) would pay $0 in premiums for a benchmark plan. The media outlet also reports that the bill would boost incentives for states to expand Medicaid by having the federal government pick up the tab for new recipients.  

"These ACA changes have really flown under the radar and not attracted major opposition from Republicans," Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation, told NBC News.