RISE summarizes recent headlines that impact Medicare and Medicare Advantage.
House Democrats meet to markup $3.5T spending proposal, including offering dental benefits to Medicare enrollees in 2028
The House Ways and Means Committee will consider several legislative proposals this week under the budget reconciliation process to expand the social safety net, including adding vision, dental, and hearing benefits to traditional Medicare, under the $3.5 trillion infrastructure package, known as the Build Back Better Act. The panel will meet on Thursday and Friday to markup the legislation.
“This is our historic opportunity to support working families and ensure our economy is stronger, more inclusive, and more resilient for generations to come,” House Ways and Means Committee Chairman Richard E. Neal (D-Mass.) said in a statement.
The language for the legislation was released Tuesday and proposes to add vision and hearing benefits to original Medicare in 2022 and 2023, respectively, and offering dental benefits beginning in 2028. If the legislation as written becomes law, Medicare would cover two dental cleanings a year as well as other preventive services; basic treatments such as tooth extractions; and major treatments like bridges, crowns, and root canals.
Nearly half of Medicare enrollees go without dental care, according to a recent study, because of lack of coverage and costs. Although the additional benefits would be welcome to Medicare enrollees, a recent analysis from the Wakely Consulting Group, funded by AHIP, found that adding dental, hearing, and vision benefits to traditional Medicare without adjusting the benchmark for Medicare Advantage (MA) could result in fewer benefit dollars for MA plans to pay for supplemental benefits.
In 2019, the Congressional Budget Office estimated that it would cost $358 billion to add dental, vision, and hearing coverage to Medicare.
HHS releases proposal to lower prescription drug costs
The Department of Health and Human Services (HHS) this week released its “Drug Pricing Plan,” which aims to make prescription drugs more affordable by promoting negotiation, competition, and innovation in the health care industry.
“Life-saving prescription medication should not cost anyone their life savings. Yet too often, many low-income families cannot take their prescription medications because of cost concerns,” HHS Secretary Xavier Becerra said in the announcement.
Americans, he said, pay too much for prescription drugs–more than $1,500 per person–and pay prices that are far higher than any comparable nation. Prices for brand name drugs are rising faster than inflation. As a result, many Americans don’t take medications as prescribed because of their cost, with resulting harm to their health care and health. Lack of competition is a key factor in these high drug costs, he said.
The plan calls for legislation to allow the HHS secretary to negotiate Medicare Part B and Part D drug prices directly with pharmaceutical companies and make those prices available to other purchasers. This approach would generate reductions in patient cost-sharing and large savings for patients, government, and commercial payers, according to Becerra.
Other legislative and administrative actions in the plan would lead to a reduction in prices the federal government pays for prescription drugs; curb brand drug manufacturers’ abuse of patents and exclusivities to avoid competition; increase transparency for patients and across the drug industry; enhance domestic pharmaceutical supply chains; and address price gouging.
Click here for an executive summary about the plan and here for the full HHS plan.
Health Affairs study: MA double bonuses fail to improve quality, foster racial disparities
A new study published in the September issue of Health Affairs examines the Medicare Advantage (MA) quality bonus payment program, particularly plans in eligible counties that receive “double bonuses.” Researchers, led by Adam A Markovitz, an internal medicine resident at the University of Michigan, used national data over a 10-year period (2008-2018) and determined that the double bonuses didn’t lead to improvements in plan quality or increased MA enrollment. In fact, they found that Black beneficiaries were less likely to live in eligible counties and plans given increased payments received $31 less to care for Black beneficiaries compared to white beneficiaries. The findings suggest that double bonuses fail to improve quality and enrollment and foster a racially inequitable distribution of Medicare funds. Eliminating the double bonuses could save Medicare $1.8 billion per year, researchers said.