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Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to preserve and expand consumer protections and quality coverage for all Medicare Beneficiaries – including parity between traditional Medicare and private Medicare plans. We previously wrote about limited access to Medigap plans, oral health care, and the lack of an out-of-pocket cap on beneficiary expenses in traditional Medicare.

One long-standing and significant gap in Medicare coverage is the lack of coverage for comprehensive long-term services and supports (LTSS, also known as long term care).  As discussed in a Center Special Report issued in September 2018, recent changes in law (namely the Bipartisan Budget Act of 2018, or BBA) and CMS policy have expanded the scope of both medical and non-medical services that Medicare Advantage (MA) plans can cover.  While MA coverage of LTSS appears limited so far, as noted in an AARP blog, this important extension of coverage leaves behind the majority of beneficiaries in traditional Medicare. 

This month, the Commonwealth Fund issued two companion reports exploring LTSS and Medicare beneficiaries: “Are Older Americans Getting the Long-Term Services and Supports They Need?” and “The Financial Hardship Faced by Older Americans Needing Long-Term Services and Supports”.

As summarized in the key findings of the report exploring financial hardship, 

Beneficiaries with high LTSS needs have higher Medicare and out-of-pocket spending than those without such needs and are more likely to report that medical care makes up part of their credit card debt. Those with high LTSS needs are also more likely to report trouble paying for food, rent, utilities, medical care, and prescription drugs. Many older Medicare beneficiaries using LTSS are vulnerable to incurring substantial costs. Without an affordable, sustainable financing solution, Medicare beneficiaries with LTSS needs will continue to be at greater risk of delaying necessary care, being placed in a nursing home prematurely, and having to “spend down” into the Medicaid program.

The report highlighting the need for such services finds that “[t]wo-thirds of older adults living in the community use some degree of LTSS.”  Noting that the “recent policy change allowing MA plans to offer LTSS benefits is an important step toward meeting the medical and nonmedical needs of Medicare beneficiaries, only the one-third of Medicare beneficiaries enrolled in MA plans stand to benefit.” Looking “[b]eyond the BBA” and policy that only expands LTSS in MA, the report notes that “other proposals could provide more flexibility (as well as broader accountability) in the traditional Medicare program to ensure the health and well-being of most Medicare beneficiaries.”

The Center agrees. It is imperative that beneficiaries in traditional Medicare have access to all the same coverage provided through Medicare Advantage plans. The Medicare program as a whole must be expanded to cover critical long term coverage/LTSS needs.

January 2019 – D. Lipschutz

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