The Issues

As of this writing, more than 565,000 Americans have lost their lives due to COVID-19 – with seniors and those with disabilities among those most at-risk. Better Medicare Alliance advocates for solutions to ensure Medicare Advantage has the tools it needs to keep seniors safe in this uncertain time.

• Report: “The COVID-19 Response: Differences in Medicare Advantage and Fee-For-Service Medicare in Meeting Beneficiary and Provider Needs” (November 4, 2021)
• Data Brief: “Medicare Advantage Sees Fewer Covid-19 Hospitalizations In Beneficiaries And Offers Greater Access To In-Person And Telehealth Non-Covid Care During Pandemic” (October 7, 2021)
• Fact Sheet: “Benefit Flexibilities Granted to Medicare Advantage Amid the COVID-19 Crisis” (January 12, 2021)
• Report: “The Impact of COVID-19 on Medicare Advantage Risk Scores and Payment” (November 5, 2020)
• Report: “Telehealth During a Time of Crisis: Medicare Experiences Amid COVID-19″(July 28, 2020)
• Report: “Spotlight on Innovation: The Response to COVID-19″(June 24, 2020)
• Fact Sheet: “Medicare Advantage Medical Loss Ratio” (June 19, 2020)
• Fact Sheet: “Benefit Flexibilities Granted to Medicare Advantage Amid the COVID-19 Crisis” (May 21, 2020)
• Letter: “Better Medicare Alliance Writes to HHS and CMS on Policies to Ensure Stability for Medicare Advantage Amid COVID-19” (April 27, 2020)
• Press release: “Better Medicare Alliance Secures Key Protections for Beneficiaries in CMS COVID-19 Announcement.” (March 31, 2020)

As a diverse community of Ally organizations and beneficiaries, Better Medicare Alliance has a keen focus on addressing racial disparities that persist across the health care spectrum and bringing the tools uniquely found in Medicare Advantage to bear in the effort to achieve true equality in health care.

• Data Brief: “Medicare Advantage Offers High Quality Care And Cost Protections To Racially And Ethnically Diverse Beneficiaries” (June 17, 2021)
• Press Release: “Better Medicare Alliance Statement on Racial Disparities and Violence” (June 2, 2020)
• BMA Op-Ed with National Black Nurses Association: “Racial Divide of Coronavirus is Real, So are Innovations That Can Help” (May 29, 2020)
• BMA Op-Ed with Daniel Dawes, Morehouse School of Medicine: “Racial inequality persists in health care, but this insurance plan is narrowing the gap” (January 21, 2020)
• Press Release & Convening Report: “Better Medicare Alliance Issues Report on Racial, Ethnic Disparities in Medicare” (December 11, 2019)

First proposed in early 2019, former President Trump’s administration revived this flawed plan shortly before leaving office. The rebate rule would effectively ban rebates used to lower the final cost of a drug from the list price offered by drug manufacturers. The previous administration’s own actuaries found that the plan could raise Medicare Part D premiums by 19 percent in the first year, and 25 percent in the decade thereafter. Further, a 2019 analysis from Avalere Health found that eliminating prescription drug rebates would “have the consequence of increasing beneficiary premiums and reducing benefit offerings by Medicare Advantage-Prescription Drug (MA-PD) plans.”

Better Medicare Alliance led the successful charge to shelve the rebate rule in 2019 and continues to stand in strong opposition to the measure. Recently, our efforts helped secure a one-year delay of the rule. Read more for our latest resources on the need to stop the flawed rebate rule and pursue real solutions to lower prescription drug costs that don’t carry unintended consequences for vulnerable seniors.

• Letter: “Letter: BMA Leads Over 20 Organizations in Opposing New Drug Rebate Executive Order” (September 1, 2020)
• Press Release: “Better Medicare Alliance decries executive order reviving flawed rebate rule” (July 24, 2020)
• Letter: “Better Medicare Alliance writes to HHS Secretary Alex Azar urging against restarting rebate rule efforts” (July 21, 2020)
• Report: “Impact of Proposed Rule to Eliminate Prescription Drug Rebates on Medicare Advantage Beneficiaries” (April 2019)
• Fact Sheet: “The HHS Rule to Eliminate Manufacturer Rebates in Part D Will Harm Medicare Advantage” (April 2019)

Telehealth is already improving access to health care across Medicare Advantage. Even before the onset of the COVID-19 pandemic, an actuarial analysis commissioned by Better Medicare Alliance found that over two-thirds of Medicare Advantage plans provided telehealth as a supplemental benefit. Now, with new flexibilities granted to ease adoption of telehealth in the face of the current COVID-19 crisis, a poll conducted by Morning Consult for Better Medicare Alliance finds that 91% of seniors on Medicare Advantage who use this technology report a positive experience.

• Letter: “BMA, More than 30 Health Care Leaders Urge Support for Audio-Only Telehealth” (April 15, 2021)
• Press Release: “Better Medicare Alliance Applauds Introduction of Bipartisan Legislation Supporting Audio-Only Telehealth” (March 24, 2021)
• Fact Sheet: “Telemedicine in Medicare Advantage” (January 12, 2021)
• Issue Brief: “Audio Only Telehealth Visits Essential for Use in Medicare Advantage Risk Adjustment” (August 3, 2020)
• Fact Sheet: “Audio Only Telehealth Visits Essential for Use in Medicare Advantage Risk Adjustment” (June 25, 2020)
• Blog Post: “BMA Seniors Tell us Their Telehealth Stories” (June 9, 2020)
• Letter: “Better Medicare Alliance writes to CMS on allowing audio-only telehealth visits for risk adjustment purposes” (June 2, 2020)
• Fact Sheet: “Benefit Flexibilities Granted to Medicare Advantage Amid the COVID-19 Crisis” (includes those related to telehealth) (May 21, 2020)

Better Medicare Alliance is leading the charge for solutions to streamline the Medicare enrollment process and ensure that all beneficiaries know of the option of Medicare Advantage so they can be active choosers in their health coverage. Already, our advocacy efforts led to additional anguage in the annual “Medicare & You” handbook that includes easy-to-read, upfront comparisons of Medicare Advantage and Traditional Medicare. We also worked with leaders in Congress like Rep. Jimmy Gomez (D-CA) to urge the Centers for Medicare & Medicaid Services (CMS) to increase the number of languages used in Medicare’s educational and enrollment materials.

• Op-Ed: “Open enrollment season for Medicare can be confusing but worth the effort” (November 6, 2020)
• Report: “Empowering Beneficiaries and Modernizing Medicare Enrollment” (October 1, 2020)
• Press Release: “Congressman Jimmy Gomez Leads Letter to Expand Medicare Language Access” (May 14, 2019)

In addition to individuals age 65 and older and people with disabilities, Medicare covers people with End-Stage Renal Disease (ESRD), also known as kidney failure. ESRD occurs when an individual’s kidneys permanently and completely stop functioning. By 2021, all Traditional Medicare beneficiaries with ESRD will be allowed to enroll in Medicare Advantage. While Better Medicare Alliance secured a number of key solutions to improve care for ESRD beneficiaries, a payment gap remains that could result in Medicare Advantage failing to recoup the full cost of these beneficiaries’ care. Accurate payment for ESRD enrollees protects all Medicare Advantage beneficiaries from higher costs or fewer opportunities to expand and improve supplemental benefits.

• Fact Sheet: “Expanded Access to Medicare Advantage for Individuals with End-Stage Renal Disease in 2021” (July 16, 2020)
• Press Release: “Better Medicare Alliance Urges Fairness for ESRD Patients, Backs Telehealth Reforms in CMS Advance Notice Letter” (March 6, 2020)
• Fact Sheet: “Understanding End-Stage Renal Disease Enrollment in Medicare Advantage for Medicare Beneficiaries” (January 24, 2020)
• Fact Sheet: “Preparing for End-Stage Renal Disease 2021 Enrollment into Medicare Advantage by Addressing Payment Adequacy” (January 14, 2020)
• White Paper: “Caring for ESRD Beneficiaries in Medicare & Medicare Advantage” (January 6, 2020 (updated and re-released July 20, 2020)
• Issue Brief: “Analysis of End-Stage Renal Disease Payment Adequacy in Medicare Advantage” (December 13, 2019)

Medicare Advantage is built on a value-based system in which Medicare Advantage health plans receive a per-member, per-month payment for each beneficiary’s care, and are tasked with using those dollars most effectively – incentivizing high quality, high-value care for the 24.2 million enrollees who trust Medicare Advantage with their health care needs.

Our President and CEO, Congresswoman Allyson Y. Schwartz, penned a four-part blog series for Health Affairs about how Medicare Advantage’s value-based structure works to serve beneficiaries, which you can read below:

• “The Value of Medicare Advantage: 21st Century Care” (February 4, 2020 – with ChenMed)
• “The Value of Medicare Advantage: Health Coverage as Unique as You” (February 19, 2020 – with National Minority Quality Forum)
• “The Value of Medicare Advantage: Coverage Security, Consumer Choice, and Lower Costs” (January 21, 2020 – with Oak Street Health)
• “The Value of Medicare Advantage: Understanding What’s at Stake” (January 7, 2020)

Additionally, Better Medicare Alliance publishes a report series entitled “Spotlight on Innovation” which has detailed advances in health care made possible by Medicare Advantage’s value-based structure. Recent reports include:

• Landmark Health Spotlight on Innovation (March 11, 2020)
• SCAN Health Plan Addresses Social Determinants of Health to Enable Medicare Advantage Beneficiaries to Live Independently (May 20, 2019)
• ChenMed & Patient-Centered Care for Medicare Advantage Patients (January 10, 2018)

Keeping consumer costs low for consumers is at the heart of Better Medicare Alliance’s mission, and is among the many reasons why more than 26 million Americans trust Medicare Advantage with their health coverage today. Survey data shows that Medicare Advantage beneficiaries report $1,640 less in total annual health expenditures than their Traditional Medicare counterparts. Read more about the cost savings found in Medicare Advantage below:

• Press Release: “Study: Medicare Advantage Saves Beneficiaries $1,640 Year, Delivering 40% Lower Cost Burden than Traditional Medicare” (March 30, 2021)
• Data Brief: “Medicare Advantage Outperforms Traditional Medicare on Cost Protections for Low and Modest Income Populations” (March 30, 2021)
• Report: “Medicare Advantage Provides Strong Financial Value to Beneficiaries as Compared to All Other Coverage Options” (May 13, 2020)
• Press Release: “Medicare Advantage Beneficiaries See Lower Costs Across Sites of Care” (May 13, 2020)

Special Needs Plans (SNPs) are a type of Medicare Advantage plan that specializes in care for the health care system’s fastest-growing and most costly and complex beneficiaries: frail, disabled, and chronically-ill Medicare beneficiaries. SNPs are authorized to tailor services and models of care to the unique population they serve through the Medicare Advantage framework.

• Spotlight on Innovation report: “Medicare Advantage Special Needs Plans” (August 7, 2017)
• Issue Brief: “Medicare Advantage Special Needs Plans” (July 28, 2017)

Three million American seniors will be denied critically important benefits like care coordination, vision, dental, hearing, and wellness programs. If Washington allows the Cap to stay in place seniors will be negatively impacted, facing higher costs and fewer benefits. At Better Medicare Alliance, we use the power of our allies to urge Congress and CMS to lift the cap, thus giving beneficiaries higher-quality care.

• Fact Sheet: “The Use of Benchmarks for Payment in Medicare Advantage and Necessary Adjustments” (February 24, 2021)
• Fact Sheet: “The Impact of the Medicare Advantage Benchmark Cap on Beneficiaries” (June 29, 2018)
• White Paper: “The Impact of the Medicare Advantage Benchmark Cap on Beneficiaries” (October 28, 2016)

BMA VICTORY: The Health Insurance Tax applied to individual policies, small groups, employers that are not self-insured, Medicaid managed care, Medicare Part D, and Medicare Advantage. Over 20% of the tax would have fallen on Medicare Advantage and Part D plans, likely resulting in an increase in premiums and/or cost sharing paid by seniors and other beneficiaries. Better Medicare Alliance led the successful fight for permanent repeal of the Health Insurance Tax in 2019, safeguarding millions of seniors from the threat of punishing taxes on the health coverage they depend on to stay well.