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Medicare Legislative Information



NAHU believes it is important to increase Medicare beneficiaries’ access to a wide range of Medicare health plan choices which meet their interests and economic circumstances. NAHU’s legislative effort and work with CMS also focuses on improving the ability of professional agent/brokers to service their Medicare clients. Americans have come to depend on Medicare as a core financial and health security element. NAHU looks forward to working with policymakers to ensure that all Americans have access to licensed professional health insurance agents and brokers who advocate for and support beneficiaries. There are more details on NAHU's effort in our Medicare Position Paper.

Below are bills related to Medicare NAHU is actively working on or monitoring. A link to get more information regarding cosponsors or participate in an NAHU Operation Shout is provided if one was prepared. Other supporting materials may accompany a bill for further insights.

The intersection between employer coverage and Medicare has blurred as employees over 65 remain at work longer. Then too, eligibility for Social Security full retirement age changed and full benefits are no longer available at age 65. Whether due to illness or spousal age difference or perhaps having met the plan year deductible, some over 65 employees opt for COBRA coverage when they decide to leave their employer. While it looks and feels the same, since premium responsibility is on the employee it is considered individual coverage. Then too, if a person on COBRA waits 12 or more months after being eligible for Medicare to sign up for Part B, they face a 10% penalty for life.

NAHU supports legislation to allow individuals over 65 enrolled in COBRA coverage to transition to Medicare Part B without a penalty by providing for a one-time special enrollment period.

H.R. 2564 | Reps. Kurt Schrader (D-OR) and Gus Bilirakis (R-FL)

Patients require a 3-day hospital stay to qualify for skill nursing care (SNF). Medicare beneficiaries who are placed in observation status do not qualify for meeting this requirement though they receive the same treatment and stay overnight. Some beneficiaries have had their status changed after receiving SNF services creating a financial burden. Furthermore, payment for drugs received in the hospital differs depending on your admission status, another potential financial hardship for seniors.

NAHU supports legislation to allow observation stays to be counted toward the three-day mandatory inpatient stay for Medicare coverage of a skilled nursing facility.

NEW! H.R. 3650 | Reps. Joe Courtney (D-CT) and Glenn Thompson (R-PA); Rep. Suzan DelBene (D-WA) and Ron Estes (R-KS)

NEW! S. 2048 | Sens. Sherrod Brown (D-OH), Susan Collins (R-ME), Sheldon Whitehouse (D-RI) and Shelley Moore Capito (R-WV)

Further reading: 

UPDATE! On December 21, 2020, Congress passed the BENES Act as part of the end-of-year omnibus package. The bill achieves three primary objectives:

  • The Coverage Gap Closure. The bill eliminates the up to seven-month-long wait for coverage that people can experience when they sign up for Medicare during the General Enrollment Period or in the later months of their Initial Enrollment Period. Beginning in 2023, Medicare coverage will begin the month after enrollment.
  • The “Exceptional Circumstances” SEP. It reduces barriers to care by expanding Medicare’s authority to grant a Special Enrollment Period for “exceptional circumstances.” A long-standing flexibility within Medicare Advantage and Part D, in 2023 this critical tool will be available to facilitate enrollments program-wide, enhancing beneficiary access and administrative consistency.
  • The Enrollment Alignment Study. To further maximize coverage continuity and ease transitions to Medicare, the bill directs HHS to identify ways to align Medicare’s annual enrollment periods. HHS is to present these findings in a report to Congress by January 1, 2023.

 

NAHU supports passage of the BENES Act including the House version introduced this Congress. We appreciate positive references to agents as well as other provisions that provide some clarity around first time enrollment in Medicare. The lack of coordination between federal agencies in disseminating concise and timely information to people regarding their eligibility responsibilities has left many with an unwelcome to Medicare penalty that is lifelong and unfair. The BENES Act would direct Social Security and other Federal agencies to provide Human Resource offices and consumers aging into Medicare, the information they need to make the right choices regarding their Medicare options.

NAHU signed on to a letter to the House Ways and Means Committee in support of the BENES Act.

H.R. 2477 | Rep. Raul Ruiz (D-CA)

HSA

Health Savings Accounts are tax-advantaged personal savings accounts used in conjunction with a qualified high-deductible health plan (HDHPs) to help pay for unreimbursed medical expenses. HSAs were authorized under the Medicare Prescription Drug and Modernization Act of 2003. Contributions to HSAs may be received from employers, individuals or any combination of both. Employer contributions are excludable from income and individual contributions are deductible, regardless of whether or not a taxpayer itemizes deductions. Employers may also offer HSAs as part of a section 125(d) cafeteria plan. Annual contributions are limited to the maximum annual federally established deductible amount, but individuals 55 an older can make additional contributions. HSAs are portable and belong to the individual; funds carry over to subsequent years.

Forthcoming legislation includes several provisions NAHU has advocated in recent years to address issues with HSAs and employer-sponsored coverage. The legislation seeks to promote flexibility, encourage innovation and expand access to HSAs by aligning HSA regulations with the most effective cost-containment strategies that will help consumers save money and stay healthy.

Specifically, the legislation would:

  • allow HSA plans to offer pre-deductible coverage of health services at onsite employee clinics and retail health clinics.
  • allow HSA plans to offer pre-deductible coverage for services and medication that manage chronic conditions.
  • permit the use of HSA dollars toward wellness benefits, including exercise and other expenses associated with physical activity.
  • clarify that employers can offer “excepted benefits” like telehealth and second-opinion services to employees with an HSA plan.
  • correct the definition of “dependents,” streamline FSA conversion and fix the prohibition on a spouse using an HSA.

H.R. 3796 | Reps. Ami Bera (D-CA) and Jason Smith (R-MO)