Advisory Council May 2021 Meeting Presentation: 24 Month Medicare Gap

ADVISORY COUNCIL ON ALZHEIMER'S RESEARCH, CARE, AND SERVICES

Monday, May 3, 2021

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Medicare and the 24 Month Gap in Coverage

Leslie Fried
Senior Director, Center for Benefits Access

National Council on Aging (NCOA)

• Vision
  • A just and caring society in which each of us, as we age, lives with dignity, purpose, and security
• Mission
  • Improve the lives of millions of older adults, especially those who are struggling
• Goal
  • Impact the health and economic security of 40 million older adults by 2030, especially women, people of color, LGBTQ+, low-income, and rural individuals

The work we do

• Resources
  • Trusted, unbiased information that enable older adults and their caregivers to take small steps that can have a big impact on their health and financial security
• Tools
  • Personalized, online support for individuals to find benefits, choose a Medicare plan, prevent falls, and plan for a healthy and secure life
• Best Practices
  • Technical assistance and support for professionals in community-based organizations who serve older adults every day
• Advocacy
  • A national platform and voice to fight against ageism--and to strengthen the federal programs we all depend on as we age

Medicare and Medicaid -- July 1965

• President Johnson signs Medicare and Medicaid into law
  • President Truman first called for a national health program in 1945
  • Medicare only for adults aged 65 and over
  • July 1, 1966 -- when Medicare hospital and physician services are covered, more than 19 million are already enrolled
  • Medicaid covers low-income individuals and is funded by federal and state governments

1972: Medicare Expanded to Under 65 on SSDI or ESRD

• Medicare and 24-month waiting period
  • President Nixon expands Medicare eligibility to two additional groups: individuals under 65 on Social Security Disability Insurance (SSDI) and those with end-state renal disease (ESRD)
  • For individuals under 65 and on SSDI, there is a 24-month wait from the date of eligibility for benefits
  • These changes added 1.7 million Medicare enrollees when they took effect
  • Why the wait? In 1972, Senate Finance Committee wanted to limit costs to Medicare trust fund and avoid cost shift from coverage for a disabled worker receiving benefits from a private group health plan

Medicare Waiting Period and ALS

• Signed into law December 2000, effective July 1
• Waiver of 24-month waiting period For Medicare coverage of individuals disabled with Amyotrophic Lateral Sclerosis (ALS)
• Five-month SSDI elimination 1/2021

Other Legislative and Administrative Actions

• Legislative Action
  • Medicare Modernization Act (2003) -- Part D and Low-Income Subsidy effective 2006
  • Affordable Care Act -- March 2010
  • Implementation phased in: Marketplaces, Medicaid expansion, elimination of pre-existing exclusion provisions
  • National Alzheimer's Project Act -- Jan 2011
  • Creates an Advisory Counsel for AD/ADRD
• Administrative Action
  • Prohibition of Medicare claims edits to deny coverage with people with Alzheimer's diagnosis (9/2001)
  • Creations of SSA Compassionate Allowance Initiative by SSA Comm. Astrue - 2007
  • Fast-tracks SSDI/SSI disability decisions for certain conditions
  • Early-onset Alzheimer's disease added to the list -- Feb 2010

Access to Health Care During the Waiting Period

• Health Insurance Access During the Waiting Period
  • Marketplace plans under the ACA
  • Medicaid -- either age, blind or disabled (ABD) or Medicaid expansion
  • Employer-based coverage
    • Family member's employer -- limited
    • COBRA - expensive

Considerations for Next Steps

• Gather additional and updated data to support policy proposals
  • Need data to determine health insurance/Medicaid coverage of SSDI individuals during the Medicare waiting period
  • Research on the health care costs and financial means to meet the needs, including through Marketplace, employer and Medicaid if available
  • Estimate the impact on the Medicare trust fund if eliminate or reduce the waiting period
• Explore improving Medicare services and coverage
  • Individuals with Alzheimer's and related dementias want to live at home as long as possible
  • Caregivers/family members require additional support to provide care at home and address SDOH
  • Long-term services and supports are not currently covered by Original Medicare but some Medicare Advantage plans are providing very limited services
  • Expanding Medicare coverage of respite coverage currently only available under the hospice benefit
  • Impact on national economy of caregivers leaving the workforce

Contact

Leslie Fried
Senior Director, National Council on Aging
Leslie.Fried@ncoa.org

National Council on Aging

Age+Action
2021 Virtual Conference
June 7-June 10