By Melissa Attias, CQ Roll Call
January 14, 2013 -- Individuals who get health insurance because of the overhaul law could see coverage gaps and unnecessary costs as they transition to Medicare if state and federal officials don't make proper preparations, according to a recent report from the Medicare Rights Center.
The report emphasizes the importance of developing "a thoughtful and comprehensive plan" that provides consumers with seamless coverage as the transition occurs, and it lays out recommendations to accomplish that goal. The health care law (PL 111-148, PL 111-152) creates brand-new transitions to Medicare, beginning in 2014, as individuals who obtain coverage because of the overhaul become eligible for the program, the authors note.
"Measures will be needed to help ensure seamless transitions into Medicare," Joe Baker, president of the Medicare Rights Center and a primary author of the report, said in a news release. "By taking these steps now, state and federal governments can help ensure that people who become eligible for Medicare are protected from gaps in coverage and unnecessary out-of-pocket costs that could put their health and economic security at risk."
The report advises states and the federal government to focus on three groups of people: those who receive coverage under the law's Medicaid expansion who cannot continue that coverage once they're eligible for Medicare, but may be eligible for other government subsidies; those who get Medicaid coverage as a result of the expansion who may still be able to remain in Medicaid once they join Medicare; and those who have private insurance coverage through the health care law's exchanges, some of whom may be getting federal subsidies to help pay their premiums.
Under the 2010 overhaul, states can extend their Medicaid programs to individuals under age 65 with annual incomes up to 138 percent of the federal poverty line with an enhanced federal match.
The authors call on states and the federal government to examine how the eligibility requirements and enrollment systems for Medicare line up with the new procedures set up under the overhaul for those without Medicare coverage. The law establishes "a streamlined and mostly automated eligibility determination and enrollment process" for plans offered through the exchanges and Medicaid, they write, but those eligibility provisions do not apply to Medicare.
The report suggests building on provisions in the health care law and other programs in order to help provide seamless transitions to Medicare. It recommends lining up and simplifying financial eligibility requirements, as well as application and renewal rules, and using electronic data-sharing. It also proposes updating the eligibility and enrollment systems for the entire Medicaid program and using outreach and education to provide clear and timely information about benefits and the enrollment process.
"To ensure a smooth transition to Medicare, federal and state policymakers must examine the potential pitfalls, complications and disruptions involved in that transition and must implement the solutions recommended above or propose other solutions that will help these individuals, especially those with limited incomes, maintain seamless, comprehensive and affordable coverage," the report says.
