The Future of Medicare: Original vs. Advantage, Raising the Eligibility Age, Solvency, More

Some suggest that one way to level the playing field between original and Medicare Advantage is to let original Medicare offer the same extra services as MA, especially dental, vision and hearing. What are the prospects that that will happen?

I know the administration has made it clear how important it is that we continue to build on traditional Medicare and offer more services. We continue to look for ways to expand our authority. There have been two major expansions for traditional Medicare between the prescription drug benefit [in the Inflation Reduction Act (IRA)] and mental health services. 

The Medicare trustees say that the Medicare hospital insurance trust fund will be depleted by 2031. What do you think is the best way to assure the program’s solvency for the long term?

Stephen Voss

 Looking at Medicare solvency is something that policymakers have to do every couple of years. We’re very excited about the changes in the IRA [prescription drug enhancements] to make Medicare more affordable, both for the people who are on the Medicare program and for the taxpayers. Making sure that people are getting the services they need is an important element of making sure that the Medicare program is solvent.

Do you think that the eligibility age for Medicare will be raised in the next decade just as the age for full Social Security benefits has been raised? Would you favor such a move?

The most important thing is that we have everybody in America covered. We’ve just learned over the COVID 19 pandemic how important it is for people to have insurance so that they can get preventive care, access to vaccines, access to doctors and prescription drugs. I favor strengthening all of our programs and keeping expanding eligibility. That is where I would focus my attention, making sure that we continue to make sure that people have robust coverage. We’re at the lowest uninsured rate ever right now, and I think it’s critical that we continue to build on that progress.

Advocates and Medicare beneficiaries are increasingly concerned about Medicare Advantage requiring what’s called prior authorization before enrollees can get some medical services. What can CMS do to make sure prior authorization is not used as a tactic to provide less care to beneficiaries?

Prior authorization and its use in the Medicare Advantage plan has definitely been a focus for us. We have strengthened our rules and requirements around prior authorization as an area we will continue to monitor to make sure that it is being used as a tool to ensure the quality for Medicare beneficiaries and not negatively. 

We hear from AARP members all the time that they want to live out their lives at home in the community, not in a nursing home or other institution. What more can CMS do to make this possible?

The administration is focused on trying to make sure that people are getting care in the most appropriate setting. We have made some changes where we are encouraging community-based services particularly through the Medicaid program, which people who are eligible for both Medicare and Medicaid are able to take advantage of. The president has proposed and been supportive of additional expansions to home- and community-based services. The administration will continue to encourage Congress to give us more authority in that area.

What more can CMS do to help family caregivers, particularly when it comes to such things as helping caregivers have fuller access to the health care information they need to better care for their loved ones, including compensating doctors for training caregivers? So caregivers can actually sit with their loved one’s physicians and get a full picture of how they can care for their loved ones.

We’ve proposed expanding benefits for patient navigation services for community health workers who often are able to provide some of those additional services and help in making sure that people get access to the care that they need. We continue to look at our innovation center model authority and hear from stakeholders and try to support caregivers through that avenue as well.

A question on mental health services: People anecdotally tell us that while the benefit is there, it’s very difficult to find providers that will participate in Medicare when it comes to mental health. Is that something that you’ve seen, and is there some something that you can do to help people find mental health practitioners?

Making sure that we have a strong workforce is something that the entire administration is thinking about. Obviously people make their own decisions about going into health care as a profession, but we have been doing all that we can to fund additional residency positions, particularly in hospitals that serve the underserved, and about three-fourths of the positions are going to be for primary care and for mental health specialties to really encourage providers to go into those areas. There has been a focus on mental health across the administration in Medicare, including our mental health parity rule, which we announced earlier this year. So there are so many ways that we’re trying to think about how to support mental health services and mental health providers.​