releases: https://web.archive.org/web/20140309084959/http://rothfus.house.gov/index.cfm?sectionid=25&itemid=632
Data license: MIT · Data source: dwillis/congress-press
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| https://web.archive.org/web/20140309084959/http://rothfus.house.gov/index.cfm?sectionid=25&itemid=632 | Policy Member Spotlight: Rep. Keith Rothfus (R-PA) – H.R. 2453, The Medicare Beneficiary Preservation of Choice Act | 2013-12-13 | 2013 | 2013-12 | Republican | House | PA | Keith Rothfus | R000598 | web.archive.org | legacy | Policy Member Spotlight: Rep. Keith Rothfus (R-PA) – H.R. 2453, The Medicare Beneficiary Preservation of Choice Act H.R. 2453, the Medicare Beneficiary Preservation of Choice Act, introduced by Rep. Keith Rothfus (R-PA), restores the 90-day Medicare Advantage open enrollment period from January 1 to March 31. The bill currently has 13 cosponsors. What is Medicare Advantage? Medicare Part C, also known as Medicare Advantage (MA), provides private plan options to Medicare-eligible beneficiaries. Approximately 14.8 million individuals, 28 percent of all Medicare beneficiaries, are enrolled in MA plans, which include health maintenance organizations, preferred provider organizations, private-fee-for-service plans, and special needs plans.[1] In the MA program, payments are made to private plans on behalf of beneficiaries from both the Health Insurance Trust Fund (HI) and the Supplemental Medical Insurance (SMI) fund.[2] In 2012, approximately $136 billion from both the HI and SMI funds was directed toward MA plans.[3] Enrollment in MA plans has grown over the years from 1.3 million in 1985 to 14.8 million in 2013.[4] Studies have identified the MA program as more effective than the traditional fee for service,[5] particularly among those individuals with chronic conditions and those individuals who reside in rural areas.[6] What is the Problem? Prior to 2011, in addition to the general enrollment period for all Medicare plans from October 15 until December 7, Medicare beneficiaries were able to switch between MA plans during a 90-day open enrollment period from January 1 through March 31.[7] In 2011, CMS, through regulations, replaced the second enrollment with an annual 45-day disenrollment period.[9] During this period, seniors are not permitted to switch MA plans; instead they are required either to stay in their current plan or switch back to traditional Medicare plans (Part A and Part B). MA beneficiaries may switch between MA plans during the October 15th-December 7th Annual Open Enrollment Period. In November, the Wall Street Journal reported that UnitedHealth Group Inc., “the nation’s largest provider of privately managed MA plans,” had dropped thousands of doctors from its networks, citing “significant changes and pressures in the health-care environment.”[9] These notices allow doctors to appeal within 30 days. However, the length of the appeal process means that patients will not know who is in their network until after the December 7th enrollment deadline passes. This development has left thousands of seniors uncertain about whether they need to change MA plans in order to see their current doctor and unable to make necessary changes to their health care coverage. What is the Medicare Beneficiary Preservation of Choice Act? H.R. 2453, the Medicare Beneficiary Preservation of Choice Act, restores the 90-day MA open enrollment period at the beginning of the year, while preserving the option for seniors to change their MA plan during the October open enrollment period. This would allow seniors to once again change their MA plans one time during the first quarter of the year, if they determine that their current plan does not meet their health needs. This bill gives seniors the same flexibility and freedom to change their plans that was afforded to them prior to 2011. The bill is supported by America’s Health Insurance Plans (AHIP), the 60 Plus Association, and the Association of Mature American Citizens (AMAC). Additional Resources: If you are interested in cosponsoring H.R. 2453, please contact Rep. Keith Rothfus’ office at (202) 225-2065. Downloadable PDF Citations [1] See CRS Medicare Financing: September 19, 2013, p24. [2] See id. [3] See id., p8. [4] See CRS Medicare Financing: September 19, 2013, p24. [5] See What You Need to Know, Medicare Advantage: Providing High Quality, Cost Efficient Care for Medicare Beneficiaries. [6] http://kff.org/medicare/fact-sheet/medicare-advantage-fact-sheet/. [7] http://www.medicare.com/advantage-plans/enrollment-and-disenrollment-periods-for-medicare-advantage-plans.html [8] See id. [9] Melinda Beck, “UnitedHealth Culls Doctors From Medicare Advantage Plans,” Wall Street Journal(November 16, 2013). | 1 | 2026-03-30T12:14:52Z | 2026-03-30T12:14:52Z |