September 21,2016

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Taylor Harvey (202) 224-4515 

Wyden Proposes Improvements to Medicare Benefit, Enrollment Process

Ranking Finance Democrat Introduces Sweeping Bill to Establish Out-of-Pocket Caps for Seniors, Simplify Medicare Enrollment, and Make the Program More Affordable for All


Wyden’s Legislation Also Eliminates Harmful, Senseless Two-Year Wait Period for Individuals with Disabilities to Receive Health Coverage through Medicare

WASHINGTON Senate Finance Committee Ranking Member Ron Wyden, D-Ore., today introduced a bill that would improve Medicare coverage for seniors and individuals with disabilities. The bill, the “Medicare Affordability and Enrollment Act,” would establish an out-of-pocket spending cap, streamline the Medicare enrollment process by reducing penalties and roadblocks for those seeking coverage, and make the program more equitable for lower-income seniors and individuals with disabilities, among other steps to improve the program.

“Medicare has long been an ironclad guarantee to seniors of health care security and peace of mind in their later years,” Wyden said. “Today, the promise of Medicare falls short for too many who find their health costs becoming more and more unaffordable. Protecting and strengthening the Medicare guarantee is a vital task as the program prepares to enroll the next generation of older Americans, and these policies will put many seniors on a firm foundation for years to come.”

While Medicare has offered health and financial security to millions of Americans since it became law in 1965, the benefit needs to be updated to ensure the next generation of Americans entering the program have a secure retirement. That means improving affordability for many seniors, making it easier to enroll in the program, and abolishing some of the outdated policies that harm people who simply want access to health care.

There are several key challenges with the Medicare benefit today: seniors who have low-to-moderate income, but do not currently qualify for assistance with their premiums and out-of-pocket costs, face significant financial challenges when paying for health care. The enrollment process when a senior turns 65 is outdated and confusing. What’s worse, one mistake early on in the enrollment process can lead to higher premium costs for a lifetime. And people with disabilities must wait a full two years after receiving Social Security Disability Insurance to enroll in Medicare, which can result in serious hardship as they seek treatment for their disability.

The bill would:

  • Set a maximum out-of-pocket cap for medical services under traditional Medicare, which exists today for Medicare Advantage and most commercial insurance plans
  • Significantly expand the number of low-income beneficiaries eligible for financial assistance to cover premiums and out-of-pocket costs
  • Reduce cost-sharing for “near-poor” beneficiaries who are not eligible for any assistance today
  • Eliminate the arbitrary two-year waiting period for people with disabilities to enroll in Medicare
  • Modernize the Medicare enrollment system to facilitate easier enrollment, begin coverage earlier and reduce arbitrary late-enrollment penalties that today are paid for a lifetime
  • Extend cost-sharing assistance for Part D enrollees in Puerto Rico offered to all other eligible Medicare beneficiaries
  • Increase and extend permanent funding for low-income Medicare beneficiary outreach and education activities

The Medicare Affordability and Enrollment Act is another step in Wyden’s comprehensive effort to ensure all Americans have a secure retirement. Last week, he introduced a bill making it easier for working Americans to save for retirement. And earlier this year, he introduced legislation to cap prescription drug costs for beneficiaries in Medicare Part D.

The bill has been endorsed by the following organizations: American Federation of State, County and Municipal Employees (AFSCME), Alliance for Retired Americans, The Arc, Center for Medicare Advocacy, Dialysis Patient Citizens, The Epilepsy Foundation, Families USA, Justice in Aging, Medicare Rights Center, National Coalition on Aging, and the National Committee to Preserve Social Security and Medicare, National Consumer Voice for Quality Long-Term Care.

House Energy and Commerce Committee Ranking Member Frank Pallone, Jr., D-N.J., and House Ways and Means Committee Sander Levin, D-Mich., will be leading the introduction of a counterpart in the House of Representatives. The bill’s Senate co-sponsors include Debbie Stabenow, D-Mich., and Michael Bennet, D-Colo., Bill Nelson, D-Fla., Sherrod Brown, D-Ohio.

A one page summary of the bill can be found here. A section by section summary of the bill can be found here. Legislative text of the bill can be found here.