Allyson Schwartz (Credit: House) Allyson Schwartz (Credit: House)

Allyson Young Schwartz, the president of the Better Medicare Alliance, leads one of the major campaigns to defend the Medicare Advantage program.

The former health clinic director represented Pennsylvania in the U.S. House, as a Democrat, from 2005 through 2015. While in the House, she introduced bills that could have created an above-the-line deduction for long-term care insurance premiums.

(Related: Senate LTC Bill Provides Above-The-Line Deduction)

Now, she goes to Capitol Hill to win friends for the Medicare Advantage program.

Medicare Advantage Basics

The Medicare Advantage program gives private insurers a way to use a combination of federal subsidy money and consumer payments to provide an alternative to “Original Medicare.” In exchange for accepting care management, and use of provider networks, enrollees may get lower out-of-pocket costs, and access to extras such as basic dental and vision coverage.

About 21.6 million of the 60.5 million people with Medicare coverage today have signed up for Medicare Advantage plans or similar plans, according to the Centers for Medicare and Medicaid Services enrollment dashboard.

But congressional moves to change the funding formula nearly killed the predecessor of the Medicare Advantage program, the old Medicare + Choice program.

Today, the program faces wide spectrum of threats, ranging from the Affordable Care Act health insurer tax, which affects just about all health insurers, to proposals to create a completely government-run Medicare for All system.

“‘Medicare for All’ is a very good title,” Schwartz said Wednesday in an interview.

One problem with the title, Schwartz said, is that the Medicare for All proposals would eliminate Medicare Advantage, and Original Medicare.

The Better Medicare Alliance

Health insurers helped start the Better Medicare Alliance. The alliance says it has many supporting organizations outside the health insurance sector, including organizations such as Meals on Wheels and the National Hispanic Council on Aging.

Some of the insurance sector organizations on the allies list are the Council for Affordable Health Coverage, Delta Dental and the National Association of Health Underwriters.

The alliance has set up an action center that the enrollees themselves can use to sign petitions, share their stories and take action in other ways. The alliance says it has about 400,000 senior supporters.

The latest alliance Form 990 report available on the Candid 990 Finder website, which is for 2017, shows that the alliance recorded $1.9 million in operating income that year on $11 million in revenue and $4.1 million in assets. The alliance was working with the Glover Park Group LLC and Fleishman Hilliard, two communications strategy firms, according to the report.

The Interview

Here are five things Schwartz is seeing out there now, drawn from the interview.

1. People in Medicare Advantage plans love their coverage.

The alliance conducted a survey of about 2,000 Medicare Advantage plan enrollees in late September and early October. About 94% of the participants said they like their coverage.

2. Issuers are enthusiastic about the new supplemental, non-medical ‘social determinants of care’ benefits that Medicare Advantage managers are letting into the plans.

The flexibility is new, and issuers are not getting extra funding to pay for the new benefits, Schwartz said.

But Milliman found, when it analyzed benefits menus for the alliance, that the number of supplemental benefits offered has increased to 364 for 2020,from 102 for 2019.

About 12% of the issuers are offering at least one of the new benefits, Schwartz said.

Some issuers have used the new flexibility to add small amounts of short-term care coverage. About 64 plans will offer small amounts of coverage for adult day services for example.

The most dramatic gain was in therapeutic massage benefits. The number of plans offering massage benefits will increase to 192 in 2020, from 22 this year.

That change is because of concerns about opioid use crisis, Schwartz said.

Many issuers are hoping that, for some patients, use of therapeutic massage will reduce or eliminate reliance on potentially addictive medications, she said.

3. What support for Medicare for All means is evolving.

Schwartz said that she believes many lawmakers who have endorsed Medicare for All bills are trying to express their support for everyone having affordable health coverage.

For some, she said, the feeling seems to be, “They’ll get into the details later.”

4. The Medicare Advantage program has strong bipartisan support.

Earlier this year, the Better Medicare Alliance persuaded 368 members of Congress, including more than 60 freshmen, to sign a letter expressing their support for Medicare Advantage.

“Many of them recognize that their constituents like it,” Schwartz said.

5. The Medicare Plan Finder system could still use some adjustments.

The alliance was one of the organizations asking CMS to make the Medicare program’s official online plan directory easier for consumers and others to use. CMS responded by implementing the first major update in seven years, Schwartz said.

(Related: Medicare Enrollment Period Begins With Lingering Cost Finder Problems)

“We think a lot of that update is good,” Schwartz said.

But Medicare plan agents have complained about bugs, and about design decisions that have made comparing plans based on overall out-of-pocket costs difficult, Schwartz said.

At CMS, “they want to fix inaccuracies, ” Schwartz said.

Addressing problem design choices that were originally made for the sake of site simplification could be more challenging, Schwartz said..

— Read Medicare Advantage Plans Can Pay for Many LTC Services in 2019: Feds, on ThinkAdvisor.

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