Medicare and Medical Debt

Medicare is a life-saver for older Americans, but it does have out-of-pocket costs that can expose some patients to medical debt. A new issue brief created for HCFANY by the Medicare Rights Center explains some of the causes of medical debt for people enrolled in Medicare and describes some steps patients can take to avoid it.

Some of the causes of medical debt for people covered through Medicare are the same as for people with other types of insurance. More and more New Yorkers say they cannot afford to pay for care because of deductibles and out-of-pocket costs. This can be especially difficult for patients who are cannot afford supplemental coverage but are not low-income enough for Medicaid.

Like other patients, people with Medicare deal with medical billing errors and service denials. Patients who have had their care plan denied by insurers are then in a position where they have to ask their doctor for a different care plan; attempt to appeal, which can be overwhelming without help; or pay on their own. Finally, Medicare patients have to navigate covered versus non-covered services. Long-term care, dental care, and even ambulances can leave them on the hook for large medical bills.

Patients with Medicare coverage should review their Medicare Summary Notice to know what bills may be coming and whether any services they’ve received in the past three months were not covered. They can get help with billing questions, appealing service denials, or finding affordable care by calling the Medicare Rights Center at 800-333-4114.

New York State should also do more to protect patients from medical debt. One reason that medical errors are so common and that it is so hard for patients to know what services are covered by what providers is because the current health care system is so fragmented. A single-payer system, like the one that would be created by the New York Health Act, would eliminate the complexity that causes so much distress for patients in today’s system.

New York should also take steps to make medical billing more fair in the current system:

  • Funding consumer assistance programs,
  • Capping interest rates on medical debt judgments,
  • Barring providers from placing liens on patients’ homes or garnishing their wages,
  • Banning facility fees, and
  • Making the state’s hospital financial assistance policy easier to apply for.

By Anna Szilagyi, Outreach & Program Development Coordinator, Medicare Rights Center

In September 2020, the Centers for Medicare and Medicaid Services (CMS) launched Care Compare, a redesign of their previous health care compare sites on Care Compare streamlines eight separate sites into one tool that allows Medicare beneficiaries to compare doctors and clinicians, hospitals, nursing homes, home health services, hospice care, inpatient rehabilitation facilities, long-term care hospitals, and dialysis facilities.

People need information to find providers that are right for their needs – what can New York learn from Medicare’s Care Compare when designing its own tools?

New York State announced a similar project for 2020. The goal of NYHealthcareCompare is to help New Yorkers compare the cost and quality of health care procedures at hospitals and access educational resources designed to help consumers know their rights, including financial assistance options and what to do about a surprise bill. Medicare enrollees may not have the same need to compare provider prices (except for non-covered services such as dental) as those with other types of insurance, but they do have the same problems with receiving confusing medical bills, being improperly billed, identifying in-network managed care providers, making informed decisions about their care, and finding providers with the highest safety ratings. CMS’s redesign of Medicare’s compare tool can offer direction to New York State in its design of a consumer health care compare site aimed at increasing health care transparency.

At, Medicare beneficiaries and their families and caregivers can search by zip code, provider type, and optional keywords to get information on providers and compare up to three at a time. Once someone has started a search, Care Compare includes a list view and a map view (excluding for home health and hospice providers). The one-stop Care Compare tool is easier to navigate than using a different site for each type of provider, and the tool includes descriptions of each provider type to assist consumers with their searches. Care Compare’s design is a significant improvement from Medicare’s previous provider compare tools. However, not all provider information is relevant to consumers, and information that is relevant is lacking in certain areas.

When searching for doctors and clinicians, beyond basic contact and specialty information, consumers can see whether a provider is “participating,” which is important in estimating their Medicare cost-sharing. Participating providers accept Medicare’s approved amount for health care services as full payment and cannot charge beneficiaries more for Medicare-covered services. However, consumers enrolled in Medicare Advantage Plans would still need to confirm whether a provider is in network for their specific plan to ensure the most affordable care. Additionally, not all doctors and clinicians listed have performance information available, which makes it difficult to accurately compare providers.

Similarly, when comparing nursing homes, the tool shows how many fines or citations the facility has for fire safety and inspections. However, if the nursing home has not had an inspection, then the facility does not appear to have any quality issues. The importance of consistency and transparency is particularly important when comparing nursing homes.

Fortunately, Care Compare does include educational information for consumers in the compare view. Below the side-by-side comparison of providers, the tool includes next steps and key questions to ask before visiting a provider or receiving a health care service or procedure. For instance, when comparing hospitals, the tool links to the Medicare resources “Steps to choosing a hospital,” “How Medicare covers inpatient hospital care,” and “How Medicare covers outpatient hospital care” to help consumers make more informed health care decisions. This is also an opportunity to increase education and access to resources in New York State, such as financial assistance programs and consumer assistance programs.

While working to increase health care transparency for consumers, user-friendly tools with meaningful and relevant information are critical. In creating and updating a health care compare tool for New Yorkers, New York State should meaningfully engage consumers to identify what information and features are valuable to them. Consumer testing and focus groups could help inform NYHealthcareCompare and ensure the site is responsive to consumers’ needs.

While building out NYHealthcareCompare, New York State should consider including:

  • Consistent and comprehensive quality measures to facilitate fair comparisons across health care providers. These measures should be clearly defined, so consumers understand how quality is assessed.
  • Streamlined information that is relevant and comprehensible to consumers, such as insurance plans a provider accepts.
  • Educational resources on questions consumers should ask before visiting a provider or receiving a health care service or procedure.
  • Information to redirect people with Medicare to the Care Compare tool for comparing health care providers.
  • Information on how to access financial assistance programs.
  • Promotion of consumer assistance programs to help people navigate health care options and costs.
  • A portal for consumer feedback and comments to inform updates to the site.
  • Clear accessibility information, such as options to view content in different languages and larger type.

numbersYesterday, the House of Representatives adopted a budget resolution that paves the way for the federal government to approve up to $1.5 trillion in tax cuts to wealthy people and corporations with only Republican votes.

What’s a budget resolution?

A budget resolution is a piece of legislation that outlines the congressional budget. It establishes how much the federal government is allowed to spend and in which categories (for example, transportation) and how much they can increase the federal debt or deficit. The resolution can also include budget reconciliation instructions, which allow the House of Representatives and the Senate to pass budget-related measures with fewer votes and without filibusters from opponents.

The budget resolution just passed includes reconciliation instructions, which means that Republicans, who have majorities in both houses, could pass major tax legislation without the support of their democratic colleagues. Democrats who disagree with the tax legislation would also be very limited in their ability to delay or stop the vote.

How is this related to health care?

Any tax cuts will eventually have to be paid for. The budget resolution that ultimately passed did not specify which programs would be cut in order to pay for the tax legislation, but an earlier version of the budget resolution introduced in the House gives us a pretty good idea of what the cuts might look like. This earlier version of the resolution called for $5.8 trillion over 10 years in cuts to programs that help low- and moderate-income families. This included a devastating $1.8 trillion in cuts to Medicaid, Medicare, and other health care programs, which would hurt millions of children, families, and seniors.

What does this mean for consumers right now?

Nothing yet. The budget resolution is a set of guidelines. It will not be submitted to the President, and it does not have the force of law. However, Congress is planning on releasing formal tax legislation as early as next week, which if passed by both houses, would affect consumers beginning in 2018.

Check back with HCFANY in the coming weeks for updates on the budget and other federal health care policy issues.

Never Fear! Navigators ARE Here!

Never Fear! Navigators ARE Here!

Many of you may have heard reports that the Trump Administration will be cutting federal funding for the Navigator program for the upcoming year. Navigators are individuals or organizations specially trained and certified to help consumers shop for and enroll in health insurance coverage through the Marketplace.

These cuts do not affect New York. New York State runs its own state-based Marketplace, the New York State of Health (NYSOH), and thanks to the continued support of the State government, New York also funds its own Navigator program and will not be affected by federal cuts.

Navigators and other in-person assistors are available to help consumers in every county in New York State. According to the 2017 NYSOH Open Enrollment Report, there were 526 Navigators and more than 5,000 Certified Application Counselors (CAC) and Facilitated Enrollers (FE) in New York as of January 31, 2017. Among consumers who enrolled in coverage through NYSOH, 72 percent did so with the help of a Navigator, CAC, or FE. An even greater proportion of consumers used in-person assistance when enrolling in public coverage through the Marketplace. Seventy-seven percent of consumers who enrolled in Medicaid, 74 percent of consumers who enrolled in Child Health Plus, and 83 percent of consumers who enrolled in the Essential Plan all used in-person assistance to choose the best plan for their needs.

Open Enrollment for the 2018 plan year begins on November 1, 2017. If you or someone you know needs help selecting and enrolling in a health insurance plan, please call (888) 614.5400 for in-person assistance in your area. Remember, consumers enrolling in Medicaid, the Essential Plan, and Child Health Plus can enroll year-round!