Think ACA enrollment is complicated? Try Medicare

One of the early and persistent raps against the ACA is that the benefit structure and application process are too complex. There's a lot of questions to answer. It takes a half hour to an hour -- if you're not called on to provide extra verification for your identity or immigration status or income. There are benefit cliffs -- between Medicaid and the marketplace; between marketplace enrollees who qualify for strong Cost Sharing Reduction and those who don't; and, most precipitous (for older enrollees), between those who qualify for premium subsidies and those who don't. As for plan offerings, in some markets a dominant insurer will throw up a half-dozen minutely differentiated plans, sowing confusion.

All this is true. But I'd like to take a first pass here at a myth that I'd like to explore more fully later: that by comparison, Medicare is a blessed zone of simplicity, equity and benefit adequacy.

What I learned at Health Action 2018

Below, a few notes from Health Action 2018, Families USA's annual conference -- things I learned, or learned in more detail, or was forcefully reminded of. [Update: my report about what the conference suggested about where Democrats may be headed on the healthcare front is up at Crooked Media.]

         Re Medicare:

• Many low income sixtysomethings face a "Medicare cliff" at age 65. They've had all their medical expenses paid by Medicaid;  now, suddenly, they're faced with Medicare's 20% copays, drug costs, etc. (Leslie Fried, National Council on Aging)


• Medicare Savings Programs (MSPs), a variety of programs through which low-income Medicare enrollees' premiums or out-of--pocket costs are picked up by Medicaid, are all underutilized. Only about half of those eligible are enrolled. Funding for State Health Insurance Assistance Programs (SHIP), which provide enrollment assistance to seniors, is grossly inadequate and at risk. Susan Collins has stood up for SHIP. (Leslie Fried).  I plan to learn more/post more about the Medicaid-->Medicare cliff.