CHICAGO — Physician and medical student leaders at the Annual Meeting of the American Medical Association (AMA) House of Delegates approved policies aimed at expanding health care coverage for Medicare and Medicaid patients. These steps build on the AMA’s longtime advocacy for health insurance coverage for all Americans and are central to the AMA’s mission of improving public health.

The new policies adopted today include:

Expanding Medicaid coverage to include hearing and vision

With Medicaid’s patchwork coverage leaving patients with untreated health concerns, the AMA will work with interested state medical associations to support efforts to cover hearing and vision services for all Medicaid patients.

Although Medicaid provides basic hearing, vision, and dental services to children enrolled in Medicaid, those services are optional benefits for adults in Medicaid and CHIP, and states vary drastically in covering them.

Twenty-eight states provide some Medicaid hearing coverage, leaving patients unable to afford hearing aids or help with their use. New AMA policy advocates working with state medical associations to support coverage of hearing exams, hearing aids, cochlear implants, and aural rehabilitative services.

Thirty-three states offer some Medicaid vision coverage, with 28 limiting access based on severity of vision impairment, pre-existing conditions, restrictions to only eyeglasses and not contacts, number and frequency of visits allowed. New AMA policy advocates working with state medical associations to support coverage of routine comprehensive vision exams and visual aids, including eyeglasses and contact lenses.

Medicaid is not required to provide any adult coverage for dental service, and 19 states offer comprehensive coverage while 31 offered limited/emergency coverage.  Medicaid patients routinely forego dental services because of out-of-pocket costs. About 18% of Medicaid patients under 65 report an unmet dental need due to cost, double the rate of privately insured patients. It is estimated there are 2 million dental-related emergency room visits a year, costing $2 billion. Revised AMA policy supports working with the American Dental Association and other national organizations to improve access to dental care for Medicare, Medicaid and CHIP patients.

“There isn’t much logic to the fact that most Medicaid patients don’t get comprehensive coverage above the neck. Failure to address vision, hearing and dental issues not only leads to more severe health problems but also represents preventable obstacles to work and everyday life,” said Pratistha Koirala, M.D., PhD, a member of the AMA Board of Trustees. “Advocating for a healthier nation means advocating for expanded Medicaid.”

Making Medigap policies affordable for Medicare patients

The House of Delegates adopted a resolution calling for a change in federal policy that would reduce costs and burdens to patients who want to switch from Medicare Advantage to traditional Medicare.

If individuals enrolled in a Medicare Advantage plan want to switch to traditional Medicare, they may not be able to enroll in a Medigap plan to handle out-of-pocket expenses. Medigap currently offers a one-time, six-month enrollment period, during which individuals are protected by “guaranteed issue” and community rating, which prevent discrimination based on health, age, or gender. Guaranteed issue protections prohibit insurers from denying a Medigap policy to eligible applicants, including individuals with pre-existing conditions. The new policy supports Medigaps plans offering annual open enrollment periods, guaranteed lifetime enrollment eligibility, and extended modified community rating regulations. 

“This guarantee is baked into the Affordable Care Act marketplaces but is not yet part of Medicare. There are good reasons that patients switch to traditional Medicare, and they shouldn’t have to pay a higher cost to do so,” said Scott Ferguson, M.D, a member of the AMA Board of Trustees.  

Medigap regulations for individuals who are switching Medicare coverage vary from state to state. In some states, patients might see their Medigap policy increase in cost or narrow in coverage – or even become unavailable – once they switch coverage. Other states have enacted Medigap protections for cost, community rating and eligibility.

Under current law, Medigap plans are required to be offered to all Medicare patients over 65 but not to other Medicare patients under 65 on dialysis or with disabilities. The AMA will support efforts to expand access to Medigap policies to all individuals who qualify for Medicare benefit.