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The NSPA Blog

Medicare and Medicaid Announcements

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Posted on June 22nd, 2020 by Guest Blogger, under Medicaid, Medicare, Patient Tools, Tips & Resources

Last week, we received information regarding some recent announcements affecting Medicare Beneficiaries from Carrie Espinosa at Horizon Benefit Services (http://www.horizonbenefitservices.com). Considering Medicare enrollment is coming up sooner than we think and is quite complex to maneuver, we want to share this information with you to give you some heads up on early developments. 

As a Medicare Advisor and Legislative Chair for her professional association (CNIAHU),  Carrie Espinosa is always reading and staying on top of current issues. There are 4 pretty big topics she wants us to be aware of (if you are not already):

Online enrollment process for Medicare Part B (for now, anyway):

During the COVID-19 pandemic, the Social Security Administration will be taking Medicare Part B enrollment applications online for working-aged individuals who qualify for a Special Enrollment Period (SEP). 

Those who already have Medicare Part A and wish to enroll in Medicare Part B can use this online enrollment application if you are 65 or older and you have or had group health plan (GHP) coverage within the last 8 months through your or your spouse’s current employment.

Part D Senior Savings Model for the 2021 plan year will provide for more affordable insulin Medicare beneficiaries access to a broad set of insulins at a maximum $35 copay:

In May, the Centers for Medicare & Medicaid Services (CMS) announced that over 1,750 standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage have applied to offer lower insulin costs through the Part D Senior Savings Model for the 2021 plan year. 

Even better, for the first time, CMS is enabling and encouraging Part D plans to offer fixed, predictable copays for beneficiaries rather than leaving seniors paying 25 percent of the drug’s cost in the coverage gap (aka “donut hole”).

Long Term Care planning and Patient Advocates are needed NOW, more than ever: 

The National Alliance for Caregiving (NAC) and AARP released the following report: Caregiving in the U.S. 2020. Here are some stats from the report: 

• One in five Americans (21.3 percent) are caregivers.

• They spend nearly 24 hours a week providing help through activities of daily living (dressing, toileting, etc.) and instrumental activities of daily living (driving, shopping, cooking, etc.)

• They are increasingly being called on to be health care advocates, interfacing with providers and agencies in an environment where it is harder to coordinate care.

• Female boomers still comprise the majority of caregivers and care recipients still skew older. That said, the percentage of GenX and millennial caregivers is increasing and care for those 18-34 rose from five percent to eight percent of caregivers.

• There is growth in the number of African American caregivers (88 percent compared to 77 percent in 2015) and Hispanic caregivers (92 percent vs. 85 percent in 2015). The youngest caregivers are also more often caring for an adult relative (91 percent) than in 2015 (85 percent).

• Care recipients have increasingly complex medical and support needs.

• A greater proportion of caregivers report being in fair or poor health (21 percent, up from 17 percent in 2015), particularly acute among Millennials.

• Many caregivers live together with their recipient (40 percent), a proportion that has grown since 2015 (34 percent).

Illinois is expanding Medicaid for undocumented seniors

Starting July 1st, Illinois will become the first state to provide Medicaid for undocumented seniors. This was included in the recent budget passed by Governor Pritzker. The provision was tucked in near the end of the 465-page budget implementation bill and will give Medicaid access to non-citizens over 65 years old and whose income is $12,670 or less, which is at or under the federal poverty level. 

It is important to note that immigrants who are permanent residents for 5 years and have continuously resided in the U.S. for that duration, can BUY Medicare coverage from the U.S. Government once they are age 65 years of age or above. They may even qualify for Medicaid based on their income and assets. 


As we all know, between now and Open Enrollment in October, there will be more changes and developments. As we come across any more big developments, we will update you.

Stay well. 

Teri’s Corner

Black Lives Matter in health care, too. Daily Herald. https://www.dailyherald.com/entlife/20200620/black-lives-matter-in-health-care-too

Help seniors avoid COVID-19 health scams. Daily Herald. https://www.dailyherald.com/entlife/20200614/help-seniors-avoid-covid-19-health-scams

Going Overboard on Booze.  Reader’s Digest. https://www.rd.com/health/wellness/things-youre-doing-that-nurses-wouldnt/

Senior Orphans. The Lake Oconee Boomers Team. https://www.lakeoconeeboomers.com/senior-orphans/

How Fido and Fluffy Improve Your Health. The Lake Oconee Boomers Team. https://www.lakeoconeeboomers.com/how-fido-and-fluffy-improve-your-health/

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