Medicare

Ending the Two Year Waiting Period for Medicare Benefits

→ Background: When the Medicare program expanded to cover individuals with disabilities in 1972, a waiting period was implemented to limit costs and ensure that only those with severe and long-term disabilities would qualify for the program. Unlike older Americans who typically enroll and become eligible for Medicare coverage within months of turning age 65, disabled beneficiaries must wait two years for their coverage to take effect.

The ACA is concerned about the impact of policy on amputees in need of Medicare coverage in order to remain healthy, productive and independent. There is a fiscal impact of delayed care, as well as an extreme burden on the health and quality of life of individuals with limb loss. No one with disabilities severe enough to qualify for disability benefits should be without health insurance.

The ACA joined the Coalition to End the Two-Year Wait for Medicare in the fall of 2008 in order to band together with other organizations to successfully phase out this unnecessary delay.

→ Status: We are working with the coalition to utilize the healthcare reform legislation to generate action on the waiting period issue. We recently signed on to a letter to the Tri-Committee --- the committee members working in the House to finalize a healthcare reform bill --- regarding the need to address this issue in order to meet the needs of people with disabilities. Click here to read the letter.

First Month Purchase Option

→ Background: Medicare currently allows an individual to choose whether to purchase or rent mobility devices in the first month of use. Nearly all Medicare beneficiaries in need of power wheelchairs purchase their devices in the first month of delivery because they have long-term needs and often require a specific “fit” of each device to meet their medical and functional needs. The policy change under consideration would eliminate patient choice forcing beneficiaries to rent their mobility for thirteen months before they can own the devices. This proposal would essentially require wheelchair suppliers to purchase power wheelchairs from the manufacturers and finance these devices to beneficiaries over a thirteen-month period. We fear this policy change would cause suppliers to supply patients with wheelchairs based more on their diagnosis and prognosis than on their current mobility needs. Instead of suppliers tailoring the mobility devices to the needs of the beneficiary, suppliers may be incentivized to only finance more functional (and consequently more extensive) mobility devices to healthier patients with perceived longer-term need. All beneficiaries in need of power wheelchairs should have access to devices that help them remain functional and independent.

→ Status: The ACA is working with our partners to address this issue through the healthcare reform bills. Click here to read a coalition letter that was recently submitted to House Speaker, Nancy Pelosi (D-CA) and Majority Leader, Steny Hoyer (D-MD). It was copied to key health policy leaders Representatives Henry Waxman (D-CA), Charles Rangel (D-NY), George Miller (D-CA), Frank Pallone (D-NJ) and Pete Stark (D-CA).

Ensuring Access to Assistive Devices for Medicare Patients

→ Background: The ACA is working with our partners to support legislation to modify Medicare’s restriction on “in the home” mobility devices such as wheelchairs and scooters.

Currently, the language regarding mobility devices is considered coverage for needs in the home. That means that they restrict coverage to only those mobility devices that are being used in the patient’s residence. That has a very negative impact on people who may be able to get around in their own home with out a wheelchair or scooter but require an assistive device if they want to leave their home.

→ Status: The Medicare Independent Living Act was introduced in 2007. We will continue to work to advance policy changes to allow people to have access to the devices they need to go to work or school, to get to a doctor’s appointment or just live a more active, independent life.

Halting Cuts to Medicare Coverage for Orthotic and Prosthetic Care

→ Background: Congress was being pushed to advance a 2008 Medicare law in order to avoid a Medicare cut of about 10% to all physicians and to address issues with a competitive bidding program that was scheduled to take effect in 10 U.S. cities on July 1, 2008. There was discussion of including a freeze or cut on Medicare reimbursement for orthotic and prosthetic coverage benefits as part of a payment fix to pay for the delay of competitive bidding.

The Medicare Improvements for Patients and Providers Act of 2008 (HR 6311) was passed in the fall. It delays the implementation of the competitive bidding program for 18 months in order to give the Center for Medicare and Medicaid Services time to reevaluate the process. It would also spare power wheelchairs and oxygen equipment from deep cuts. President Bush vetoed the bill on July 15th. The Senate voted 70-26 to overturn Bush's veto, following the House of Representatives, which voted 383-41 to override.

→ Status: On July 16th, the Centers for Medicare & Medicaid Services (CMS) announced steps it is taking to implement certain Medicare provisions in HR 6311. CMS also created a fact sheet on the Medicare Improvements for Patients and Providers Act of 2008. Click here to read the fact sheet.

The ACA is committed to advocating for access to Medicare benefits and common sense regulations in order to meet the needs of people with limb loss. Contact us for more information, to get involved or report an issue (federal@amputee-coalition.org).

For more information about our efforts on the state or federal campaigns, contact the Government Relations Department at 202/742-1885 or Dan@amputee-coalition.org.

*This page is funded by the ACA and not supported with CDC grant funding. Views expressed in the contents are solely the responsibility of the authors and do not necessarily represent the official views of the ACA.