Significant Changes Proposed for Medicare Advantage Plans - Western Asset Protection
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Significant Changes Proposed for Medicare Advantage Plans

Changes could be coming to Medicare. CMS published a proposed rule that would make significant changes to Medicare Advantage. Although the proposed changes are intended to provide more flexibility, some concerns have already been raised.

The Proposal

The proposed rule, CMS-4182-P, was published in November 2017. A CMS fact sheet provides a summary of the major provisions.

Included in the proposed rule are changes that would expand the Patients Over Paperwork initiative, improve transparency for Star Ratings, update the definition of marketing, alter enrollment processes, implement the Comprehensive Addiction and Recovery Act of 2016 and more.

In addition, the following two provisions would have significant impacts on Medicare Advantage offerings:

  • Elimination of artificial limits on Medicare Advantage plans. According to the fact sheet, “CMS is concerned the current requirement may result in organizations reducing the value of certain benefit offerings in order to make their benefit packages comply with these artificial limits. This may include instances where differences in benefit packages exist but are not incorporated in the agency’s evaluation (e.g., unique benefit packages based on enrollee health conditions). CMS expects that eliminating the artificial limits will improve the plan options available for beneficiaries. New flexibilities in benefit design and more sophisticated approaches to consumer engagement and decision-making should help beneficiaries, caregivers, and family members make more informed plan choices.”
  • Reinterpretation of requirements regarding the uniformity of Part C benefits. According to the fact sheet, “These changes give MA organizations new tools to improve care and outcomes for the most vulnerable enrollees by allowing MA organizations the ability to reduce cost sharing for certain covered benefits, offer specific tailored supplemental benefits, and offer different deductibles for beneficiaries that meet specific medical criteria … These flexibilities are available to plans beginning in CY 2019.”

The Concerns

Medicare Rights, a non-profit consumer service organization, raised concerns over parts of the proposal. According to a post, “While Medicare Rights strongly supports getting people with Medicare the care they need, we are concerned about the potential for beneficiary confusion, inappropriate plan manipulation, and challenges related to assessing the impacts of different changes if they are all happening at once.”

The comments submitted to CMS regarding the proposed rules provide more detail into the views held by Medicare Rights. The points made include a concern that implementing the changes by 2019 would lead to challenges, that the added flexibility may be overwhelming for beneficiaries struggling to make choices, and that there may not be enough oversight. CMS stopped accepting comments on the proposed rule on January 16, 2018.  Stay tuned to the WAP blog for further developments.