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On April 26, 2018, the Center for Medicare Advocacy provided comments to the Centers for Medicare & Medicaid Services (CMS) in response to an April 12, 2018  Request for Input on the 2019 Medicare Communications and Marketing Guidelines (MMG).  Unlike previous opportunities to provide comment, CMS did not offer draft language for revisions to the MMG; instead, CMS only flagged a few issues that it is proposing to change, and solicited a broader call for comments.  CMS asked for comments on ideas rather than comments an actual draft MMG. The mechanism for commenting was also restrictive: CMS provided a  short web form, with limited space for responses, which only contemplated comments from plan sponsors. 

Pursuant to recently-issued final regulations and the Final 2019 Call Letter, there will be significant new changes to Medicare Advantage (MA) benefits in 2019. These  include elimination of meaningful difference requirements, benefit uniformity flexibility and expansion of supplemental benefits. All of these changes will make choosing MA plans significantly more complex for enrollees (note the Center for Medicare Advocacy will issue a paper discussing these changes in more depth).  Among other things, rather than having uniform benefits available to all enrollees in a given plan, MA plan sponsors will have the option of targeting certain extra benefits and/or reduced cost-sharing for certain services to enrollees with certain health conditions.  In our comments, the Center highlighted that it is critical to ensure that information about these changes, and resulting plan-specific benefits, are presented in a manner that is not unduly confusing and does not deter enrollment by individuals based upon their health conditions or other factors.  This consumer protection requires firm oversight from CMS, not a relaxation of standards and restrictions.

In the final rule describing these MA changes, CMS states that “supplemental benefits do not include items or services solely to induce enrollment.”  The agency must provide adequate marketing guidelines and oversight to ensure this does not occur. In the comments to the MMG, drafted in collaboration with several other advocacy organizations, the Center for Medicare Advocacy, among other things, urged CMS to:

  • Develop a standardized template for describing additional benefits based on health condition (to be used across the board by plans in evidence of coverage (EOC) documents, marketing materials, and in Medicare Plan Finder descriptions).
  • Prohibit those marketing plans from engaging/soliciting information about an individual’s health condition(s).

May 3, 2018 – D. Lipschutz

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