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On November 28, 2017, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule entitled Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program  (82 FR 56336).

On January 16, 2018, Center attorneys submitted comments to CMS on behalf of the Center and California Health Advocates.  The comments were drafted in collaboration with several advocacy organizations.  The proposed rule would make significant changes to, among other things, Medicare Advantage (MA) rules that require plans to provide “uniform benefits” to all plan enrollees in a given service area, and to offer “meaningful differences” in plan benefit packages if a plan sponsor (insurance company) chooses to offer more than one plan in a service area.

In its introductory comments, the Center stated, in part:

“While much of these proposed changes appear to be aimed directly at assisting plan sponsors by reducing their obligations and oversight, we are unconvinced that beneficiaries will so benefit.

These proposed changes, some of which are untested, will make things more complex, not less, for beneficiaries.  Beneficiary ‘choice’ and plan ‘flexibility’ should not be stand-ins for adequate consumer protections.  The processes for offering and selecting private Medicare plans should not be designed for the savviest consumer; rather, there must be standard, baseline means of plan comparison.

There exists a large body of research and analysis that explores the challenges consumers currently face in making choices about their health insurance coverage, including when there are multitude of plan options, with little to no standardization.  Much of the findings in this work weigh against CMS’ proposals outlined in the [proposed rule], primarily those that would loosen both uniformity and meaningful difference standards.”

The Center’s comments outlined suggestions to strengthen educational tools and beneficiary supports, including:

  • Greater investment in State Health Insurance Assistance Programs (SHIPs),
  • Improving notices sent to plans by enrollees, and
  • Advancing policies that encourage people with Medicare to make active and informed choices about the coverage option(s) that are right for them, with help selecting among Traditional Medicare, MA plans, Medigap policies, and stand-alone Part D prescription drug plans.

The Center also urged CMS to strengthen and preserve essential consumer protections in the MA program, including improving access to network providers and increasing oversight of plan sponsors.  As our comments note, “CMS should not cater to plan requests to reduce ‘burden’ but should instead redouble efforts to ensure that MA plan enrollees, and the broader Medicare population, are being well served by the Medicare program.”

To review more detailed comments on provisions in the proposed rule that the Center either opposes or supports, see the Center’s full comments at

D. Lipschutz, January 17, 2018

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