CMS Sees Too Many Medicare Advantage and Drug Plans
with Too Few Enrollees, Wants Cuts
Twenty-seven percent of Advantage plans have fewer
than 10 enrollees and agency will mandate changes
March 30, 2009 - There are too many Medicare
Advantage and Medicare prescription drug plans, which clouds the choices
senior citizens must make. Twenty-seven percent of Medicare Advantage
plans have fewer than 10 enrollees and the Centers of Medicare &
Medicaid Services under the Obama administration says things are going
to change.
Report to Congress again emphasizes Medicares
payment system for private fee-for-service plans is seriously flawed;
wants significant cuts to home healthcare providers (payments cuts of
5.5% next year), hospice end-of-life care, medical imaging services and
Medicare Advantage insurance plans; does suggest a 1.1 percent hike for
doctors but more transparency.
CMS today announced steps it is taking to provide
beneficiaries with more meaningful choices among Medicare Advantage and
Medicare prescription drug plans. In addition,
CMS says it will continue to build on its ongoing oversight efforts
relating to Medicare health and drug plans.
Having more transparent information available to
help people with Medicare make confident choices in their health and
drug coverage is important to President Obama and CMS, said Jonathan
Blum, acting director of CMSs Center for Drug and Health Plan Choice.
By strengthening our oversight efforts, we are
protecting beneficiaries and taxpayers by ensuring that the data
provided by plan sponsors is reliable and correct.
The requirements issued by CMS today are part of
the annual Call Letter which is issued to organizations that intend to
offer Medicare Advantage and Prescription Drug plans in 2010. These
organizations use this guidance to prepare bids which will be submitted
on June 1 and helps to ensure that beneficiaries have the information
they need to choose the best plan for them during the annual enrollment
period which begins Nov. 15, 2009.
More than 10 million beneficiaries are enrolled in
Medicare Advantage plans and more than 17 million are enrolled in Part D
prescription drug plans.
For 2010, CMS will be also be taking new steps in
its review of Medicare Advantage plan cost-sharing to ensure that sicker
beneficiaries will be protected from discriminatory out-of-pocket
charges for the health care services they need.
For example, CMS will be reviewing plan benefits to
ensure that cost-sharing for such services as renal dialysis, Part B
drugs or home health or skilled nursing services is not higher than the
cost sharing amounts under Original Medicare.
CMS is also asking Medicare Advantage organizations
to make sure the plans they offer in 2010 significantly differ from one
another to ensure that beneficiaries have the tools they need to make
informed decisions.
Many plan sponsors offer multiple plans with very
little distinguishing characteristics and low enrollment. These
low-volume plans crowd the field and makes selecting a plan much more
difficult for Medicare beneficiaries.
Very few beneficiaries would be affected by
Medicare Advantage organizations dropping the plans in question those
with less than one percent of all Medicare Advantage enrollees.
CMS will assist any beneficiaries affected by their
Medicare Advantage plan being terminated in enrolling in a similar
Medicare Advantage plan offered by the same organization in order to
avoid any disruption in benefits.
By eliminating these plans, beneficiaries should
then be easily able to see differences in the types of plans offered,
including clear differences in the benefits offered through each
different plan or differences in other plan features, such as the same
formulary or similar out-of-pocket costs.
Plan improvements for 2010 are designed to enable
beneficiaries to select plans that best fit their individual needs.
Beneficiaries will be able to enroll in most Medicare Advantage or
prescription drug plans at
www.medicare.govthrough the enhanced online enrollment center during
the open enrollment period.
As part of CMSs efforts to improve beneficiary
understanding of prescription drug plan options, prescription drug plan
sponsors will be required to outline all the tools used by the plan to
lower costs and improve outcomes, known as utilization management
criteria, on their Web sites.
Plan sponsors will list specific details about
quantity limits and step therapy requirements in addition to providing
comprehensive information about other types of utilization management
tools such as prior authorization.
Prescription drug plan sponsors will also be
required to provide additional and easy to understand information about
coverage in the gap on the Medicare Prescription Drug Plan Finder Web
site at
www.medicare.govlater this fall. This information will include how
the plan will cover both brand and generic drugs in the gap.
Preventive health
CMS says it is committed to promoting the
appropriate use of preventive health care benefits as part of Medicares
effort to help keep beneficiaries healthy. Medicare covers a broad
range of services to help beneficiaries prevent disease, detect and
manage their disease early when they are most treatable and curable
and avoid complications related to their care.
Medicare Advantage plans are required to provide
all Medicare covered preventive benefits.
Organizations are reminded in the 2010 Call Letter
that they may not use inappropriate incentives or rewards to enroll
beneficiaries into these programs.
As part of CMS oversight efforts of the Medicare
Advantage and Prescription Drug plans, sponsoring organizations are
being asked to conduct audits on the data provided to CMS about the
operation of their plans. These new audits will be in addition to the
current CMS financial and program compliance audits.
The existing Program compliance audits will be
strengthened by becoming more targeted, data-driven and risk-based. They
will focus on high-risk areas that have the greatest potential for
beneficiary harm, such as enrollment operations, appeals and grievances,
and marketing.
By strengthening these data collection processes,
we will have an early warning system in place to be sure beneficiaries
are not at risk of losing access to prescription drugs or health care
services if plans have problems, said Blum.
March 30, 2009 - There are too many Medicare
Advantage and Medicare prescription drug plans, which clouds the choices
senior citizens must make. Twenty-seven percent of Medicare Advantage
plans have fewer than 10 enrollees and the Centers of Medicare &
Medicaid Services under the Obama administration says things are going
to change.