The Biden-Harris administration has announced proposals to protect the more than 30 million people who receive Medicare Advantage from predatory marketing, expand access to behavioral health care, promote equity in coverage and improve supplemental benefits.
These proposed rules are intended to ensure that the program best meets the needs of beneficiaries.
“So I’m pleased that today the Department of Health and Human Services is proposing new Medicare Part C and D rules that will give seniors access to more affordable, high-quality health insurance and lower the cost of prescription drugs for seniors through competition increase,” the White House said. National Economic Council Director Lael Brainard said this during a call with reporters in which PoliticusUSA participated. “Today’s rules will save seniors on Medicare Part D money by giving them faster access to cheaper competitors for brand-name drugs and we will prevent dominant Medicare Advantage plans from taking advantage of seniors.”
Proposals for improvements to Medicare Advantage and Medicare Part D:
–New plan compensation guardrails for agents and brokers to stop anti-competitive steering
This is intended to address the marketing incentives that can sometimes be used by agents and brokers to trick seniors into signing up for plans that pay more to the broker but do not perform as well for the individual or are not in their best interests are.
While there have been limits in the past as to what brokers can be compensated, there was activity outside of that range, so they are expanding the definition to include those items under the proposed $632.00 commission cap. The same amount of money is played on each plan, so there will be no additional benefit in steering people to a particular plan.
“Currently, some major Medicare Advantage insurance companies are trying to woo brokers and agents with generous benefits like cash bonuses and golf trips to incentivize them to steer seniors toward those big plans,” Brainard explains.
CMS (Centers for Medicare and Medicaid Services) proposes to redefine “compensation” and set a clear, fixed amount that agents and brokers can be paid regardless of the plan the beneficiary enrolls in, addressing loopholes that result in commissions above this amount that lead to anti-competition, This is evident from a fact sheet from the White House.
If this rule becomes final, it will ensure that seniors get the best plan for their needs rather than the best plan for broker benefits, and it will also ensure that additional benefits such as hearing and dental insurance are actually accessible to consumers.
The proposed rule will help “close loopholes that allow Medicare managed care plans to inappropriately inflate agent and broker commissions by adding junk fees,” said Department of Health and Human Services (HHS) Secretary Xavier Becerra.
– Improving access to behavioral health providers
This rule adds a range of behavioral health providers eligible to enroll in Medicare, including marriage and family therapists and mental health counselors, beginning January 1, 2024.
The proposed rule will also improve access to behavioral health care by adding a new type of facility that includes different types of behavioral health care providers to the Medicare Advantage network requirements. This is evident from a fact sheet from the White House.
Reduce medicine costs:
The proposed rule would improve transparency about the effects of prior authorization on underserved communities and proposes more flexibility for Part D plans to more quickly replace lower-cost biosimilar biological products with their reference products.
Neera Tanden, White House domestic policy adviser, pointed out that President Biden is prioritizing lowering drug costs because nearly three in 10 Americans have not been taking their medications as prescribed because they cannot afford them. She added: “This new proposal from CMS responds to the President’s directive and therefore it is truly critical that more flexibility would be provided to Part D plans to quickly introduce replacement biosimilars so that Medicare enrollees can more quickly have access to cheaper options.”
Promote Health Equity:
The administration proposes to require Medicare Advantage plans to include a health care equity expert and to conduct an annual analysis “of the plans’ prior authorization policies and procedures. This analysis would examine the impact of prior authorization on enrollees with one or more of the following social risk factors – eligibility for low-income Part D subsidies, dual eligibility for Medicare and Medicaid, or having a disability – compared to enrollees without these risk factors. These analyzes should be published publicly to improve transparency about the effects of prior authorization on underserved populations.”
CMS has already banned misleading advertising that misleads people into thinking about the health care the government will provide in the 2024 plan year and is “prospectively reviewing all TV and radio ads,” according to CMS administrator Chiquita Brooks-LaSure.
The cries of disapproval will come from the usual suspects of pharmaceutical companies, insurance companies and this time, brokers and agents. But the White House is doing what it can to promote competition to lower prices for people while protecting them, and that’s what the administration is doing. supposed to do.
And given the absolutely terrible state of healthcare in the US (which is still much better than it was before Obamacare), every little bit they can do to make it work better for people is welcome.
The proposed rule is here. There is a 60-day comment period.
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