Making Medicare Advantage and Medicare Drug Coverage Continue to Work for You

By Jonathan Blum, CMS Deputy Administrator and Director of the Center for Medicare

Today, CMS is finalizing rules implementing the Medicare Improvements to Patients and Providers Act (MIPPA) of 2008 that help people with Medicare receive high quality, coordinated care and choose the coverage they want.   Under these final rules, the Medicare program will provide:

Stronger Consumer Protections in Choosing Plans

Under these rules, we’ve strengthened our requirements for what agents and brokers selling Medicare Advantage and Medicare Prescription Drug plans can and can’t do when they are selling you a plan.  There are limits on the commissions agents and brokers can receive, so plans will compete on the basis of benefits and quality, and not the size of their agent commissions. This rule also makes sure that agents and brokers aren’t rewarded if they sell you a plan that doesn’t meet your needs and you leave the plan within the first 90 days.

The rules also now require that Private Fee-for-Service (PFFS) plans in most parts of the country have contracts with medical providers like hospitals and specialists. PFFS plans allow you to see any provider who agrees to accept payment from the plan. These new requirements give you greater security that you will be able to use the hospitals or specialists you need when you join a PFFS plan.

Better Care for People with Special Needs

These final rules ensure that Medicare Special Needs Plans (SNPs) are improving the quality of care they provide and making sure that care meets the needs of individual patients. SNPs are a type of Medicare Advantage plan for people who are enrolled in both Medicare and Medicaid, people who have certain serious chronic conditions, or who need institutional care, like in a nursing home.

Under these rules, SNPs must develop a Model of Care that ensures your health care needs are assessed, a plan of care is developed specifically for you, and a team of health care providers manages your care. SNPs must also have a quality improvement program that measures whether the care being provided is actually making you healthier.

The rules play a key part in CMS’s overall strategy to improve the care people receive in SNPs and in all Medicare Advantage plans. Under the Affordable Care Act, starting in 2012 SNPs must be approved by the National Committee for Quality Assurance (NCQA). And, also as a result of Affordable Care Act, all Medicare Advantage plans can receive bonuses from Medicare if they rate highly on the quality of care they deliver.

These are just a few ways we are helping to protect you from being sold a policy you don’t really want, and ensuring you feel safe and confident about the health care coverage decisions you make. Under the Affordable Care Act, CMS now sets limits on how much your Medicare Advantage plan can increase your premiums and copays each year. This helps make sure what you pay out-of-pocket does not skyrocket after you join the plan.

For more detail about the revisions to the Medicare Advantage and Medicare Prescription Drug Benefit Programs, go to http://www.ofr.gov/OFRUpload/OFRData/2011-22126_PI.pdf

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