CMS has given private insurers offering Medicare Advantage and Part D plans guidelines on what will be required to offer coverage to seniors next year. 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.  Medicare officials said the changes include winnowing the number of versions of a plan that insurers can offer, protecting patients with chronic diseases from excessive co-payments, and banning a practice by some plans that can add even more to the costs of brand name drugs. Specifically CMS will:
  • Take 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.
  • Ban a practice that some prescription drug plans use to increase patients' costs for brand name drugs. Along with a higher copayment for the brand medication, these plans also tack on the difference between the cost of the brand drug and a generic version. CMS will also require Part D plans to provide additional and easy to understand information about coverage in the doughnut hole, including how the plan will cover both brand and generic drugs in the gap. That information will be available on the Medicare Prescription Drug Plan Finder Web site later this fall.
  • Closely scrutinize the private plans' bids for 2010 to eliminate MA plans which don't differ significantly from their basic plans. By eliminating these plans, CMS hopes 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. Officials said the reduction in the number of Medicare plans is meant to cut down confusion, not reduce choice.
Each of these reforms are desperately needed and we applaud CMS for working to make Medicare Advantage more responsive to seniors needs.  Clearly, there's new management in town and that's a good thing for Medicare, seniors and taxpayers.