viernes, 17 de noviembre de 2017

CMS releases proposed rule to increase choices and lower premiums for Medicare Advantage enrollees

CMS Proposes Policy Changes and Updates for Medicare Advantage and the Prescription Drug Benefit Program for Contract Year 2019 (CMS-4182-P)

Centers for Medicare & Medicaid Services


November 16, 2017

Contact: CMS Media Relations
(202) 690-6145 | CMS Media Inquiries

CMS releases proposed rule to increase choices and lower premiums for Medicare Advantage enrollees
Medicare beneficiaries will see more choices and greater affordability as a result of increased flexibilities
Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that will result in lower premiums and increased plan choices for Medicare beneficiaries. During this year’s Medicare Advantage Open Enrollment, which started October 15th and runs until December 7th, seniors enrolling in Medicare Advantage have seen average monthly premiums drop by 6%, and CMS is proposing changes to continue to drive affordable options for Medicare beneficiaries that meet their unique health needs.
Medicare Advantage remains a popular choice among beneficiaries and has high beneficiary satisfaction. Enrollment in Medicare Advantage is at an all-time high as approximately one-third of Medicare beneficiaries are in a Medicare Advantage plan. The number of Medicare Advantage plans available to individuals to choose from across the country is increasing from about 2,700 to more than 3,100 – and more than 85 percent of Medicare beneficiaries will have access to 10 or more Medicare Advantage plan choices.
CMS is providing new flexibility for customized benefit designs that address the specific health needs of certain beneficiaries. This new flexibility will allow additional plan variety and options, reduced cost sharing for customized benefits and different cost-sharing for beneficiaries that meet specific medical criteria. CMS is also proposing to provide greater flexibility to encourage lower maximum out of pocket levels of beneficiary cost sharing.
This year, CMS received numerous ideas on how to improve Medicare Advantage from beneficiaries, Medicare Advantage plans, advocacy groups, and other stakeholders. The policies in the proposed rule are responsive to this feedback.
“This administration has been committed, from the beginning, to making sure that our seniors have more choices and lower premiums in their Medicare Advantage plans. To that end, we are adding new flexibilities that will allow seniors to choose plans that are tailor-made to their unique needs, with lower out of pocket costs,” said CMS Administrator Seema Verma. “We have also been committed to reducing unnecessary regulations that have driven up the cost of healthcare without improving care, so we are eliminating burdensome regulations on plans and providers that have stood in the way of providing quality patient care.”
The proposed rule also furthers CMS’ Patients Over Paperwork initiative, which is an effort that aims to remove regulatory obstacles in order to empower patients and providers to make healthcare decisions; to develop innovative approaches to improving quality, accessibility, and affordability; and to improve Medicare beneficiaries’ customer experience. Specifically, the proposed rule would reduce regulatory burdens by:
  • Allowing CMS to permit electronic delivery of more materials to beneficiaries;
  • Improving transparency of the Medicare Advantage Star Ratings to that give patients information about each plan’s quality rating.
  • Streamlining government review and approval of materials that Medicare Advantage plans use to communicate with beneficiaries; and
  • Eliminating burdensome enrollment requirements for providers that bring value to Medicare Advantage beneficiaries.
The proposed rule (CMS-4182-P) can be downloaded from the Federal Register at:

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