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Right off the Bat
January 22, 2009 • Volume 9, Issue 3
The 2010 Call Letter for Medicare Advantage and Prescription Drug plans provides the Obama administration with its first opportunity to strengthen financial protections, improve the quality of care and enhance transparency of coverage choices for people with Medicare under these programs. Unfortunately, the early release of the draft 2010 Call Letter by the outgoing Bush administration preempts proposals for new structures and rules for the Medicare Advantage and Part D programs by the incoming leadership at the Centers for Medicare & Medicaid Services. Unless it issues a revised Call Letter, the Obama administration will not be able to seek input on its own proposals from consumers, health plans and other stakeholders in advance of issuing the final 2010 Call Letter in March.
Instead of proposing fundamental reforms, the recent draft 2010 Call Letter repeats the same ambiguous guidance on benefit design from previous Call Letters. This guidance fails to guarantee adequate protection against high medical costs for enrollees in Medicare Advantage plans, and it does nothing to make it easier for consumers to choose the most appropriate coverage. Specifically, the recent draft Call Letter:
- Does not employ CMS’s authority to reject discriminatory benefit designs to adequately assure that all Medicare Advantage plans will provide an annual out-of-pocket limit that caps consumers’ cost-sharing for medical services, the most effective way of ensuring benefit designs do not discriminate against people with high-cost illnesses.
- Provides no guidance prohibiting Medicare Advantage plans from excluding services, such as chemotherapy drugs, from counting toward out-of-pocket limits, despite the clear discriminatory effect of such exclusions. The draft Call Letter also makes no improvement to standard marketing materials that would alert consumers to such exclusions.
- Fails to adequately assure that Medicare Advantage plans’ cost-sharing for specific services does not exceed coinsurance under Original Medicare.
- Fails to steer Medicare Advantage and Prescription Drug plans toward standardized benefit designs that would clarify comparisons of plan options and facilitate consumer choice.
- Fails to take measures that would restrict marketing efforts by private fee-for-service plans that target people with Medicare and Medicaid (dual eligibles), despite the incompatibility of these plans with the requirement to establish provider contracts that guarantee limited cost-sharing for dual eligibles.
For these and other reasons, the Medicare Rights Center recommends that the Obama administration issue a revised draft 2010 Call Letter that begins the process of enacting fundamental reforms to the Medicare Advantage program and Part D drug benefit. A revised Call Letter would allow the Obama administration to put its reform ideas before the public and allow feedback from the public to improve those ideas.
“CMS will examine cost-sharing with greater scrutiny if beneficiary liability is not limited by an out-of-pocket (OOP) maximum that is equal to, or less than, an amount that will be specified in the final Call Letter. In addition, MA plans with cost-sharing amounts greater than Original Medicare for renal dialysis, Part B drugs, or skilled nursing facility services may be considered discriminatory, regardless of an out-of-pocket maximum.” (Emphasis added.) (Draft 2010 Call Letter, Centers for Medicare & Medicaid Services, December 2008)
“I am the SHIP counselor in Pennsylvania. Medicare beneficiaries in our county have to choose among 81 Medicare Advantage plans and 57 stand-alone Part D plans. People are having a very difficult time making that choice. The Medicare.gov website does not always give all of the needed information. For example, Geisinger Gold has a Classic 3 HMO option that has a very low premium and mostly low copays but what it doesn't tell you is that there is a $1500 deductible!! This should not be allowed - posting a plan like that and not showing a significant out of pocket expense!! It is extremely difficult to counsel people about these plans - there is absolutely no way that all of the 81 plans can be reviewed with a client during a counseling session - even with eliminating several plans because of network restrictions or other reasons. There are many people who come in with absolutely no idea of what they want, they don't understand it and want me to just pick a good plan - which I cannot do of course.” (Story submitted to the Medicare Private Health Plan Monitoring Project,
, May 2008) Medicare Rights Center
“We urge CMS to use the 2010 Call Letter to implement strict requirements that all plans: (1) limit cost-sharing for each identified service to no more than the cost-sharing permitted under Original Medicare, and (2) incorporate a comprehensive out-of-pocket limit set at the average premium for comprehensive Medigap supplemental coverage.” (Improving the Medicare Program for Beneficiaries: Administrative Recommendations for the Incoming Administration, Medicare Rights Center, November 2008)
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Medicare Rights Center’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
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Medicare Part D Monitoring Project
would like to hear about your experience, or that of someone you know, enrolled in a private drug plan. With information about what the issues are with Medicare Part D, we will be able to demand that those problems be fixed. Medicare Rights Center
Submit your story at http://www.medicarerights.org/about-mrc/newsletter-signup.php.
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The Louder Our Voice, the Stronger Our Message
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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.
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