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CMS Proposes Policy and Payment Changes for Medicare Advantage and Part D Plans

The Centers for Medicare & Medicaid Services (CMS) recommends policy changes to Medicare Advantage (MA) and Part D plans each year. This week, the Medicare Rights Center submitted comments on the proposed rule for 2024.

We appreciate and support many of the outlined updates. In particular, we applaud the proposals to improve access to substance use disorder and mental health care, changes that would remove barriers to care and further embed equity into Medicare. We also welcome the agency’s efforts to curb prior authorization, inappropriate coverage denials, and predatory marketing. These harmful practices routinely interfere with access to care and beneficiary decision-making. We encourage CMS to further strengthen enrollee protections in future rulemaking and guidance.

Throughout our comments and in general, we urge CMS to provide more robust oversight of MA and Part D plans to ensure they are meeting their contractual and civic duties to beneficiaries, taxpayers, and Medicare. We recognize this may require additional CMS staff and resources, which we urge the agency to pursue as necessary.

We are disappointed, however, that the proposed rule does not address several important issues in needed depth: the overly-complex MA and Part D appeals processes; the cluttered MA plan choice landscape; the marketing of supplemental benefits; financial incentives for brokers and agents; and weakened network adequacy standards. In our comments, we discuss these matters and pose solutions.

Another critical topic, plan payment, is the subject of separate annual rulemaking known as the Advance Notice. In our preliminary analysis of the proposed rates for 2024, we were pleased to see CMS taking initial steps to correct the decades-long problem of MA overpayments. We remain concerned that overpayments are negatively impacting Medicare’s finances and long-term sustainability, as well as beneficiary premiums and taxpayer costs.

The amounts inappropriately paid to plans are significant and well documented. The Government Accountability Office estimates that in 2013 alone, MA plans received an extra $14.1 billion, and the Medicare Payment Advisory Committee has cataloged approximately $140 billion in MA overpayments over the past 12 years. In 2018, CMS identified an estimated $650 million in overpayments to 90 plans from 2011 through 2013; some analysts calculated overpayments of at least twice that much.

We applaud CMS’s efforts to make payment methodology more accurate and rates more rational, and we urge further action. CMS must do even more to rein in high and unnecessary costs. A comprehensive approach is needed to address the full range of MA financing flaws, especially as Medicare eligibility and MA enrollment numbers grow. Absent systemic reforms, more and more people will experience the pitfalls of the current system, and costs will continue to escalate. We look forward to exploring these and other aspects of the 2024 Advance Notice in our comments, due March 3.

Read the 2024 MA and Part D proposed rule and our comments.

Read the 2024 Advance Notice and a CMS Fact Sheet.

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