Press Release             

Contact: Paul Precht
Director of Policy and Communications

Akiko Takano
Deputy Director of Communications

April 19, 2010

Statement by Medicare Rights Center President Joe Baker on CMS Release of
Cost-Sharing Rules for Medicare Private Health and Drug Plans

New York, NY—The limits on the cost-sharing that Medicare private health and drug plans can charge consumers in 2011 will provide important financial protections for people with Medicare who enroll in these plans. In 2011, most Medicare private health plans (also known as Medicare Advantage plans) must cap the amount consumers will pay in deductibles and copayments for Medicare-covered medical services at no more than $6,700 (local preferred provider organizations [PPOs] can set the limit at $10,000 for in- and out-of-network services combined). This new mandatory out-of-pocket limit provides a backstop for consumers who need extensive—and expensive—treatment; almost one-third of Medicare Advantage plans now have no maximum out-of-pocket limit.

The new mandatory limit is high, however, particularly for the majority of people with Medicare who have limited incomes. We are hopeful that a rigorous review of plan benefit packages by the Centers for Medicare & Medicaid Services (CMS) will encourage more plans to set a lower maximum out-of-pocket limit of $3,400 or less—the target amount for both 2010 and 2011. That review process will also determine whether the new guidelines for cost-sharing for specific services, such as chemotherapy and home health care, and for tiered copayments for prescription drugs, protect consumers from excessive cost-sharing for medical treatments and help them compare the benefit packages from competing plans.


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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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