Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and
business strategies about Medicare Advantage plans, product design, marketing,
enrollment, market expansions, CMS audits, and countless federal initiatives in
MA and Medicaid managed care.
By Lauren
Flynn Kelly, Managing Editor
June 8, 2017 Volume 23 Issue 11
Featured in Health
Business Daily, August 22, 2017
In order to ensure that Medicare beneficiaries have access to
“meaningful benefit information” when selecting plans this fall, CMS is
preparing revisions to the Medicare Plan Finder (MPF) that include showing data
on more benefit categories and an expanded display for drug costs and coverage.
The details of how these and other items will be displayed have not been made
known, but beneficiary advocates agree there’s a fine line when it comes to
transparency vs. befuddling consumers with too much information. Moreover, if
the added benefits on display drive seniors toward plans with certain benefits,
the enhanced display could potentially influence plans to incorporate more
supplemental benefits into their bids for 2019.
CMS unveiled the planned changes in a May 22 memorandum sent to
all Medicare Advantage and Part D plan sponsors, saying the enhanced “benefit
package data display” will go live on Oct. 1, 2017.
While CMS did not respond to a request from AIS Health for
additional commentary on why it is making these specific changes, a top agency
official speaking at last month’s Medicare Advantage and Prescription Drug Plan
Spring Conference identified enhancing the beneficiary plan selection process
as a chief goal of CMS this year. “Our focus is to improve the visibility of
the beneficiaries in the Medicare program to identify the best options for
them,” stated Demetrios Kouzoukas, principal deputy administrator and director
with the Center for Medicare.
According to the memo, the planned MPF enhancements include, but
are not limited to:
·
More
benefit categories, including
preventive care, diagnostic procedures/lab services/imaging, hearing services,
preventive and comprehensive dental services, vision services, rehabilitation
services, transportation, foot care (podiatry services), wellness programs and
Medicare Part B drugs;
·
In-network
vs. out-of-network cost share information;
·
Authorization
and referral information;
·
Optional
supplemental benefits with
monthly premium and deductible; and
·
An
expanded display for drug costs and
coverage.
“If CMS chooses to list of all of these benefits in a co-equal
way, it is a big change,” says Michael Adelberg, principal with FaegreBD
Consulting and a former top CMS MA official. “Historically, CMS has sought to
focus decision-making on a smaller number of core benefits.”
CMS has also historically favored minor adjustments over
broad-scale changes, most recently making a series of tweaks highlighting which
plans are under an enrollment sanction and adding more information about the
sanction itself (MAN 9/15/16, p. 1).
But adding so much new information could be problematic, consumer
advocates advise. “The Medicare Plan Finder has always been an extremely
important resource for Medicare beneficiaries seeking unbiased information
about Medicare health plans,” remarks Jane Sung, senior strategic policy
advisory with the AARP Public Policy Institute. “While AARP is pleased to hear
that CMS is continuing to improve the Medicare Plan Finder, we remain concerned
by the growing breadth and complexity of the information that is being
presented. AARP has long argued that the Medicare Plan Finder should be more
user-friendly so that it can better assist Medicare beneficiaries as they
analyze their plan options.”
She continues, “While the new information is certainly relevant
given constantly evolving Medicare Advantage and Medicare Part D plans, CMS
should ensure that it is presented in a manner that is useful and easily
understandable for beneficiaries and their families.”
Consumer Advocates Question Usability
The Medicare Rights Center, which offers a national help line to
assist Medicare beneficiaries in navigating the MPF during the Annual Election
Period, is cautiously optimistic about the planned changes. “Those are all
really good goals and we’re excited to see what CMS does, but I think we’ll
have to wait and see a little bit in terms of how usable that information is in
the Plan Finder tool. But those are things we think are important to include,”
Casey Schwarz, senior counsel for education and federal policy, remarks of the
planned enhancements.
Medicare Rights last year issued a series of recommendations to
CMS on enhancing the MPF, including providing more “individually tailored
information on the summary/comparison results page,” and requested that the
tool make it easier for beneficiaries to see if their providers are in selected
plans’ networks rather than being redirected to a plan’s website and having to
start from scratch. A “searchable provider directory” for each MA plan on the
plan finder would streamline the selection process, suggested the nonprofit
organization.
Neither a searchable provider directory nor an option for
individually tailored information were included in the list of planned changes
issued by CMS. “We’re going to continue to push CMS for providing more
information that is relevant to a particular person based on any of their
claims data or information that they enter into the Plan Finder tool, such as
information about the doctors that they use and whether the network includes
their doctors,” says Schwarz. But based on CMS’s response to the September 2016
letter from Medicare Rights and other conversations, there are technological
and other limitations facing CMS that may keep it from establishing, for
example, a searchable provider directory.
Nevertheless, Medicare Rights has observed that CMS is “willing to
make improvements” to the tool and that prior changes, such as increased
accuracy and more frequent updating to address problems experienced during open
enrollment, have made it more usable over time, adds Schwarz.
Meanwhile, whether the expansion of core benefits on display will
drive plans to incorporate more low cost “extras” (e.g., dental and vision
benefits, wellness programs) into their bids remains to be seen. Shelly Brandel
and Pat Dunks, both principals and consulting actuaries with Milliman, say
there was no immediate reaction from plans to change up their 2018 bids (see
story, p. 1). But the revisions may have more of an impact next year, if there
appears to be a trend of seniors gravitating toward plans that include more of
those benefits in their plan benefit packages, they suggest.
https://aishealth.com/archive/nman060817-02?utm_source=Real%20Magnet&utm_medium=email&utm_campaign=115672897
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