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These Medicare Changes Should Improve Senior Health Care

October 16, 2009
On October 9, The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to improve performance of prescription drug and health plans by strengthening standards to participate in the Medicare program. Over the next 60 days, CMS will receive comments on the proposed revisions to the Medicare Advantage (MA) program (Part C) and Prescription Drug benefit program (Part D).  The proposed changes would clarify program requirements for the more than 4000 prescription drug and health plans offerings and improve protections for Medicare beneficiaries enrolled in these plans. Jonathan Blum, acting director of CMS’s Center for Health and Drug Plan Choice, said the agency is seeking to improve the overall performance of the program to ensure that the program remains strong and that Medicare beneficiaries have meaningful drug and health plan choices to make the best possible decisions about their coverage. “CMS is strengthening and simplifying the drug and health plan program in order to deliver a level of service that is more responsive to Medicare beneficiary needs,” Blum said.  Specifically, among other things, CMS is proposing to: Strengthen CMS’ ability to identify and approve qualified drug and health plans; improve Medicare beneficiary protections from discriminatory cost sharing by clarifying health plan requirements relating to out-of-pocket costs and cost-sharing; and eliminate duplication in drug and health plan bids submitted by the same organization by requiring a meaningful difference between an organization’s product offerings with regard to premiums, beneficiary out-of-pocket costs, plan types, and formulary offerings. The comment period for this proposed rule will close on December 8, 2009.