CMS Gives New Policies for Better Transparency for Medicare Advantage

June 06, 2022

People do not often understand what a Medicare Advantage is or how it can benefit them over a long period of time. Medicare Advantage plans give many additives to insureds. However, they can also be challenging to understand — especially for nursing homes and other health care businesses. If you accept Medicare, you might be wondering, do Medicare Advantage plans follow CMS guidelines. Also, how does CMS define a Medicare Advantage plan?

The Medicare Advantage

The Centers Medicare & Medicaid Services answered many of these questions by issuing a ruling on Medicare Advantage plans. The new policy outlines several important changes that aim to make coverage more affordable and accessible. Learn about four of the most significant changes businesses can expect from these updates.

Medical Loss Ratio Reporting

One essential component of the new policy is the reinstatement of reporting requirements that track the medical loss ratios of facilities receiving Medicare Advantage funding. There are currently no plans to mandate specific ratios or take action based on reports. However, experts use data to make Medicare Advantage more transparent by providing insight into expenses and losses that come with the program.

Free Interpreter Services

Another essential part of the announcement is a provision for free interpreter services. However, providers have not set these services to expand yet. Instead, the announcement mandates that all insureds be informed if free interpreter services are available. Any required document given to an enrollee must include a multi-language component. These provisions are likely to make Medicare Advantage plans more accessible to a broader range of insureds, and it will also improve the quality of care provided to existing enrollees.

Dual Medicare and Medicaid Eligibility

Some Medicare Advantage enrollees are also eligible for coverage through Medicaid before the announcement. These individuals did not receive adequate service. New policies are in motion to ensure that dually-eligible enrollees can take full advantage of the benefits they can claim. To achieve this, states must integrate both plans and provide eligible individuals with tools to easily access their coverage. It’s unclear what form these tools will take but increased access to resources may be particularly helpful to special needs beneficiaries.

Lower Out-of-Pocket Medication Cost

Perhaps the most beneficial update announced in the plan is the reduction of beneficiaries’ out-of-pocket expenses for medication. Though this change will not roll out until 2024, it’s poised to reduce the financial burden many insureds face as they seek medical care. The price reduction will come from the new requirement that Medicare Advantage and Part D plans pass discounts on to insureds received at the point of sale. These discounts may reduce the price of some of the most common prescription drugs on the market.

About Brooks, Todd & McNeil

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