Ritter Insurance Marketing, Craig Ritter

Proposed Rule Would Offer More Protection for Seniors in Medicare Advantage

I copied this headline from the Washington Post, but I’m not sure that it’s entirely accurate!  The basis for the article is the 2015 CMS Advance Notice and Draft Call Letter.  The section the Washington Post is referencing is found on pages 118 through 121.  To me, it seems like CMS is contemplating proposing new rules as opposed to actually proposing anything concrete right now.

Mid-year changes to a provider network is a sticky issue and it seems that narrowing networks is a likely response to reduced funding in Medicare advantage, so I’m not sure this issue is going away anytime soon.  It’s very hard for an MA company to notify a Medicare beneficiary of possible cancellations since the very nature of these contract negotiations is that they often run right up to the last minute and, sometimes, into the “grace” period of contract terminations.  Certainly, there is brinksmanship on both sides of the table.  Too much transparency might cause undo concern for many Medicare beneficiaries.

On the other hand, an increase in the notification time from 30 days to 60 days when a termination does occur and communications on how to find an in-network provider might prove helpful.  I’ll continue to follow this as this will be an ongoing issue with Medicare advatnage.

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