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.

Posted by filed under CMS .

  • Dave – What you are describing is a Medicare COST plan and they already exist. I would love to see more of these as well. I am sure it all comes down to $$. My guess is they get less (from Medicare) and make less (profit)

  • Dave G.

    My first thought is why not just provide a Point of Service option for every MA plan, including HMOs? How difficult would that be? Whatever extra premium would be needed may be modest in comparison.

    We all know how difficult it can be to explain to MA clients in HMOs that they have ZERO Medicare coverage outside the plan. They think, If they still have Medicare, why can’t they still go to any provider who accepts Medicare? Maybe they understand more than us on this point after all.

    Giving MA members a built-in POS opt-out to traditional Medicare benefits would go a long way to smoothing over the narrowed network complaints.


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