Changes to Medicare
Post Date:March 12, 2018
CMS Has Proposed a Number of Changes for 2019
CMS has proposed a number of changes for 2019 that would be agent- and client-friendly. This may be the one of the best reads I have had with CMS proposals. The comment period was over January 26 and NAHU gave CMS its feedback. If implemented as proposed, here are some of the highlights:
- Opioids will be more heavily scrutinized with greater review for those given prescriptions. For clients suffering real pain, the drugs won’t be denied, but over-prescribing will be prohibited.
- Seamless conversions, when a carrier moves a client from individual under-65 coverage directly to a Medicare Advantage plan, will be prohibited. Clients will have to opt in rather than opt out, with the dual-eligible population as the sole exception.
- Open enrollment switch period replaces the Medicare Advantage Disenrollment Period beginning 1/1/2019. This one-time switch allows a client to make a change in Medicare Advantage plans between 1/1 and 3/31 annually. This would be very helpful to the clients who regret their Annual Election Period selection perhaps due to network or formulary restrictions.
- Dual-eligibles would be able to make a switch to another Special Needs Plan once per calendar year rather than unlimited changes in a year, as it is today.
- "Meaningful Difference” has been a rule by CMS that required an actuarial difference for a carrier in offering Part D and Medicare Advantage plans. These rules are being relaxed to encourage more competition and consumer choice. Expect to see carriers offering three Part D plans instead of two starting in 2019. Also expect to see more creativity in plan designs.
- Reduced paperwork and approvals are being proposed, especially for marketing materials unlikely to directly result in an enrollment. Expect fewer required pieces needing a CMS approval code in 2019.
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