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FFS Article Casts Shadow Over Medicare Drug Plan Hearing

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Democrats on the Senate Finance Committee are asking whether Centers for Medicare and Medicaid officials have similar problems overseeing the insurers in the Medicare Part D prescription drug program and in the Medicare fee-for-service program.

The committee convened a hearing today that was supposed to focus on CMS management of the Medicare drug program.

Committee members spent much of their time talking about the Medicare FFS program article that ran Monday on the front page of the New York Times.

The Times article quoted participants, CMS officials and state insurance regulators who criticized marketing of the Medicare FFS program, which gives Medicare beneficiaries the option of buying traditional fee-for-service health coverage from a private insurer.

Critics say the Medicare FFS, which is separate from the Medicare drug program, offers coverage that resembles traditional Medicare coverage but costs purchasers and the federal government substantially more.

Abby Block, the director of the Center for Beneficiary Choices at the CMS, said that the agency has “zero tolerance for ripping seniors off,” and a new program will require that seniors be called before their enrollment in a fee-for-service plan takes effect.

But Sen. Ron Wyden, D-Ore., said it is not clear whether CMS proposals to remedy the problems by, for example, calling seniors as they enroll in Medicare FFS plans, will help.

“A lot of this seems to be after the fact,” Wyden said.

Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, also expressed concerns about the Medicare FFS program.

Baucus also expressed concerns about whether the CMS is doing enough to make sure beneficiaries know their Medicare Part D drug plan rights and to protect them from unscrupulous marketing.

“I don’t get the feeling that CMS is rigorously protecting seniors,” Baucus said. “More needs to be done.”

Baucus asked Block how often CMS officials deny applications from insurers that want to participate in the Part D drug program.

About 400 insurers participate in the Part D program, and it is “not typical that we would disapprove plans in the application process,” Block said.

Instead, the CMS looks for “deficiencies” in a plan’s application and works with the plan to address them, Block said.

Block said there are “numerous processes in place” to keep watch over plans.

One oversight program is a “secret shopper,” Block said.

The secret shopper program has only been around “for a few months,” Block said.

State insurance commissioners do not have authority to regulate private Medicare prescription drug plans, but Block noted that any agent offering a drug plan is required to be licensed by the states, giving commissioners some degree of authority.


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