For purposes of complying with the new federal summary of benefits and coverage (SBC) rules, Medicare Advantage plan benefits are Medicare benefits, according to the Employee Benefits Security Administration (EBSA).
EBSA, an arm of the U.S. Labor Department, has included that interpretation in guidance posted in a collection of answers to frequently asked questions (FAQs).
EBSA officials have developed the answers in an effort to help employers comply with the SBC provisions in the Patient Protection and Affordable Care Act of 2010 (PPACA) and other PPACA provisions.
The PPACA SBC provisions, which are set to take effect Sept. 23, will require health insurers and employers to provide standardized, 4-page SBCs. The SBCs are supposed to help individuals and employers make apples-to-apples comparisons when they’re shopping for coverage.
An SBC would include a summary of basic plan features, along with coverage examples that show how a specific enrollee’s plan would work if the enrollee had a baby, were managing Type II diabetes, or were dealing with other common illnesses, chronic conditions or life events. Consumers would get SBCs when they apply for coverage or enroll in group plans. Consumers also could get SBCs upon request.
When members of Congress were debating PPACA, Democrats made a point of distinguishing between the traditional Medicare program, which is administered by the Centers for Medicare & Medicare Services, an arm of the U.S. Department of Health and Human Serivces (HHS), and the Medicare Advantage program.
The Medicare Advantage program gives private health insurers and managed care companies an opportunity to sell plans that serve as an alternative to the traditional Medicare plan to Medicare program enrollees.
In December 2009, when members of Congress were debating health system change legislation, Democrats made of point of arguing that Medicare Advantage coverage was something other than Medicare coverage.