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April 05, 2022 at 03:15 PM
What You Need to Know
- The proposal could increase Medicare plan issuers' total average 2023 revenue by about 8%.
- CMS wants to cut the grades of plans with many enrollees who end up with coverage canceled retroactively because of marketing complaints.
- The agency says it may introduce the bad broker penalty proposal through the formal rulemaking process.
Medicare program managers still want to crack down on Medicare plans that use bad agents, brokers and sales reps to sell coverage — but they left an extra marketing penalty out of the new set of rules for 2023 coverage.
The Centers for Medicare and Medicaid Services said that adding the new bad marketer penalty would be a major change in program. To make such a big change, CMS will have to propose the change through a formal rulemaking process, officials said.
CMS officials talked about the bad marketer penalty proposal when they released the final version of the 2023 Medicare plan payment policy announcement.
The announcement affects issuers of ordinary Medicare Advantage plans, Medicare Part D prescription drug plans and some other types of Medicare plans.
This is the first Medicare payment policy announcement developed entirely by the administration of President Joe Biden.
Private Medicare Plans
The Medicare Advantage program gives private insurers a chance to use a combination of federal money and enrollee premiums to provide what amounts to an alternative to traditional Medicare coverage.
The Medicare drug plan gives private insurers a chance to use federal money and enrollee premiums to provide prescription drug coverage.
About 29 million of the 64 million people enrolled in Medicare have Medicare Advantage plan coverage, and 48 million have Medicare drug coverage.
CMS officials said in February, when they released a draft version of the 2023 announcement, that the base level of federal support for Medicare Advantage plans will increase 4.75% in 2023, and that the issuers’ average total revenue should increase by an average of about 8%.
Health insurers are happy with the current 2023 payment rules.
Mary Beth Donahue, president of the Better Medicare Alliance — a group that includes health insurers and other individuals and organizations with an interest in private Medicare plans — said that the group is continuing to review the payment announcement details, but that the announcement “puts beneficiaries first and ensures stability and continuity of care” for Medicare Advantage enrollees.
Matt Eyles, president of America’s Health Insurance Plans also praised the announcement.
