An Overview of Proposed CMS Rule Changes for Medicare Advantage Plans
In the hopes of benefiting consumers, the Centers for Medicare and Medicaid Services (CMS) proposed several rules in late 2023 that could impact Medicare Advantage (MA) marketing. Those rules, which are detailed on the website of the U.S. Department of Health and Human Services (HHS), are currently open for comments.
The rules aim to crack down on predatory MA marketing tactics and improve marketplace competition by limiting payments to brokers, among other changes. The proposal came amid the 2024 Annual Election Period (AEP).
The proposed CMS rules include the following:
- Fixed limits on agent and broker compensation regardless of the plan the beneficiary enrolls in
- Improved access to behavioral health care providers
- Mid-year reminder of unused available supplemental benefits to enrollees
- New requirements for supplemental benefits for chronically ill enrollees
- Annual healthy equity analysis that is publicly available online
- More frequent opportunities for dual-eligible individuals to sign up for integrated plans
- Increased protections for dual-eligible individuals from unaffordable costs
- Standardized process for MA Risk Adjustment Data Validation appeals
- Lowered D-SNP look-alike threshold
- Improved enrollee access to equally effective, but possible more affordable, biological products
If approved, these changes would have a substantial impact on MA and D-SNP plans, from design, to marketing, to ongoing enrollee communications. Organizations including the American Hospital Association have already taken the opportunity to comment on the proposed changes. Other advocacy groups and organizations are likely to weigh in before the 60-day comment period ends in early March 2024.
We will continue to monitor the progress of the proposed changes. Keep an eye on our blog for updates on how these propositions could impact health insurance marketing and communications.
Any questions? Reach out to Media Logic today.
