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Wednesday, September 26, 2018

Medicare Advantage Program Changes

The Center for Medicare Advocacy (CMS) recently issued a special report summarizing a number of changes made to Medicare law, regulations and guidance during the first half of this year. For the most part, these changes loosen some of the rules regarding Medicare Advantage.

As a result of these changes, Medicare Advantage plans now have more ability to tailor their supplemental benefits to the unique needs of their patients.

One example of the change is that the law requires that Medicare Advantage plans provide uniform benefits at a uniform premium to all enrollees in a specific plan. Previously, CMS interpreted the law to include uniform cost-sharing. But under its new rules, CMS allows plans, for enrollees that meet specific medical criteria, to reduce cost-sharing for certain benefits, to offer certain supplemental benefits and to provide lower deductibles – as long as all enrollees in similar situations are treated the same and that such tailored benefits are for services medically related to the shared medical condition.

There are a number of other significant changes in the rules. For a complete overview, you can review this report from the Center for Medical Advocacy.



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