Medicare private plans may see more regulation

Revisions to Medicare Advantage and Part D policies are geared to protect beneficiaries and make choosing a plan easier.

By Chris Silva — Posted Oct. 29, 2009

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

The Centers for Medicare & Medicaid Services issued a proposed rule Oct. 9 that seeks to improve the performance of Medicare prescription drug and health plans.

The changes to Medicare Advantage and Part D would clarify program requirements for the more than 4,000 plan offerings and improve protections for beneficiaries enrolled in these plans, CMS said. Officials said the agency is seeking to improve the overall performance of the programs to ensure that beneficiaries have the best choices available when making decisions about their coverage.

"CMS is strengthening and simplifying the drug and health plan program in order to deliver a level of service that is more responsive to Medicare beneficiary needs," said Jonathan Blum, acting director of the agency's Center for Health and Drug Plan Choice. "While CMS made important improvements through the 2010 contracting process, these rules will enable the agency to make further improvements."

Among other revisions, CMS is proposing to:

  • Increase its ability to identify and approve qualified drug and health plans.
  • Improve protections from discriminatory cost-sharing by clarifying plan requirements on out-of-pocket costs and cost-sharing.
  • Eliminate duplication by requiring meaningful differences between an insurer's various product offerings with regard to premiums, beneficiary out-of-pocket costs, plan types and drug formularies.

Additional policy revisions include a proposal to collect all prescription drug event data elements to provide more accurate information for analysis of how Medicare beneficiaries are using their Part D plan benefits.

The proposed rule was published in the Federal Register Oct. 22. The public comment period is set to close Dec. 8.

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn