Medicare Announces New Protections Proposal for People Enrolled in Medicare Advantage and Prescription Drug Programs

On May 8, 2008, The Centers for Medicare & Medicaid Services proposed measures to further protect those in MA health plans and Medicare prescription drug plans.  The proposal is in addition to other protective steps taken by CMS recently, such as posting summaries of corrective action against MA plans online and creating a rating system for plan performance.  The new changes are intended to continue to ensure Medicare beneficiaries, or potential beneficiaries, in MA plans and drug plans are treated fairly and transparently.

The proposal would require a number of specific measures.  For instance, it would prohibit cold-calling and door-to-door solicitation.  It would limit an appointment with a beneficiary to market health care products to what the beneficiary has already agreed to.  It would prohibit sales at educational events or waiting rooms.  It would limit the value of promotional items offered to potential clients, as well as the type.  It would introduce measures to help enrollees get the information to select the best plan for their health care needs. 

There are also measures in the new proposal to streamline extra-help eligibility determinations, to reduce beneficiary liability, and to create specific cost sharing protections.  Additionally, the proposal would allow Medicare clearer authority in calculating financial penalties against MAs or prescription drug plans that break Medicare rules, negatively affecting beneficiaries. 

The measures suggested by the new proposal should see increased protection of Medicare Advantage and Medicare Prescription Drug Plan beneficiaries and, hopefully, increased confidence in the integrity of the system.