Featured in Health Business Daily, August 22, 2017

In Pursuit of Transparency, CMS Unveils Big Changes to Medicare Plan Finder

Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and business strategies about Medicare Advantage plans, product design, marketing, enrollment, market expansions, CMS audits, and countless federal initiatives in MA and Medicaid managed care. Subscribe today!

By Lauren Flynn Kelly, Managing Editor
June 8, 2017Volume 23Issue 11

In order to ensure that Medicare beneficiaries have access to “meaningful benefit information” when selecting plans this fall, CMS is preparing revisions to the Medicare Plan Finder (MPF) that include showing data on more benefit categories and an expanded display for drug costs and coverage. The details of how these and other items will be displayed have not been made known, but beneficiary advocates agree there’s a fine line when it comes to transparency vs. befuddling consumers with too much information. Moreover, if the added benefits on display drive seniors toward plans with certain benefits, the enhanced display could potentially influence plans to incorporate more supplemental benefits into their bids for 2019.

CMS unveiled the planned changes in a May 22 memorandum sent to all Medicare Advantage and Part D plan sponsors, saying the enhanced “benefit package data display” will go live on Oct. 1, 2017.

While CMS did not respond to a request from AIS Health for additional commentary on why it is making these specific changes, a top agency official speaking at last month’s Medicare Advantage and Prescription Drug Plan Spring Conference identified enhancing the beneficiary plan selection process as a chief goal of CMS this year. “Our focus is to improve the visibility of the beneficiaries in the Medicare program to identify the best options for them,” stated Demetrios Kouzoukas, principal deputy administrator and director with the Center for Medicare.

Medicare Advantage News

According to the memo, the planned MPF enhancements include, but are not limited to:

  • More benefit categories, including preventive care, diagnostic procedures/lab services/imaging, hearing services, preventive and comprehensive dental services, vision services, rehabilitation services, transportation, foot care (podiatry services), wellness programs and Medicare Part B drugs;

  • In-network vs. out-of-network cost share information;

  • Authorization and referral information;

  • Optional supplemental benefits with monthly premium and deductible; and

  • An expanded display for drug costs and coverage.

“If CMS chooses to list of all of these benefits in a co-equal way, it is a big change,” says Michael Adelberg, principal with FaegreBD Consulting and a former top CMS MA official. “Historically, CMS has sought to focus decision-making on a smaller number of core benefits.”

CMS has also historically favored minor adjustments over broad-scale changes, most recently making a series of tweaks highlighting which plans are under an enrollment sanction and adding more information about the sanction itself (MAN 9/15/16, p. 1).

But adding so much new information could be problematic, consumer advocates advise. “The Medicare Plan Finder has always been an extremely important resource for Medicare beneficiaries seeking unbiased information about Medicare health plans,” remarks Jane Sung, senior strategic policy advisory with the AARP Public Policy Institute. “While AARP is pleased to hear that CMS is continuing to improve the Medicare Plan Finder, we remain concerned by the growing breadth and complexity of the information that is being presented. AARP has long argued that the Medicare Plan Finder should be more user-friendly so that it can better assist Medicare beneficiaries as they analyze their plan options.”

She continues, “While the new information is certainly relevant given constantly evolving Medicare Advantage and Medicare Part D plans, CMS should ensure that it is presented in a manner that is useful and easily understandable for beneficiaries and their families.”

Consumer Advocates Question Usability

The Medicare Rights Center, which offers a national help line to assist Medicare beneficiaries in navigating the MPF during the Annual Election Period, is cautiously optimistic about the planned changes. “Those are all really good goals and we’re excited to see what CMS does, but I think we’ll have to wait and see a little bit in terms of how usable that information is in the Plan Finder tool. But those are things we think are important to include,” Casey Schwarz, senior counsel for education and federal policy, remarks of the planned enhancements.

Medicare Rights last year issued a series of recommendations to CMS on enhancing the MPF, including providing more “individually tailored information on the summary/comparison results page,” and requested that the tool make it easier for beneficiaries to see if their providers are in selected plans’ networks rather than being redirected to a plan’s website and having to start from scratch. A “searchable provider directory” for each MA plan on the plan finder would streamline the selection process, suggested the nonprofit organization.

Neither a searchable provider directory nor an option for individually tailored information were included in the list of planned changes issued by CMS. “We’re going to continue to push CMS for providing more information that is relevant to a particular person based on any of their claims data or information that they enter into the Plan Finder tool, such as information about the doctors that they use and whether the network includes their doctors,” says Schwarz. But based on CMS’s response to the September 2016 letter from Medicare Rights and other conversations, there are technological and other limitations facing CMS that may keep it from establishing, for example, a searchable provider directory.

Nevertheless, Medicare Rights has observed that CMS is “willing to make improvements” to the tool and that prior changes, such as increased accuracy and more frequent updating to address problems experienced during open enrollment, have made it more usable over time, adds Schwarz.

Meanwhile, whether the expansion of core benefits on display will drive plans to incorporate more low cost “extras” (e.g., dental and vision benefits, wellness programs) into their bids remains to be seen. Shelly Brandel and Pat Dunks, both principals and consulting actuaries with Milliman, say there was no immediate reaction from plans to change up their 2018 bids (see story, p. 1). But the revisions may have more of an impact next year, if there appears to be a trend of seniors gravitating toward plans that include more of those benefits in their plan benefit packages, they suggest.


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