CMS Proposed Rule for Plan Flexibility Risks Consumer Confusion

This week, Medicare Rights Center submitted comments in response to the Centers for Medicare & Medicaid Services (CMS) proposed rule for Medicare Parts C & D. The proposed rule contemplates many broad changes to the Medicare Advantage and prescription drug coverage programs, largely focusing on providing more flexibility and options for plan sponsors. CMS’s stated aim is to allow plans to use the proposed flexibility to better serve beneficiaries—by creating disease- or condition-specific sets of benefits, offering more plans, and altering cost sharing arrangements.

While Medicare Rights strongly supports getting people with Medicare the care they need, we are concerned about the potential for beneficiary confusion, inappropriate plan manipulation, and challenges related to assessing the impacts of different changes if they are all happening at once. In addition, some of the proposed changes overlap with or may interact with existing, carefully constructed demonstration programs that are testing how such flexible options affect care. Medicare Rights’ comments highlight the need for CMS to apply the crucial beneficiary protections in those demonstration programs if more flexibility is introduced.

CMS acknowledges that these changes will make the already difficult process of plan comparison and selection more difficult. To help tackle this challenge, CMS proposes to make changes and improvements to the Medicare Plan Finder tool. While Medicare Rights enthusiastically looks forward to needed updates and improvements to the Plan Finder—especially a useful integration of plan network information—such improvements alone are unlikely to be sufficient to make plan comparison transparent and easy and end beneficiary confusion. In addition, such improvements are long overdue and must be in place and thoroughly tested before changes that make the process even more confusing are implemented.

This article made possible by generous support from the Retirement Research Foundation.