The proposal would also help give Americans with Medicare drug benefits access to biosimilars, which are cheaper versions of biological drugs made from living cells or other organisms. right.
Health and Human Services Secretary Xavier Becerra said at a briefing that older Americans who choose Medicare insurance “should not be subject to a quick and loose marketing rule.” He outlined the proposal at a press conference on Monday.
The proposed rule would be the second time in a year that the administration has sought to tighten regulations on Medicare Advantage, the private version of Medicare that has surged in popularity in recent years. Late last year, HHS issued a separate proposed a series of changes. The rule was finalized in April.
What President Biden is aiming for Senior aides to the president, who is seeking a second term in power, have portrayed the proposal as an aspect of “table economics” that they hope will appeal to voters in elections a year from now.
Medicare Advantage was introduced in 2003 as part of the same federal law that added prescription drug benefits to Medicare for the first time since the vast insurance program was created in the 1960s as part of President Lyndon B. Johnson’s “Great Society.” was founded in. Traditional Medicare allows people over 65 and people with disabilities to choose their own doctor and pay a monthly premium for outpatient care. Privatized versions of managed care plans often offer additional benefits that are popular with older patients, such as vision and hearing services, but these plans typically limit patient acceptance to a particular provider. Limited to a narrow network of registered healthcare professionals. plan.
When Medicare Advantage was created to replace some previous forms of managed Medicare, Republicans, who held majorities in both houses of Congress, wanted the government to replace private plans as an incentive to encourage more plans. They insisted on paying more than the original Medicare reimbursement rate. participate.
The incentive was a success. For the first time this year, Medicare Advantage enrollees account for just over half of all Medicare beneficiaries, bringing the number to about 31 million people with private plans, with the typical Medicare enrollee having about 40 private health plans to choose from. It is a record. According to KFF, a nonpartisan health policy group, there are many options.
As its popularity has grown, privatized versions of Medicare have come under increasing scrutiny, including from Congressional Democrats.
“This is based on fundamental concerns about market disruption and aggressive marketing by insurers,” said Tricia Newman, senior vice president who leads the Medicare policy program at health policy group KFF.
Specifically, the proposed rule would establish guardrails that would more strongly limit the compensation of insurance agents and brokers who advise Medicare customers, regardless of which plan the consumer chooses, and would A fixed amount is set for such advice. Despite the current cap, some companies are paying agents and intermediaries luxuries like golf trips to attract business, said Lael Brainard, director of the White House National Economic Council. He told reporters at a press conference on Monday.
In addition, the rule change will require private health insurance plans to notify individual Medicare customers of the additions mid-year. They can still benefit. A typical Medicare Advantage plan offers 23 health benefits not found in traditional Medicare, but utilization is low, according to an HHS fact sheet. The goal of the proposal is to “ensure that the federal government’s significant tax investment in these benefits actually goes to beneficiaries and is not used primarily as a marketing strategy,” the HHS document says. .
Another aspect of the proposal would expand access to mental health services by expanding the supply of behavioral health workers in offices and clinics, including marriage and family therapists and addiction treatment specialists. This is a requirement for private Medicare health plans.
This rule change will also impact Medicare Part D coverage because of the program’s known drug benefits. The proposal would go further than current federal regulations by requiring plans to sell prescription drug coverage to make it easier for patients to obtain coverage for biosimilar products.
The proposed changes announced Monday will be issued during the annual Medicare enrollment period, which runs from mid-October to Dec. 7. The proposal will be open for public comment for 60 days. The final version is expected to go into effect next fall, in time for the 2025 Medicare enrollment period.
