Keenan Briefings

Briefing

CMS Issues Changes for Medicare Advantage Plans

On April 4, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing the Inflation Reduction Act and revising certain Medicare programs including Medicare Advantage and the Medicare Prescription Drug Benefit Program (Part D). We recently outlined the changes to Part D here. This briefing discusses changes to the Medicare Advantage program.

WHAT IS MEDICARE ADVANTAGE?

A Medicare Advantage Plan is another way to obtain Medicare Part A and Part B coverage. Medicare Advantage Plans (MA plans) are offered by Medicare-approved private companies that follow rules set by Medicare. About half of Medicare users are enrolled in MA plans. Most MA plans include drug coverage (Part D) and many cover “supplemental benefits”-- items and services that traditional Medicare doesn’t, like fitness programs (gym memberships or discounts) and some vision, hearing, and dental services.

UTILIZATION CONCERNS

MA plans have reported that enrollee utilization of many of these benefits is low. Currently, MA plans are not required to send any communication specific to an enrollee's usage of supplemental benefits and CMS believes such a notice could be an important part of a plan's overall care coordination efforts.

MID-YEAR ENROLLEE NOTIFICATION OF UNUSED SUPPLEMENTAL BENEFITS

Beginning January 1, 2026, MA plans will be required to issue a personalized “Mid-Year Enrollee Notification of Unused Supplemental Benefits” to each enrollee annually, between June 30 and July 31, listing the supplemental benefits the enrollee did not access during the first six months of the plan year and providing information necessary to obtain the benefit. The notification must include the scope of the benefit, cost-sharing, instructions on how to access the benefit, and a customer service phone number. We expect CMS to release a template for these notifications in coming months. Additional information must be provided for special supplemental benefits for the chronically ill (SSBCI).

It is hoped that this policy will educate enrollees on their access to supplemental benefits to encourage greater utilization of these benefits.

For more information, please see the CMS Fact Sheet, Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F), as well as the final rule.

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