All sorts of proposed changes for people in Medicare Advantage are afoot, reports Allison Bell for ThinkAdvisor. The Centers for Medicare and Medicaid Services has released proposed rules effective 2027 that largely benefit insurers, eliminating several protections against misleading marketing, health inequities, and prior authorization gaming.
One proposed rule, if finalized, would give Medicare Advantage enrollees who lose their in-network providers mid-year the right to switch to another Medicare plan without CMS approval. However, it does not appear that this new rule would give Medicare Advantage enrollees a guaranteed right to enroll in a Medigap plan if they opted to switch to Traditional Medicare. Consequently, if their in-network providers have opted out of all Medicare Advantage plans, as many have been doing, they would still likely not be able to continue care with these providers without paying entirely out of pocket for that care.
Medicare Advantage enrollees currently only have the right to disenroll from their Medicare Advantage plans mid-year if CMS deems that there has been a “significant change” in their provider network. They must wait for a CMS determination to switch out of their Medicare Advantage plan. The CMS determination can take a long time, preventing enrollees’ continuity of care from the same physicians and hospitals. But, if CMS makes the determination, they have a guaranteed right to buy Medicare supplemental coverage (Medigap) if they opt to switch to traditional Medicare. People in traditional Medicare generally get Medigap for financial security.
Of concern, if finalized, the proposed rules would also give insurance agents more leeway to approach prospective customers and sign them up for a Medicare Advantage plan after an “educational” meeting. Worse still, they would give third parties selling Medicare Advantage plans more leeway to use images of a Medicare card in their marketing materials; they would no longer need CMS approval.
Perhaps most unconscionable, CMS proposes to free agents and brokers from including in their sales material information about the independent unbiased free counseling people can get from State Health Insurance Assistance Programs (SHIPs). Right now, they must include this information. It’s not clear what’s motivating the administration to keep people from getting unbiased information.
Of note, the proposed rules also would eliminate the requirement that Medicare Advantage plans notify their enrollees mid-year about unused “extra” benefits. And, the proposed rules add no additional protections for people from Medicare Advantage insurers’ inappropriate use of prior authorization protocols.
CMS says that it wants to penalize Medicare Advantage insurers for their bad acts. At the same time, it is loosening regulations that attempt to protect people from their bad acts. Rather than focusing on protecting the vulnerable older Americans and people with disabilities in Medicare, CMS says it does not want to “burden” the insurers.
Here’s more from Just Care:
- Ten ways Medicare Advantage plans differ from traditional Medicare
- When your doctors leave your Medicare HMO, will the government protect you?
- 2026: Big changes in Medicare Advantage
- If you’re in a Medicare Advantage plan, watch out! Your doctor or hospital might no longer be in-network
- 2026: Five things to think about when choosing between Traditional Medicare and a Medicare Advantage plan
