- Updates – Medicare Open Enrollment Period, Starting October 15
- Free Webinar – Medicare Enrollment Issues for 2021
- MA Plans Allowed to Report Less Data about Appeals Outcomes
Updates – Medicare Open Enrollment Period, Starting October 15
The Annual Election Period (AEP) – the period during which individuals with Medicare can make coverage elections regarding Medicare Advantage (MA) and Part D plans for the following year – will start October 15th and last until December 7th. This period is sometimes referred to as the Open Enrollment Period (OEP).
Below is some information issued by the Centers for Medicare & Medicaid Services (CMS) about 2021 Medicare Advantage and Part D plan offerings, and by the Administration for Community Living (ACL) about CMS mailings and notices.
Also below, the Center for Medicare Advocacy expresses our ongoing concern about CMS’ continued steering of beneficiaries towards MA enrollment.
2021 Plan Information
Information about 2021 MA and Part D plan offerings is available on the Medicare Plan Finder at medicare.gov starting today, October 1st.
On September 24, the Centers for Medicare & Medicaid Services (CMS) issued a press release about 2021 plan offerings. The following links to additional information about such offerings are reproduced from the press release:
- To view the premiums and costs of 2021 Medicare Advantage and Part D plans, please visit: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/index.html. Select the various 2021 landscape source files in the downloads section of the webpage.
- To view a chart on the Medicare Advantage premium change between 2017 and 2020 on a state-by-state basis, please visit: https://www.cms.gov/files/document/medicare-advantage-premium-change-between-2017-2020.pdf.
- For state-by-state information on Medicare Advantage and Part D in 2021, please visit: https://www.cms.gov/files/document/2021-ma-part-d-landscape-state-state-fact-sheets.pdf.
- For more information on the Part D Senior Savings Model, including plan participation, please visit: https://innovation.cms.gov/innovation-models/part-d-savings-model.
- For more information on the Medicare Advantage Value-Based Insurance Design Model, including plan participation, please visit: https://innovation.cms.gov/innovation-models/vbid. A fact sheet on the CY 2021 participation in the Medicare Advantage Value-Based Insurance Design Model is attached and available at: https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-value-based-insurance-design-model-calendar-year-2021-model-participation
CMS Mailings Chart and Key Notices
The Administration for Community Living (ACL), which oversees State Health Insurance Assistance Programs (SHIP) programs, issued the following information to SHIPs and other Medicare stakeholders. We reproduce it here:
The following CMS mailings chart and HPMS plan memos regarding required notices serve as reminders of the notices beneficiaries will receive in coming weeks:
- CMS mailings chart includes hyperlinks to model notices (standard language) from CMS on colored paper as well as plan notices. Keep this chart handy as beneficiaries will often refer to the color of the notice received https://www.cms.gov/Medicare/Prescription-Drug-Coverage/LimitedIncomeandResources/Downloads/Consumer-Mailings.pdf See the NCOA provided detailed explanation of the notice chart https://www.ncoa.org/wp-content/uploads/AEP-guide-to-mailings-and-key-events.pdf
Key highlights of CMS notices in coming weeks
- By Sept 30
- Annual Notice of Change (ANOC) from plan
- Extra Help/LIS deemed status loss letter from CMS
- Medicare and You Handbook from CMS
- Plan marketing materials starting Oct. 1 from plans
- Plan non-renewal and LIS notices by Oct. 2- 3 from plan
- By Sept 30
- HPMS plan memos on Extra Help Reassignment
- Prescription Drug Plan (PDP) zero premium reassignment
- Beneficiaries who have chosen their own plan (themselves or with help from another, like a SHIP counselor) or who no longer qualify for Extra Help in 2021 will not be reassigned. These beneficiaries will receive a notice from CMS listing zero premium plan choices in their service area in late Cot. (see mailings chart). The plan list is a starting point. Beneficiaries may need SHIP counselor comparison help to determine whether the plans on the list cover their specific medications (must on formulary be to get LIS price) and whether utilization management rules (like quantity limits, step therapy) apply.
- Medicare Advantage service area changes reassignment
- Applies to beneficiaries with Extra Help in 2020 and 2021
- By Oct. 3, beneficiaries must receive notice of reassignment
- Prescription Drug Plan (PDP) zero premium reassignment
Ongoing Steering Towards Medicare Advantage Plans
Since Fall 2017, the Center for Medicare Advocacy has expressed concerns about bias towards Medicare Advantage in CMS materials, including outreach and enrollment materials, email campaigns and the 2018, 2019 and 2020 Medicare & You handbooks (see, e.g., here, here and here).
On September 18, 2020, the Center released an Issue Brief titled “Medicare & You 2021 – An Assessment of Bias in Favor of Medicare Advantage” which provides an in-depth analysis of the new handbook and the ways in which it treats Medicare coverage options in a way that is not balanced or neutral, as it should be.
As noted in our analysis the 2021 Medicare & You handbook, throughout CMS education and outreach materials, in recent years there has been a focus on “plans”, often implying that a Medicare “plan” is the only or best option for individuals. CMS’ repeated reference to plans undermines the option of Original Medicare, and assumes that private MA plans are the default option. While people with Original Medicare may have stand-alone Part D plans, which they would be advised to review every year, CMS language has often blurred the distinction between MA and Part D plans and refers to them as “health and drug” plans or other characterizations that imply that they are either one and the same, or that a combination of both (a Medicare-Advantage Prescription Drug, or MA-PD) is the best choice.
It appears that the 2020 CMS email campaign will continue in this vein. On September 25, the Center received the first CMS Fall 2020 enrollment period email entitled “Plan ahead for Medicare Open Enrollment.” The email states, in part (emphasis in original):
Medicare Open Enrollment begins October 15! This year, Medicare plans have historically low premiums — dropping an average of 34% over the last 3 years, and in some states up to 60%! Starting October 1, you’ll be able to take a sneak peek at plans available in your area.
If you’re among the 1 in 3 people with Medicare who has diabetes, here’s some more good news: many participating drug plans will offer a 30-day supply of insulin for $35 or less starting January 2021.
Think you’ll need help comparing plans once Open Enrollment begins? Here are some things you can do from the safety of your home:
- Find Plans at Medicare.gov,where you can see estimates for all your prescriptions.
- Look at the eHandbook (also available in accessible formats like Braille, large print, and data/audio files).
- Call us at 1-800-MEDICARE during Open Enrollment.”
Similarly, on October 1 CMS sent another email with the heading “Sneak peek into Open Enrollment” which states, in part (emphasis in original):
Medicare Open Enrollment starts October 15 — but you can get a head start by previewing 2021 plans today! Now’s a great time to review your coverage and see if there’s a better fit for you. Plans have historically low premiums — dropping an average of 34% over the last 3 years, and in some states up to 60%!
Here’s something new for Open Enrollment: Many participating drug plans will offer a 30-day supply of insulin for $35 or less in 2021. Visit Medicare.gov now to preview participating plans ahead of Open Enrollment.
Remember: When comparing plans, look at the estimated “Yearly Drug & Premium Cost.” A plan with the lowest premium may not always provide the lowest total cost to you.
While this email adds the important caveat that the lowest premium does not necessarily mean the lowest total cost, the promotion of generic “plans” blurs distinctions between plan types, and is not geared towards someone who wishes to remain (or switch to) traditional Medicare
The complaints the Center has received about the September 25th email include one from an insurance agent whose client with a Medicare supplemental policy (Medigap) received this email. As noted by the agent, “You know how inappropriate this is as it is only partly true, and is in essence advertising for Medicare Advantage plans.” We couldn’t agree more.
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Free Webinar: Medicare Enrollment Issues for 2021
October 14, 2020, 2:00 PM EDT
This webinar will discuss the 2020 Annual Coordinated Election Period (ACEP), including outreach and education materials issued by the Medicare program, Medicare Plan Finder updates, common enrollment pitfalls, options when you miss your Initial Enrollment Period, and other considerations for Medicare beneficiaries and those who assist them. Policy changes, potential helpful legislation, and other updates for 2021 will also be discussed, including Medicare Advantage network adequacy and other changes made by final regulations.
- Register now at: https://medicareadvocacy.org/webinars/
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MA Plans Allowed to Report Less Data about Appeals Outcomes
CMS rolls back beneficiary protection in the name of reducing “MA plan burden” and making things “easy to read” for eligible beneficiaries
The most urgent and frequent type of call we receive at the Center for Medicare Advocacy is from a Medicare beneficiary who is told that the health services they are currently receiving are about to end and coverage will therefore terminate. These are typically crisis situations for people who often have no alternative care and can’t afford to pay for continued care out of pocket. When a hospital, skilled nursing facility, home health, comprehensive outpatient rehabilitation facility, or hospice provider decides that Medicare will no longer cover services being provided to a beneficiary, in both traditional Medicare and Medicare Advantage (MA), a notice must be issued informing the beneficiary of their right to an Expedited Appeal, (also called “fast appeal”).
Access to information regarding a plan sponsor’s number and outcome of expedited appeals is critical information to have before enrolling in a Medicare Advantage plan. One could use this information to evaluate and compare Medicare Advantage plan performance and specifically how they treat their members who are receiving covered care in various settings. In fact when we speak to a Medicare beneficiary who is considering enrolling in an MA plan we often advise them to request information regarding appeals to fully evaluate the plan. If, for example, a Medicare Advantage plan reports a high number of expedited appeals and denials per case one might seriously consider not enrolling in that Medicare Advantage plan.
Currently, Medicare Advantage plans are required to disclose grievances and appeals information regarding the number of disputes and their disposition to any MA plan eligible individual who requests this information. The language in both the Social Security Act and the Medicare regulations is clear and unambiguous. MA plans must report all appeals. Both the Social Security Act and the Medicare regulations specifically require that upon request of a MA eligible individual, a MA plan must provide to the individual information on the number of grievances, redeterminations, and appeals and on the disposition in the aggregate of such matters. The regulations specifically refer to “Appeals according to §422.578 et. seq.” This includes expedited and second level appeals.
On September 24, 2020 the Director of the Medicare Enrollment & Appeals Group from the Centers for Medicare and Medicaid Services (CMS) issued a memorandum to plan sponsors regarding “Revised Appeal and Grievance Data Form, Form CMS-R-0282” that outlined changes to the Appeal and Grievance Data Form. The changes were made “[i]n an effort to identify opportunities to reduce MA plan burden and provide a simplified, easy to read report to MA plan eligible individuals…” (emphasis added). The revised data form specifically removed the following data elements:
- Expedited appeals
- Disposition of expedited appeals
- IRE (level 2) appeals
- Disposition of IRE (level 2) appeals
In an era of regulatory rollback and general deference to private plans, and likely some pressure from the MA industry, in essence, CMS decided that it is o.k. for MA plans to not fully comply with the clear reading of the Social Security Act and the Medicare regulations by not having to report information about expedited or second level appeals. CMS expressly states in the revised Form Instructions CMS-R-0282 that the MA plan will meet the disclosure requirements set forth in the regulations using the revised form. However, clearly missing from the revised form is data regarding expedited and second level appeals which is included in the disclosure requirements of the MA regulations.
CMS touts these changes as reducing “MA plan burden” and creating an “easy to read report” for MA eligible individuals as though it’s a win-win situation for everyone. Clearly the Medicare beneficiary comes out on the losing end because they have been stripped of a very important protection – the ability to fully evaluate an MA plan before enrollment. In general, it is becoming more difficult to obtain accurate information about MA plans. For example, CMS continues to paint MA plans in a light most favorable, including downplaying any drawbacks, as discussed in a recent Center Alert concerning the 2021 Medicare & You handbook, and the Medicare Payment Advisory Commission (MedPAC) has called into question the accuracy of plan quality ratings, one of the primary tools that consumers have to compare plans.
More specifically, information about how a given plan handles appeals is critically important to determine access to care. The use of prior authorization for items and services – by virtually all MA plans, as noted by the Kaiser Family Foundation – often serves as a barrier to accessing care and often the trigger for filing an appeal. However, a 2018 Dept. of Health and Human Services Office of Inspector General (OIG) report found “‘widespread and persistent problems related to denials of care and payment in Medicare Advantage’ plans”. The report’s findings included: when beneficiaries and providers appealed preauthorization and payment denials, MA plans “overturned 75 percent of their own denials”; however, OIG found that “beneficiaries and providers appealed only 1 percent of denials to the first level of appeal.” In short, the public needs more – not less – information about MA appeals.
CMS does not have the authority to allow plans and providers to only partially comply with the Social Security Act and regulations. CMS should immediately rescind this memorandum, uphold the Social Security Act and Medicare regulations, and require that all MA plans fully comply with the law. As more people enroll in MA plans CMS should be more concerned with beneficiary protections and less concerned with burdens to major insurance companies that include MA plans.
 §1852(c)(2)(C) of the Social Security Act and 42 C.F.R. §422.111(c)(3).
 See 42 C.F.R. Subpart M – Grievances, Organization Determinations and Appeals.
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