The Centers for Medicare & Medicaid Services (CMS) has abandoned a proposal that would allow people who lose practitioners due to Medicare Advantage plan network changes to stay with their preferred providers more easily. Currently, when an MA plan drops providers, CMS makes a determination as to whether the loss constitutes a “significant network change.” If it is determined to be so, beneficiaries get a Special Enrollment Period to change plans or return to real Medicare; note that there has never been a clear definition of what “significant” means. A proposal made last November would have removed the “significant network change” requirement.
- See the recent New York Times article by reporter Susan Jaffe for more information on this, as well as some other MA Issues.