Medicare Advantage providers face government oversight, new rules

The Centers for Medicare and Medicaid (CMS) has set new policies for Medicare Advantage providers that will require it to eliminate or reduce out-of-pocket fees charged to enrollees by 2010. CMS also plans to take a more proactive role in overseeing the Medicare Advantage providers to ensure adherence to its new rules.

Under the new CMS rules, enrollees' annual out-of-pocket costs are not to exceed $3,400. Medicare Advantage providers cannot charge more than Medicare charges for dialysis, home health care and other services. Nor can enrollees be discriminated against on the basis of their health status or income, or charged more than Medicare would charge for care.

Providers will also have to clearly and publicly state what they are doing to lower drug costs, such as offering generic versions of medications. CMS says that it will strictly enforce these rules to protect the rights of vulnerable patients. Medicare Advantage providers will also be required to cut the number of plans they sell to eliminate redundancy and to streamline their offerings. In addition to ensure fair pricing, CMS is eager to make it easier for patients eligible for Medicare to compare their options by next year.

To learn more:
- see this Wall Street Journal article