CMS ISSUES FINAL 2011 BENEFICIARY PROTECTIONS AND PAYMENT POLICIES FOR MEDICARE ADVANTAGE AND PRESCRIPTION DRUG PLANS

April 6, 2010--Seniors and people with disabilities enrolled in Medicare Advantage and Medicare prescription drug plans will see improved protections from discriminatory cost sharing and be able to better compare plans in 2011 under a final regulation issued today by the Centers for Medicare & Medicaid Services (CMS).

With more than 110 comments received from consumer groups, health care industry professionals and providers, CMS' final regulation eliminates duplication among drug and health plans.  CMS is requiring Medicare Advantage and prescription drug plan sponsors to have meaningful differences between their product offerings of a Medicare Advantage organization or prescription drug plan sponsor with regard to premiums, beneficiary out-of-pocket costs, plan types, and formulary offerings. The final rule is consistent with cost-sharing protections made in the health reform bill by limiting cost sharing for three Medicare services to no higher than the fee-for-service amount. CMS also intends to conduct further rule making to add additional cost-sharing services for future plan years.

"This final Medicare drug and health plan rule strengthens our oversight and add protections for people with Medicare," said Jonathan Blum, CMS' acting director of the Centers for Medicare Management and Center for Drug and Health Plan Choice. "Relying on input and feedback from beneficiaries, plans and other stakeholders, we are able to ensure that all the plan offerings for next year have meaningful differences in how they are designed and meet Medicare's quality standards.

In addition, CMS yesterday announced the capitation rates for Medicare Advantage plans in 2011 will be the same amounts they were in 2010, as required by the Health Care and Education Reconciliation Act of 2010. The 2011 Rate Announcement was accompanied by the final 2011 Call Letter for Medicare Advantage (Part C) and Medicare prescription drug (Part D) plans.

"CMS is working closely with Medicare Advantage organizations and prescription drug plan sponsors to help make sure that the improvements we are announcing today will help people with Medicare receive better health care and prescription drug benefits," said Blum.

Fact sheet with additional details are can be found at http://www.cms.gov/apps/media/fact_sheets.asp

The regulation is available at http://www.federalregister.gov/inspection.aspx#special

Once the regulation is published on April 15, 2010, it may be viewed thereafter at: www.regulations.gov (Search Publication date and for Centers for Medicare & Medicaid Services)

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