CMS Proposes Medicare Advantage and Part D Payment and Policy Updates to Maximize Competition and Coverage

Today, the Centers for Medicare & Medicaid Services (CMS) released proposed changes that will take significant steps in continuing the agency’s efforts to maximize competition among Medicare Advantage and Part D plans. These proposals will increase plan choices and benefits and include important actions to address the opioid crisis.

“CMS is committed to modernizing Medicare and our top priority is to ensure that seniors have more choices and affordable options in receiving their Medicare benefits,” said CMS Administrator Seema Verma. “Medicare Advantage enrollment is at an all-time high as more and more seniors are choosing to enroll in private Medicare health and drug plans, and we need to maximize competition by providing plans the flexibility to meet patients’ needs.”

The proposed changes will expand opportunities for seniors to choose Medicare Advantage plans that for the first time are providing new supplemental benefits in 2019. Beginning with the 2019 plan year, Medicare Advantage plans can provide certain enrollees with access to different benefits and services. For the 2020 plan year and beyond, under statutory changes and the proposed guidance on which we are soliciting comment in today’s release, Medicare Advantage plans will have greater flexibility to offer chronically ill patients a broader range of supplemental benefits that are tailored to their specific needs, such as providing home-delivered meals or transportation for non-medical needs. 

The agency is also proposing new action to combat the nation’s opioid crisis. CMS is encouraging Medicare Advantage plans to take advantage of new flexibilities to offer targeted benefits and cost sharing reductions for patients with chronic pain or undergoing addiction treatment, and encouraging Part D plans to provide lower cost sharing for opioid-reversal agents. CMS’ overutilization policies have resulted in a 14 percent decrease in the share of Part D beneficiaries using opioids between 2010 and 2017 (36.3 percent to 31.3 percent), with the largest decrease from 2016 to 2017 (5 percent).

Medicare Advantage remains a popular choice among beneficiaries and has high satisfaction ratings. Average Medicare Advantage and Part D premiums are at their lowest in three years and plan choices have increased. Today’s proposals build in additional flexibilities to continue to increase choice and competition among Medicare health and drug plans. 

For a fact sheet on the 2020 Advance Notices (Part I and Part II) and the Draft Call Letter, please visit: https://www.cms.gov/newsroom/fact-sheets/2020-medicare-advantage-and-part-d-advance-notice-part-ii-and-draft-call-letter. CMS released Part I of the Advance Notice on December 20, 2018.

The 2020 Advance Notices (Part I and Part II) and Draft Call Letter may be viewed by going to: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Advance2020Part2.pdf.

All comments on the Advance Notices – including Part I – and Draft Call Letter must be submitted by March 1, 2019. The final 2020 Rate Announcement will be published by Monday, April 1, 2019.