Medicare Proposes New Rules For Parts C and D. Public Comment Invited

Earlier this month, the Centers for Medicare and Medicaid announced a proposed rule affecting everyone under Medicare Part D and C. They intend to implement the Affordable Care Act’s medical loss ratio (MLR) requirements to Medicare Advantage and prescription drug (Part C and Part D) plans.

The proposed rule will limit how much plans may spend on marketing, overhead, and profit. Under the Affordable Care Act, similar requirements already benefit consumers in the private health insurance market. Under the proposed rule, any company offering drugs under Part D, and any Medicare Advantage Plan under Part C, must spend more on patient care than on advertising, upper management pay packages, and overhead.

In some cases the compensation of the CEO of a health insurance company accounted for as much as 5% of the insurance premium. My wife is a gerontological nurse practitioner, and I accompany her to some N.P. conventions. A few nurses employed by Medicare Advantage Plans decry the policies of their employer. The company will allegedly lay off nurses and low level staff, and make it hard to obtain some medical services, in order to meet the high salary of the CEO and other executives. This new rule proposed by CMS will make those abuses more difficult. 

The full press release by CMS can be found here.

There is a link to a way to file electronic comments on the proposed rule. All comments posted will be available for reading by the general public. 

Unfortunately, many people on Medicare are over age 65, and do not use a computer. Under the current system, they cannot comment. When I called CMS, they did not have a solution, but are working on it. Do you Elder who wants to speak out? Would you help them file comments to the proposed rule? 

Stay well until the next post,

Bob Gasparro

Bob Gasparro is an Elder Practitioner (accountant and attorney). He can be reached at Robert.Gasparro@lifespanlegal.com or (484) 297-2050. Comments to this post, and ideas for future posts are welcome.