Medicare plans attract seniors, more scrutiny

The good news from the Centers for Medicare and Medicaid Services (CMS) is that more beneficiaries are joining Medicare Advantage plans, and that the trend is saving money for the federal government. CMS Administrator Mark McClellan, MD, announced last month that nearly 7 million seniors had enrolled in MA (Medicare Advantage) and MA-PD (Medicare prescription drug) plans, an increase of nearly 1 million since last fall.

Dr. McClellan praised MA plans for cutting costs for beneficiaries and for CMS.

MA plans are somewhat inhibited from complaining too loudly about too-low rates. They want to convince members of Congress and CMS that they are not wallowing in "windfall profits." At the same time, plans want to assure Wall Street that Medicare business will be profitable and support the bottom line.

STREAMLINING CHOICES

CMS also is taking steps to eliminate redundant plan choices that don't meet clear beneficiary needs. The agency stated last month that it intends to negotiate with sponsors of prescription drug plans (PDPs) and MA-PDs to ensure that each bid submitted for 2007 will provide "meaningful, clearly understandable and substantially significant options for beneficiaries." Benefits that might warrant a third plan include low premiums and deductibles, flat copays, coverage of the "donut hole" and broader formularies. Another reason to approve a plan for 2007 would be substantial enrollment this year; no one wants to cancel an enhanced plan that has signed up 10,000 beneficiaries.

This effort to reduce the number of redundant coverage choices reflects complaints since enrollment began last fall that seniors find it difficult to select Medicare drug coverage because of an overabundance of options. For many sponsors, Dr. McClellan noted, "two plan choices will be sufficient."

But for now, CMS is not officially limiting sponsors to two plans in a service area. The agency expects that "the cooperation of MA organizations in this matter will enable beneficiaries to meaningfully select the MA plan that is best for them."

In addition to curbing redundant options, CMS says that it will "consider non-renewal" of plans that fail to comply with program requirements. The agency is evaluating how well plans have established effective data systems and provided timely customer service, plus its compliance with transition policies. CMS is checking whether plans provided sufficient off-formulary drug supplies to beneficiaries and clearly informed members about transition policies.

Jill Wechsler, a veteran reporter, has been covering Capitol Hill since 1994.