America's Benefit Specialist March 2023

MEDICARE MATTERS

“Protecting Medicare is one of my highest responsibilities as secretary, and this commonsense rule is a critical account ability measure that strengthens the Medicare Advantage program. CMS has a responsibility to recover overpayments across all of its programs, and improper payments made to Medicare Advantage plans are no exception,” said HHS Secre tary Xavier Becerra. “For years, federal watchdogs and outside experts have identified the Medicare Advantage program as one of the top management and performance challeng es facing HHS, and today we are taking long overdue steps to conduct audits and recoup funds. These steps will make Medicare and the Medicare Advantage program stronger.” “CMS is committed to protecting people with Medicare and being a responsible steward of taxpayer dollars,” said CMS Administrator Chiquita Brooks-LaSure. “By establishing our approach to RADV audits through this regulation, we

are protecting access to Medicare both now and for future generations. We have considered significant stakeholder feedback and developed a balanced approach to ensure ap propriate oversight of the Medicare Advantage program that aligns with our oversight of Traditional Medicare.” The RADV final rule reflects CMS’s consideration of exten sive public comments and stakeholder engagement after the release of the 2018 Notice of Proposed Rulemaking. The finalized policies will also allow CMS to continue to focus its audits on those MAOs identified as being at the highest risk for improper payments. The RADV final rule can be accessed at the Federal Regis ter at www.federalregister.gov/public-inspection/2023-01942/ medicare-and-medicaid-programs-policy-and-technical- changes-to-the-medicare-advantage-medicare.

Percent of Medicare Beneficiaries with Access to Medicare Advantage Plans, by Plan Type

Location

Any Plan Local HMO Local PPO MSA

PFFS

Regional PPO

United States

100%

98%

99%

64%

30%

74%

Alabama

100%

99%

100%

100%

0%

100%

Alaska

100%

0%

0%

100%

0%

0%

Arizona

100%

97%

100%

100%

0%

100%

Arkansas

100%

100%

100%

100%

99%

100%

California

100%

100%

98%

0%

0%

0%

Colorado

99%

94%

97%

0%

89%

0%

Connecticut

100%

100%

100%

0%

0%

100%

Delaware

100%

100%

100%

100%

0%

0%

District of Columbia

100%

100%

100%

100%

0%

0%

Florida

100%

100%

100%

100%

0%

100%

Georgia

100%

100%

100%

100%

41%

100%

Hawaii

100%

100%

100%

100%

0%

0%

Idaho

97%

95%

96%

0%

0%

0%

Illinois

100%

100%

100%

100%

69%

100%

Indiana

100%

100%

100%

100%

69%

100%

Iowa

97%

97%

97%

0%

10%

0%

Kansas

100%

91%

92%

100%

100%

100%

Kentucky

100%

100%

100%

100%

25%

100%

Louisiana

100%

100%

100%

100%

0%

100%

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