America's Benefit Specialist October 2023

MEDICARE MATTERS

Medicare Advantage enrollment and plan availability in ru ral areas have increased rapidly in recent years, as they have in more populated counties. Private plans often provide sup plemental benefits to enrollees for no additional premium (other than the Part B premium), including some coverage of dental, vision and hearing services, as well as reduced cost sharing compared to traditional Medicare without a supple mental plan. At the same time, Medicare Advantage plans may use provider networks, limiting coverage of services de livered by out-of-network providers. Provider networks may impose barriers to people living in rural areas who already face challenges obtaining healthcare services because of fewer providers and longer travel distances.

Despite recent growth, Medicare Advantage enrollment in rural areas remains lower than enrollment in more populated areas. This could be the result of fewer investments in mar keting and outreach in these areas by Medicare Advantage insurers, because financial returns are lower given the small er population of potential enrollees. As Medicare Advantage enrollment continues to grow, understanding how plans differ across metropolitan, micropolitan and rural areas will be increasingly relevant to assessing how well private plans meet the needs of their enrollees.

CMS ISSUES DRAFT GUIDANCE ON PROGRAM TO ALLOW PEOPLE WITH MEDICARE TO PAY OUT-OF-POCKET PRESCRIPTION DRUG COSTS IN MONTHLY PAYMENTS

President Biden’s prescription drug law, the Inflation Re duction Act, gives people with Medicare prescription drug coverage (Medicare Part D) the option to pay out-of-pocket costs in monthly payments spread out over the year, starting in 2025. CMS recently released draft guidance for comment that outlines the requirements and procedures for certain aspects of the new Medicare Prescription Payment Plan. By enabling seniors and people with disabilities with Medicare Part D coverage to spread out cost sharing over the year, the program could reduce the burden of high upfront out-of pocket prescription drug costs. “People with Medicare are already feeling the benefits of the prescription drug law— such as free recommended vaccines and lower costs for insulin,” said CMS Administrator Chiquita Brooks-LaSure. “The draft guidance CMS is releasing today is an important step in standing up a new program that will help certain people with Medicare prescription drug coverage who have high upfront drug costs.” The draft guidance focuses on helping Medicare Part D plan sponsors and pharmacies prepare for the new program and build the necessary infrastructure for successful imple mentation. The draft guidance provides information on topics such as identifying Medicare Part D enrollees likely to benefit from the program, the opt-in process for Part D enrollees, program participant protections, and the data collection needed to evaluate the program. The draft guidance solicits comment on these topics and on strategies to help ensure eligible Part D enrollees benefit from programs like the Medi care Savings Programs and Extra Help to lower their out-of pocket prescription drug costs. Given the size of the new program, CMS is releasing the guidance in two parts, starting with the guidance released.

Additional draft guidance will be released for comment in early 2024. The second part of the guidance will focus on Medicare Part D enrollee outreach and education, Medicare Part D plan bid information, and monitoring and compliance. CMS also intends to develop tools, such as calculators, to help people with Medicare Part D and their caregivers learn what monthly payments may look like under the new program. “The new Medicare Prescription Payment Plan helps those who struggle the most with high upfront prescription drug costs and provides a way to ensure people with Medicare can get the life-saving medications they need,” said Meena Seshamani, MD, PhD, CMS deputy administrator and director of the Center for Medicare. “Public feedback, both through comments on this draft guidance and extensive engage ment, continues to be instrumental in the implementation of the prescription drug law and delivering on the promise of more affordable drugs for people with Medicare.” CMS is committed to collaborating and engaging with the public on the implementation of the Inflation Reduction Act. CMS is working closely with patients and consumers, Medi care Part D plan sponsors and Medicare Advantage organi zations, drug companies, hospitals and healthcare providers, wholesalers, pharmacies and other interested parties. Public feedback contributes to the success of the Inflation Reduc tion Act, and this guidance is one tool, among many, that CMS will use to ensure interested parties know when and how they can make their voices heard on implementation of the drug law. For a fact sheet on the Medicare Prescription Payment Plan , visit www.cms.gov/files/document/medicare-prescrip tion-payment-plan-fact-sheet.pdf.

34 ABS | benefitspecialistmagazine.com