President Bidens Proposal to Protect Medicare Advantage Enrollees

Summary: The Biden administration announced plans to allow Medicare enrollees easier access to Medicare Advantage plans that best fit their needs. This is achieved through more transparent marketing and communication from Medicare Advantage carriers. Estimated Read Time: 4 min

Table of Contents:

1. 1. Biden-Harris Proposal to Protect Medicare Advantage Enrollees and Extend Benefits 
   2. Insurance Agent/Broker Compensation Limits
   3. Additional Benefits for Medicare Advantage Enrollees
   4. Lowering the Cost of Biologic Drugs
   5. Accessible Behavioral Health Care Coverage
   6. How MedicareFAQ Follows Medicare Advantage Marketing Rules and Guidelines

Regardless of where you fall on the political spectrum, 2023 is a year that continues to see politics and rhetoric connected to Medicare benefits. Specifically, there are a lot of misconceptions about potential cuts and changes coming from President Biden regarding Medicare Advantage plans. Earlier this week, President Biden announced his plan to protect Medicare Advantage enrollees from predatory marketing and false claims.

Biden-Harris Proposal to Protect Medicare Advantage Enrollees and Extend Benefits

On November 7, 2023, in partnership with the Centers for Medicare and Medicaid Services (CMS), the Biden administration announced its plans to strengthen Medicare Advantage plans. The proposed rule will allow Medicare enrollees to enroll in Medicare Advantage coverage options that suit their needs by requiring more transparent marketing and communication from Medicare Advantage carriers. Companies who offer Medicare Advantage plans will be unable to engage in “anti-competitive steering” based on which plan pays the agent a higher commission.

Unfortunately, this practice is too often the case when enrollees are under-educated on the benefits of the plan options available to them. The new proposed rule requires agents to offer clients the best plans for their needs rather than the best plan for the agents’ wallets. There are four main parts to the rule:

• Puts a limit on broker/agent compensation from Medicare Advantage plans
• Provides Medicare Advantage enrollees with a better understanding of their additional benefits
• Lowers biologic drug costs for Medicare Advantage Enrollees
• Offers a wider range of behavioral healthcare services to Medicare Advantage enrollees

With just over half of the Medicare enrollees nationwide enrolled in a Medicare Advantage plan, it is essential to put these protections in place to ensure the quality of healthcare services provided to these individuals.

Insurance Agent/Broker Compensation Limits

If passed, the new rule will provide a limit to how much an agent or brokerage can earn on a single Medicare Advantage policy.

Unfortunately, it is not uncommon for agents to recommend plans that help line their pockets rather than plans that provide the best benefits possible for the individual client. Currently, insurance companies have a free range to offer cash incentives, all-expense-paid trips, and run promotions for agents to enroll clients in their plans. These acts incentivize agents to persuade the client to choose one carrier over another solely due to the benefits the agent receives.

If passed, this new rule puts an end to these unfair practices and will require agents to review your needs thoroughly and ensure the plan you enroll in matches those needs properly.

Additional Benefits for Medicare Advantage Enrollees

When enrolling in a Medicare Advantage plan, many do so under the impression that they will receive additional benefits on top of what Original Medicare already provides them. Often, the benefits they believe will be incorporated into their plan include dental, vision, hearing, and fitness benefits.

Oftentimes, these benefits are offered at no additional cost. Insurance companies do this to raise their average cost of coverage per beneficiary, which in turn allows them to receive a larger kickback from the government. However, actual use of these benefits by enrollees is low due to the lack of substantial coverage provided.

The proposed rule will require Medicare Advantage insurance companies to send reminder letters to their enrollees about these services, provide in-depth coverage information, and require the company to notify enrollees if their benefits go unused. Their goal is to make these additional benefits more transparent for the recipients.

Lowering the Cost of Biologic Drugs

Biological pharmaceuticals are a type of drug created from living cells. This drug type can be more expensive and more difficult to obtain without the right coverage in place. The new rule proposes a fix to this issue of accessibility. If passed, Medicare Advantage Prescription Drug Plans would be able to provide coverage for lower-cost versions of high-cost biologics. These drugs are known as “bio-similars”.

This will increase competition in the drug market and ultimately lower costs across the board.

Accessible Behavioral Health Care Coverage

Although Medicare Advantage plans are required to maintain an adequate number of doctors and healthcare providers in their network, there is currently no legislation in place to determine the number of behavioral health providers a plan is required to cover. In some cases, current plans may only cover a small number of behavioral health professionals. This makes it extremely difficult for enrollees to receive the care they require.

The proposed rule will require Medicare Advantage plans to include a wide range of mental health services, counseling services, and therapists in their network. If passed, an estimated 400,000 will be able to bill Medicare for services next year.

How MedicareFAQ Follows Medicare Advantage Marketing Rules and Guidelines

With so many bad actors pushing for their own interests, it’s important for agents, carriers, and brokers to be transparent. Here at MedicareFAQ, our priority remains educating the Medicare population about all of their options so that they can make an informed decision. Here’s how we remain impartial regarding your healthcare:

• Continuous application of best practices according to CMS rules. This includes editing marketing and educational materials as regulations change.
• A dedicated compliance team that makes sure our marketing materials and interactions are honest, fair, and in accordance with CMS guidelines.
• We work with a variety of carrier partners and learn about your healthcare needs before presenting you with your options. This allows our insurance agents the chance to pinpoint the right coverage options for your needs, not ours.
• Our agents work with you one-on-one to understand your needs and help you determine which plan is suitable for you. As our agents like to say, you are in the driver’s seat, we just like to help you get to where you are going.
• Our agents don’t only compare your Medicare Advantage plans but also provide you with Medicare Supplement plan options, also known as Medigap.

Everyone deserves healthcare coverage that has their best interests at heart. Through education rather than high pressure situations, beneficiaries can find the right policies. The direction of the Biden Administration regarding Medicare Advantage rules is something MedicareFAQ continues to pay attention to and adjust accordingly to better serve the community.

If you are interested in reviewing the Medicare options available in your area, complete our online rate form to find carriers and plan options available to you.