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CMS proposes Medicare Advantage and Part D payment and policy updates to provide new benefits for enrollees, new protections to combat opioid crisis

CMS proposes Medicare Advantage and Part D payment and policy updates to provide new benefits for enrollees, new protections to combat opioid crisis

Today, the Centers for Medicare & Medicaid Services (CMS) released proposed changes for the Medicare health and drug programs in 2019 that increase flexibility in Medicare Advantage that will allow more options and new benefits to Medicare beneficiaries, meeting their unique health needs and improving their quality of life. Furthermore, the proposal includes important new steps to ensure new patient-doctor-plan communication in combatting the opioid crisis.

As a part of these changes, CMS is redefining health-related supplemental benefits to include services that increase health and improve quality of life, including coverage of non-skilled in-home supports, portable wheelchair ramps and other assistive devices and modifications when patients need them. 

“Our priority is to ensure that our seniors have more choices and lower premiums in their Medicare health and drug plans,” said CMS Administrator Seema Verma. “We are focused on addressing the specific needs of beneficiaries and providing new flexibilities for Medicare Advantage plans to offer new health-related benefits. This is a big win for patients.”  

CMS has previously not allowed an item or service to be eligible as a supplemental benefit if the primary purpose included daily maintenance. Under the new policy announced today, CMS would allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.

CMS also announced new action to combat the nation’s opioid epidemic through its effective oversight of programs that have successfully reduced opioid overutilization by Part D enrollees. The agency is also designing the framework of several new policies that would give health plans additional tools to better manage chronic overuse among beneficiaries by ensuring patient-doctor-plan communication regarding opioid use.

Medicare Advantage remains a popular choice among beneficiaries and has high satisfaction ratings. In 2018, Medicare Advantage and Part D premiums decreased and the number of Medicare Advantage plans available to choose from across the country increased from about 2,700 to more than 3,100 – and enrollment in Medicare Advantage is at an all-time high as approximately one-third of all Medicare beneficiaries are enrolled in a plan.

The proposed updates will result in a payment increase that promotes stability and insures that resources will be available to support beneficiaries enrolled in private Medicare plans.

For a fact sheet on the 2019 Advance Notice, Part II, and the Draft Call Letter, please visit: CMS released Part I of the Advance Notice on December 27, 2017.

The 2019 Advance Notices (Part I and Part II) and Draft Call Letter may viewed by going to: and selecting “2019 Advance Notices.” Comments on the proposed Advance Notices and Draft Call Letter are invited from industry, seniors, consumer advocates, and the public and must be submitted by March 5, 2018. The 2019 Final Rate Announcement and Call Letter will be published on Monday, April 2, 2018.