A new Biden proposal would make changes to Advantage plans for Medicare: What to know

WASHINGTON − The Biden administration wants to make changes to private Medicare insurance plans that officials say will help seniors find plans that best suit their needs, promote access to behavioral health care and increase use of extra benefits such as fitness and dental plans.

“We want to ensure that taxpayer dollars actually provide meaningful benefits to enrollees,” said Health and Human Services Secretary Xavier Becerra.

If finalized, the proposed rules rolled out Monday could also give seniors faster access to some lower-cost drugs.

Administration officials said the changes, which are subject to a 60-day comment period, build on recent steps taken to address what they called confusing or misleading advertisements for Medicare Advantage plans.

Just over half of those eligible for Medicare get coverage through a private insurance plan rather than traditional, government-run Medicare.

Here’s what you need to know.

Extra Medicare benefits

Nearly all Medicare Advantage plans offer extra benefits such as eye exams, dental and fitness benefits. They’re offered at no additional cost to seniors because the insurance companies receive a bump up from their estimated cost of providing Medicare-covered services.

But enrollees use of those benefits is low, according to the Centers for Medicare and Medicaid Services.

To prevent the extra benefits serving primarily as a marketing ploy, the government wants to require insurers to remind seniors mid-year what’s available that they haven’t used, along with information on how to access the benefits.

“The rule will make the whole process of selecting a plan and receiving additional benefits more transparent,” Becerra said.

Broker compensation limits

Because many seniors use agents or brokers to help them find a Medicare Advantage plan, the administration argues better guardrails are needed to ensure agents are acting in the best interest of seniors. Officials said the change would also help reduce market consolidation.

“Some large Medicare Advantage insurance companies are wooing agents and brokers with lavish perks like cash bonuses and golf trips to incentivize them to steer seniors to those large plans,” said Lael Brainard, director of Biden’s National Economic Council.

“That’s not right. Seniors should get the plan that is based on their needs, in their best interests, not based on which plan has the biggest payoff for marketers,” Brainard said.

The proposed changes would broaden the definition of broker compensation so limits on compensation are harder to get around.

Behavioral health care

Medicare Advantage plans must maintain an adequate network of providers. Under the proposed changes, networks would have to include a range of behavioral health providers, including marriage and family therapists and mental health counselors.

An estimated 400,000 of such therapists and counselors will be able to bill Medicare for services next year under recently passed legislation intended to expand access to mental health services.

Lower drug costs

The administration wants to give seniors faster access to cheaper versions of biologic pharmaceuticals, which are made from living cells. The proposed change would give Medicare drug plans more flexibility to substitute a lower-cost version of a biologic – a “biosimilar” – for the more expensive original.

“Any increased competition in the prescription drug market is a key part of our comprehensive effort to lower drug prices,” said Neera Tanden, Biden’s domestic policy adviser.

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