On January 19, 2021, the Centers for Medicaid and Medicaid Services (CMS) issued a final rule addressing Medicare Part C – Medicare Advantage Plans and Part D Prescription Programs. The rule is far-reaching, but I want to touch on some of the provisions particularly relevant to consumer education and access.

Medicare Advantage Plans and Prescription Programs

The rule codifies many of the agency’s marketing guidelines but has been criticized for blurring the line between educational events and marketing events held by insurers and managed care organizations. Under the new rule, plan sponsors can hold an event advertised as educational and immediately thereafter, or essentially within the event itself, solicit enrollees in their plans. The agency walked back prior guidelines that had required clear separation in time and venue between educational events and those that are meant to market specific plans.

The rule also codified a 2019 change eliminating the requirement that plan materials contain language informing non-English speakers of the availability of interpreters and translated plan documents. Advocates had fought for language access based on the number of speakers of a particular language in the plan service area, but this was rejected.

The rule also allows Part D plans to offer a “preferred” tier for each of their plan offerings. The idea is to allow access to specialty drugs within the higher tier, but many see it as a further complication of an already complex system.

Changes We May See First Under the New Administration

It seems likely that the Biden administration will take aim at these new rules once new staff is in place and acclimated. The administration has already overturned one Trump-era policy change that sought to allow individuals to enroll in Social Security while opting out of Medicare Part A. Advocates have asked the Biden administration to quickly suspend or rescind the January 19 final rule as well as the following CMS actions undertaken under the prior administration:

• The “Geo” Demonstration Model and the Medicaid Managed Care Organization (MCO)-based Direct Contracting Entity Model

• Revisions to the Medicare Part D Model that weakens the protected drug classes guarantee

• Expansion of a program that limits access to home care for those with longer-term and chronic conditions

• The SUNSET Rule that puts an arbitrary expiration date on almost all regulations issued by HHS