Who Relies On Medicare+Choice?

Subtitle C provisions relating to Part C of the new medicare laws bases the Medicare Advantage (MA) benchmark on the average of the bids from MA plans in each medical products market. These policies revise the formula for calculating the annual Medicare+Choice capitation rate to reduce the national Medicare Advantage cost per capita Medicare+Choice growth percentage used to increase price benchmarks in 2011.

New Medicare Advantage Provisions

These new Medicare Advantage provision plans tend to provide rebates from 75% to 100% of the average per capital savings. These new provisions require that bid information which Medicare Advantage and Medicare Choice are required to submit to the Secretary be certified by a member of the government actuaries and meet actuarial guidelines and rules established by the Secretary for Medicare Advantage and Medicare Choice. These provisions direct the Secretary, acting through the CMMS Chief Actuary, to establish actuarial guidelines for the submission of bid information and bidding rules that are appropriate to ensure accurate bids and fair competition among Medicare Advantage and Medicare Choice plans.

New Payment Areas

These new regulations direct the Secretary to: (1) establish new Medicare Advantage payment areas for urban areas based on the Core Based Statistical Areas; and (2) make monthly care coordination and management performance bonus payments, quality performance bonus payments, and quality bonuses for new and low enrollment Medicare Advantage and Medicare Choice plans, to Medicare Advantage and medicare Choice plans that meet certain criteria.

Transitional Rebates

These new laws direct the Secretary to provide transitional rebates for the provision of extra benefits to new enrollees. Section 3202 prohibits Medicare Advantage plans from charging beneficiaries cost sharing for chemotherapy administration medical services, renal dialysis services, or skilled nursing care that is greater than what is charged under the traditional fee-for-service program that has been in force for a number of years.

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