Medicare Advantage 2024
Enhancements To Medicare Advantage 2024
The Centers for Medicare and Medicaid Services (CMS) regularly reviews the regulations that govern the provision, sale, and use of Medicare and Medicaid. CMS analyzes the experiences of both the government-contracted insurers and the beneficiaries who purchase the insurance plans. Any amendments CMS proposes take effect in the following year. In 2023, CMS examined the rules surrounding Medicare Advantage and proposed changes to be implemented in 2024.
On April 5th, 2023, CMS issued a final proposal to enhance Medicare Advantage. While CMS did not address the public’s comments on the proposed amendments, they plan to address them at a later date. The proposed amendments concern prior authorization and how it affects beneficiaries’ access to healthcare. Previously, beneficiaries with Medicare Advantage plans had to request permission to receive care, which could lead to care denial. However, the new rules proposed by CMS aim to ensure that Medicare Advantage customers have access to necessary tests, scans, prescriptions, and procedures that their counterparts in Original Medicare have.
CMS’s new rule requires that prior authorization policies confirm the presence of a diagnosis, ensuring that the treatment is medically necessary. CMS also requires that all Medicare Advantage plans develop committees to ensure that denials and approvals work effectively to get beneficiaries the care they need. Finally, the new rules require that prior authorization approval is effective for the entire course of treatment as long as it is medically reasonable and necessary to avoid disruptions in care.
The American Medical Association has praised the new rules, saying that they have “taken important steps towards rightsizing the prior authorization process.” UnitedHealthcare, one of the insurers with Medicare Advantage plans, plans to reduce the number of care denials by nearly three million a year.
The hope is that these new regulations will ensure that Medicare Advantage plans provide equitable access to care for both beneficiaries and insurers in the future.
