Summary
Establishes an open enrollment period of 10/15 through 12/7 for MA effective for plan years 2012 and beyond. Allows MA enrollees to dis-enroll within first 45 days of the year.
Implementation Status
On April 15, 2011, CMS published a Final Rule implementing several provisions of the ACA, including this section (see pp. 21442-43).
On Apr. 6, 2015 CMS released the CY 2016 MA Rate Announcement (press release; fact sheet) delineating the agency’s changes in the MA capitation rate methodology and risk adjustment methodology, as well as some policy changes under Part D. Citing a non-discretionary change to expected growth rates, CMS estimates that, on average, MA plans will see a +1.25% revenue increase relative to CY15 and +3.25% when coupled with an additional 2.0% expectation for coding trend. This compares to -0.95% from policy-driven changes the Advance Notice (+1.05% with the same coding expectation)
2016
On Nov. 4, MedPAC held a discussion on coding intensity and calculating benchmarks in Medicare Advantage (MA). The Commission has long-sought to keep MA spending on par with fee-for-service (FFS) levels.
2017
On Feb. 1, CMS posted the CY2018 Advance Noticedelineating proposed methodological and payment changes for MA plans, as well as key policies under Part D.
Statutory Text
SEC. 3204. SIMPLIFICATION OF ANNUAL BENEFICIARY ELECTION PERIODS. (a) ANNUAL 45-DAY PERIOD FOR DISENROLLMENT FROM MA PLANS TO ELECT TO RECEIVE BENEFITS UNDER THE ORIGINAL MEDICARE FEE-FOR-SERVICE PROGRAM.— (1) IN GENERAL.—Section 1851(e)(2)(C) of the Social Security Act (42 U.S.C. 1395w–1(e)(2)(C)) is amended to read as follows: ‘‘(C) ANNUAL 45-DAY PERIOD FOR DISENROLLMENT FROM MA PLANS TO ELECT TO RECEIVE BENEFITS UNDER THE ORIGINAL MEDICARE FEE-FOR-SERVICE PROGRAM.—Subject to subparagraph (D), at any time during the first 45 days of a year (beginning with 2011), an individual who is enrolled in a Medicare Advantage plan may change the election under subsection (a)(1), but only with respect to coverage under the original medicare fee-for-service program under parts A and B, and may elect qualified prescription drug coverage in accordance with section 1860D–1.’’. (2) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply with respect to 2011 and succeeding years. (b) TIMING OF THE ANNUAL, COORDINATED ELECTION PERIOD UNDER PARTS C AND D.—Section 1851(e)(3)(B) of the Social Security Act (42 U.S.C. 1395w–1(e)(3)(B)) is amended— (1) in clause (iii), by striking ‘‘and’’ at the end; (2) in clause (iv)— (A) by striking ‘‘and succeeding years’’ and inserting ‘‘, 2008, 2009, and 2010’’; and (B) by striking the period at the end and inserting ‘‘; and’’; and (3) by adding at the end the following new clause: ‘‘(v) with respect to 2012 and succeeding years, the period beginning on October 15 and ending on December 7 of the year before such year.’’.