News & Perspectives

CMS Expands Coverage Flexibility for Medicare Advantage Plans

6. April 2018 Tom Entrikin Health

On April 2, 2018, the Centers for Medicare and Medicaid Services (CMS) issued instructions to Medicare Advantage plans encouraging more flexible service coverage policies in such plans for 2019. Such capitated plans cover the same services as traditional, fee-for-service Medicare, plus supplemental benefits adopted by the plan with CMS approval. Under the new CMS instructions, any Medicare Advantage plan would have additional flexibility to cover supplemental benefits to compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization. Twenty million aged and disabled Medicare beneficiaries who receive coverage through Medicare Advantage plans, about one-third of all Medicare beneficiaries, could benefit in 2019 from this new flexibility. Each plan must develop its new policies within the parameters set by the CMS announcement of the Medicare Advantage capitation rates and policies for calendar year 2019. Additional information on expanding health related supplemental benefits, capitation rate adjustments, quality metrics, improvements in drug utilization review to control the overuse of opioids, and other important innovations for 2019 under the Medicare Advantage program can be obtained here.