Consumer Protections

The Center for Medicare Advocacy (CMA) recently released a tip sheet providing guidance to Medicare Advantage (MA) enrollees facing difficulty obtaining in-network care. This article addresses the complexities of MA plans, which can restrict enrollees to contracted networks of healthcare providers. Despite strengthened regulations by the Centers for Medicare & Medicaid Services (CMS) requiring MA plans to cover necessary care outside the network under specific circumstances, recent reports indicate issues with network adequacy. CMA emphasizes the importance of MA enrollees and advocates utilizing consumer protections, reporting difficulties in obtaining necessary care, and urging CMS to publicize and enforce these rights.

On July 7, The U.S. Department of Health and Human Services (HHS) announced actions to protect consumers from junk health plans, surprise medical bills, and excess costs that lead to medical debt. HHS also released a new report projecting that nearly 19 million older adults and people with disabilities with Medicare will save on average $400 per year on prescription drug costs when the $2,000 out-of-pocket prescription drug spending cap from the Inflation Reduction Act (IRA) goes into effect in 2025...