Medicare Advantage - CMS Sets Out-of-Pocket Expense Caps

 

Starting in 2011, most private Medicare “Advantage” (HMO) health plans will have to set a cap of no more than $6,700 on how much consumers spend on deductibles and copayments for medical services during the year (local preferred provider organizations [PPOs] can set the limit at $10,000 for in- and out-of-network services combined). This new mandatory out-of-pocket limit provides a backstop for consumers who need extensive—and expensive—treatment; almost one-third of Medicare Advantage plans now have no maximum out-of-pocket limit.

The new cap on out-of-pocket spending, along with new limits on how much plans can charge for individual services like chemotherapy, are described in recent guidelines on benefit packages released by CMS.

-From “CMS Sets Benefit Rules for MA Plans”, Medicare Watch, e-mail entitled “A New CMS Administrator?”, April 22, 2010 and Statement by Medicare Rights Center President Joe Baker on CMS Release of Cost-Sharing Rules for Medicare Private Health and Drug Plans, April 19, 2010, at http://www.medicarerights.org/newsroom/pressreleases/2010_27.html, retrieved 4/26/10.

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