WASHINGTON, D.C. – As Ohio seniors prepare to enroll in or change their Medicare plans for 2016 starting next week, U.S. Sen. Sherrod Brown (D-OH) today announced a plan to prevent their doctors from being dropped by networks once coverage begins. During a news conference call today, Brown was joined by Veva Vesper, a southwest Ohio senior whose doctor was dropped from her Medicare Advantage (MA) plan after she signed up last year for a plan that initially covered her doctor.

“When seniors sign up for a Medicare plan, they should have the peace of mind that their doctors and other health care providers will be covered all year long,” Brown said. “That’s why I’m reintroducing legislation that would ensure that Medicare Advantage plans cannot drop providers from their network in the middle of a plan year. My bill would also improve network adequacy protections in Medicare Advantage plans, and ensure consistency for both beneficiaries and health care providers on an annual basis. This is an important step we can take to make Medicare work better for both patients and doctors. These massive disruptions cannot happen again.”

In advance of this year’s open enrollment period – which begins Oct. 15 – Brown is reintroducing the Medicare Advantage Bill of Rights Act, legislation that would ensure that enrollees know what providers will be covered for the entire year under their plan, rather than just at enrollment time.

Under current law, MA plans can drop providers without cause during the year after seniors have already selected their plans – leaving many seniors without access to their preferred doctors.

Brown’s legislation would address this by:

  • Requiring MA plans to finalize their provider networks 60 days before the annual open enrollment period begins to ensure that enrollees know what providers will be covered before they enroll in an MA plan;
  • Prohibiting plans from dropping doctors without cause outside during the middle of a coverage year, to ensure that enrollees do not lose access to their doctors mid-year;
  • Enhancing transparency by requiring MA plans to disclose the reasons for dropping providers;
  • Defining the minimum information requirements for MA enrollee notification letters that alert beneficiaries to changes to their networks ahead of reenrolling;
  • Directing the Centers for Medicare and Medicaid Services (CMS) to redesign the tool that enables patients to compare plans; and
  • Improving network adequacy standards for MA plans and requiring CMS to review MA networks on a more regular basis.

Brown’s announcement comes one week after the release of a Government Accountability Office (GAO) report that found CMS needs to take action to ensure MA participants can access an appropriate number of doctors, known as an adequate provider network. CMS defines an adequate provider network has having a minimum number of providers, and a certain travel time and distance to those providers. The Medicare Advantage Bill of Rights will address many of the issues raised in the GAO report, which can be read in its entirety here.

 

 

 

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