The White House is proposing a rule to increase Medicare competition

Healthcare brokers will have to adhere to stricter rules on compensation under a new rule the Biden administration proposed on Monday.

The rules are intended to prevent predatory marketing of Medicare Advantage plans and reduce associated prescription drug prices.


What you need to know

  • The Centers for Medicare and Medicaid Services on Monday proposed a rule to increase competition among Medicare Advantage plans and lower prescription drug prices
  • The rule is intended to prevent predatory marketing practices
  • Medicare Advantage brokers and agents often steer seniors into plans that may not be in their best interests
  • The new rule would also expand Medicare access to behavioral health services, such as mental health counselors

“We want to ensure that Medicare enrollment helps people who are looking for a Medicare option that best meets their needs,” Health and Human Services Secretary Xavier Becerra said Monday in a White House briefing detailing the proposed rule was explained. “We don't need a system that just steers people toward certain insurance plans and further consolidates markets.”

The rule, proposed by the Centers for Medicare and Medicaid Services, aims to prevent predatory marketing practices such as misleading TV ads. It also tightens rules on agent compensation to limit giveaways such as paid golf trips that Medicare Advantage providers use to entice agents to sell certain policies to seniors that may not be in the patient's best interest.

“Many people with Medicare rely on agents and brokers to help them make the best choice about their health care coverage,” said Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure, adding that the proposed rule “will implement new guardrails so that people with Medicare Medicare receives honest, transparent and accurate information about their options.”

The proposed rule also aims to increase access to behavioral health care services, such as marriage and family therapists, mental health counselors, and opioid treatment providers.

Additionally, it would increase patients' ability to replace prescriptions with comparable, lower-cost options. Under President Biden's executive order to promote competition in the U.S. economy, the Department of Health and Human Services has developed a plan to promote so-called biosimilar generics that can be provided to patients for less.

White House domestic policy adviser Neera Tanden said Monday that the federal government is “looking everywhere for opportunities” to lower prescription drug costs. She said nearly three in 10 Americans don't take their medications as prescribed because of the cost. They miss doses, cut pills or skip prescriptions entirely because they can't afford them.

The CMS filed its proposed rulemaking with the Federal Register on Monday. It is open for public comment until January 5, 2024.

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