The Growing Disparity Between Medicare Advantage and Traditional Medicare: CMS Publishes Final MA Telehealth Benefit Rule

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The Centers for Medicare & Medicaid Services (CMS) published a Final Rule this week implementing provisions of the Bipartisan Budget Act of 2018.[1] As detailed in this Rule, Medicare Advantage (MA) plans will be allowed to offer telehealth services as a basic benefit starting in 2020. The Rule limits this telehealth benefit to services available under Medicare Part B which have been identified as “as clinically appropriate to furnish through electronic information and telecommunications technology . . .” and not payable under Section 1834(m) of the Social Security Act.[2] CMS makes clear that MA enrollees will have the ability to decide whether to receive Part B services in-person or through the telehealth benefit, although different cost sharing may apply. In addition to this newly created basic benefit, MA plans will also be able to offer supplemental telehealth services not covered by traditional Medicare.

While expanding telehealth services may be beneficial to MA enrollees, the Center for Medicare Advocacy is concerned by the growing disparity between MA and traditional Medicare. As outlined in our Medicare Platform, parity is essential to ensuring consumer protections and quality coverage extend to all Medicare beneficiaries. Although traditional Medicare does have limited telehealth coverage, Congress’s decision to allow MA plans to offer additional telehealth services as a basic benefit is just one more example of the growing disparity between traditional Medicare and MA, and reinforces the Administration’s efforts to steer individuals to MA plans.[3] The Administration and Congress must ensure that beneficiaries in traditional Medicare have the same benefits and access to the same services as MA enrollees, including those created by the new telehealth benefit.

April 18, 2019 – D. Valanejad


[1] Medicare and Medicaid Programs; Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Programs of All-Inclusive Care for the Elderly (PACE), Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021, 84 Fed. Reg. 15680, 15683 (Apr. 16, 2019), available at https://www.govinfo.gov/content/pkg/FR-2019-04-16/pdf/2019-06822.pdf.
[2] See id. (referring to Medicare’s limited coverage of telehealth services). 
[3] See generally, David Lipschutz, As Medicare Enrollment Period Draws to a Close, MA Steering Continues – Advocates & Members of Congress Write Letters of Concern to CMS, Center for Medicare Advocacy (Nov. 30, 2018), https://www.medicareadvocacy.org/as-medicare-enrollment-period-draws-to-a-close-ma-steering-continues-advocates-members-of-congress-write-letters-of-concern-to-cms/.

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