Medicare Regulatory Compliance Updates
There are several upcoming changes to the Medicare regulatory landscape. To keep you informed, here are a few of the more significant changes:
Medicare Supplement Changes are coming to Kentucky!
Kentucky adopted HB345, becoming another state to implement a “birthday rule.”
Effective January 1, 2024, insurers cannot deny, condition the issuance or effectiveness of, or discriminate in the pricing of a Medicare supplement policy available for sale in Kentucky because of the health status, claims experience, receipt of health care, or medical condition of an applicant, if at the time of application the applicant is:
insured under a Medicare supplement policy; and
the application is submitted within 60 days of the applicant’s birthdate to an insurer who did not issue the applicant’s current Medicare supplement policy; and
The applicant wants to keep the same Medicare supplement plan type.
This act applies to all Medicare supplement policies available, issued, or renewed in Kentucky on or after January 1, 2024.
Medicare Part D Benefit Changes in 2024 and 2025
Beginning January 1, 2024, the Inflation Reduction Act of 2022 eliminates Medicare Part D beneficiary cost-sharing once out-of-pocket spending reaches $8,000. Payments between the beneficiary, drug manufacturer, and insurer apply to the out-of-pocket spending threshold, and according to an analysis conducted by KFF, beneficiaries themselves will pay $3,300 out-of-pocket for brand name drugs.
In 2023, Medicare Part D beneficiaries who reached the out-of-pocket spending threshold were required to pay the greater of 5% coinsurance or a $4.15 copay for their drug costs the remainder of the year, capping beneficiaries’ maximum out-of-pocket drug costs at $3,100 for brand name drugs (KFF).
Beginning January 1, 2025, Medicare Part D beneficiaries out-of-pocket drug costs will be capped at $2,000 with annual adjustments thereafter.
Do you purchase or generate Medicare leads?
On December 13, 2023, the Federal Communications Commission has adopted new rules that will impact lead generation. Previously lead-generation platforms could connect consumers with multiple businesses without distinct, individual consent for each. These new rules specify that:
text messages are required to comply with the TCPA Do Not Call (DNC) rules,
prior express written consent, meeting all E-SIGN requirements, must be obtained from a consumer one seller at a time (1:1 consent), and
calls and texts to a consumer must be logically and topically related to the website/transaction where consent was provided.
These changes will become effective 6 months after being published in the Federal Register, potentially impacting marketers this summer.
Proposed Regulatory Changes to D-SNP Plans
On November 11, 2023, CMS introduced a Proposed Rule for Contract Year 2025 plans, that includes regulatory changes to D-SNP plans. CMS has acknowledged that many D-SNP plans do not meaningfully integrate Medicare and Medicaid care, mainly because the D-SNP carrier does not also provide the enrollee’s Medicaid services. The proposed rule focuses on increasing enrollment in D-SNP types (FIDE and HIDE) that more meaningfully integrate Medicare and Medicaid services by:
replacing the current quarterly special enrollment period (SEP) with a monthly SEP for dual and other LIS eligible individuals to elect a standalone PDP,
creating a new monthly SEP allowing dually eligible individuals to elect an integrated D–SNP,
limiting enrollment in certain D–SNPs to individuals also enrolled in an affiliated Medicaid MCO (beginning plan year 2027),
requiring integrated D-SNPs to disenroll individuals who are not enrolled in both the D–SNP and Medicaid MCO offered under the same MA or parent organization (beginning plan year 2030), and
limiting the number of D–SNPs an MA or parent organization can offer in the same service area as an affiliated Medicaid MCO to reduce “choice overload” of D–SNP options.
Want to learn more about the D-SNP market? Check out our recent deep dive here.
For more regulatory compliance updates and reminders like these, check out the Compliance Chatter section in our weekly Medicare Market Insights newsletter.
As we head into the dreaded tax season, it’s also a busy time for insurance carriers as they submit annual required reporting. Some of these key reports are:
Report Due Date
NAIC Annual Statement March 1/April 1
Multiple Medicare Supplement Insurance Policies March 1
Medicare Supplement Refund Calculation Report May 31
State required statutory reporting or data calls Varies
Telos Actuarial’s team of experienced regulatory compliance professionals can help you navigate and submit these reports, keeping you in compliance.
Reach out to compliance@telosactuarial.com to learn more about the Compliance services we provide!
