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Draft MedPAC Language Calls for Medicare Benefit Redesign

By John Reichard, CQ HealthBeat Editor

March 8, 2012 -- The Medicare benefits package would be redesigned to cap enrollee out-of-pocket costs, under a draft recommendation unveiled recently at a Medicare Payment Advisory Commission (MedPAC) meeting.

The benefits redesign also would combine the deductibles for Part A and Part B services and vary copayments by the type of service and provider.

In addition, the Health and Human Services secretary would be given authority to alter beneficiary cost-sharing "based on evidence of the value of services," the draft language states.

And the draft recommendation also would require insurers to pay a surcharge on the supplemental policies they offer to beneficiaries to pick up certain expenses Medicare doesn't cover.

The proposal is designed to discourage beneficiaries from getting unnecessary or inefficient treatment. It would do so by increasing, decreasing or eliminating out-of-pocket payments, depending on the efficiency and quality of the service. But at the same time, it would protect beneficiaries by capping their out-of-pocket costs.

Such a cap would presumably make it more palatable for patients to pick up more of the initial cost of their medical care.

As an example, to encourage beneficiaries to get primary care, copayments could be set at $20 for primary care visits and $40 for visits to specialists. Or, to make beneficiaries think carefully about getting advanced imaging, which is more costly, Medicare could charge higher co-payments for that particular type of service.

The commission isn't endorsing specific copayment levels, however. There would be no change in the aggregate cost-sharing liability of the beneficiary.

The commission unveiled the draft but isn't expected to vote whether to recommend it to Congress until later this spring and may make changes to the proposal based on the discussion at this month's meeting. The panel is gearing up to make recommendations in a June report to Congress, and the benefit redesign recommendation could be part of that.

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