The Biden administration announced Tuesday that it’s proposing a number of changes to private Medicare plans designed to alleviate coverage barriers, put guardrails around the use of artificial intelligence, and ensure access to behavioral health providers and supplemental benefits.
The proposed rule would also address misleading marketing practices by Medicare Advantage plans, inaccurate provider directories, and vertical integration among the insurers that offer the plans, which cover over half of Medicare beneficiaries. The rule, which would take effect in 2026, also seeks to expand Medicare coverage for the blockbuster weight loss drugs Wegovy and Zepbound for obesity.
In a news release announcing the changes, Medicare said that data reported to the agency show that on average, Medicare Advantage plans overturn 80% of their decisions to deny claims when those denials are appealed. The data also show that fewer than 4% of denied claims are appealed in the first place. Ultimately, what these and other data show is that Medicare Advantage enrollees may not be getting access to the care they need, the release said.
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