Medicare Advantage Reform: Automatic Enrollment, Fixed Plans, and Payment Changes.
This bill introduces significant changes to the Medicare Advantage (MA) program starting in 2028. The key change is the automatic enrollment of eligible individuals into the lowest-premium MA plan, though they retain the option to opt out. Furthermore, once enrolled in an MA plan, individuals must remain in it for three years, except in cases of severe hardship, limiting the freedom to switch coverage. These changes modify how benefits are financed and managed.
Key points
Automatic Enrollment in MA: Eligible individuals will be automatically enrolled in the lowest-premium Medicare Advantage plan, but they will have the opportunity to decline this enrollment.
Mandatory 3-Year Continuous Enrollment: Once enrolled in an MA plan, individuals cannot switch to another MA plan or return to traditional Medicare for a 3-year period, except in hardship events (e.g., serious illness).
Changes to MA Plan Financing: Plans must pay for benefits solely on a capitated basis (fixed payments per member).
New Health Risk Assessment Rules: Starting in 2028, risk adjustment for health status will only use diagnoses documented from face-to-face or telehealth visits, excluding data from chart reviews or stand-alone health risk assessments.
Hospice Care Inclusion: Beginning in 2028, Medicare Advantage plans will be required to include hospice care in their covered benefits.
Introduced
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