The one-third of Medicare beneficiaries not covered by the “hold-harmless” provision will see a lower premium increase than originally projected, with consumers paying 10% in 2017, compared with projections of as much as 22% more. The CMS announced Thursday it would tap Medicare Part B program reserves to bring down premiums for those whose increases are not tied to Social Security cost of living adjustments.

Average monthly premiums for Medicare Advantage plans next year will be 3.6% lower than 2016 rates, Part D premiums will remain stable, and 67% of enrollees’ premiums will not go up, according to the CMS.

UnitedHealthcare is currently reviewing the FAQ and will be communicating at a future date any updates to coverage once determined.  Below is a summary of the questions addressed in the FAQ Part XXIX.

Coverage of Preventive Services
Health reform law requires non-grandfathered group health plans and health insurance coverage offered in the individual or group market to cover certain preventive care services without cost-sharing. The FAQ Part XXIX provides clarity on the standards used to determine which services are required to be covered in network without cost-sharing.

• Question 1 – Plans and issuers are required to provide a list of the lactation counseling providers available within the network under the plan or coverage.
• Question 2 –If a non-grandfathered health plan’s network does not have network options for lactation counseling services, the plan cannot impose cost-sharing on the member if services are received out-of-network.
• Question 3 – If a member’s state does not license lactation counseling providers and a plan only covers services received from providers licensed by the state, the lactation counseling must be covered without cost sharing when it is performed by any provider acting within the scope of his or her license or certification under state law.
• Question 4 – Plans cannot limit coverage for lactation counseling without cost-sharing to services provided on an inpatient basis, while imposing cost-sharing for lactation counseling on an outpatient basis. Additionally, coverage for lactation support services without cost-sharing must extend for the duration of the breastfeeding.
• Question 5 – The requirement to cover the rental or purchase of breastfeeding equipment without cost-sharing extends for the duration of breastfeeding and cannot be limited to a set number of months, provided the individual remains continuously enrolled in the plan or coverage.
• Question 6 – Non-grandfathered health plans cannot impose general exclusions that would encompass recommended preventive services. For example, non-grandfathered health plans cannot contain a general exclusion for weight management services for adult obesity. Non-grandfathered health plans must cover without cost-sharing, screening for obesity in adults, in addition to behavioral interventions for weight management for certain populations.
• Question 7 – If a colonoscopy is scheduled and performed as a screening procedure based on USPSTF recommendation, a plan or issuer may not impose cost-sharing with respect to a required consultation prior to the colonoscopy, if the provider determines that the pre-procedure consultation would be medically appropriate.
• Question 8 – After colonoscopy is performed as a screening procedure based on USPSTF recommendation, the plan or issuer must cover any pathology exam on a polyp biopsy without cost-sharing.

 

For more information about Preventive Care Services, Wellness Programs, and Mental Health Parity, visit the United for Reform Resource Center or contact your UnitedHealthcare representative.