PFFS plans will have to provide better education

Why This Topic Matters

PFFS plan marketing and education requirements can affect how practices interact with patients, plan representatives, and enrollment questions. The article also highlights policy changes that may influence plan oversight and payment discussions affecting Medicare Advantage more broadly.

Article Sections

1. Good first step

   Discussion of CMS’s temporary marketing pause, the participating plan sponsors, and the broader context for the agency’s response to PFFS plan concerns.

2. Patient complaints

   Overview of reported complaints, physician-facing concerns, and guidance for patients who believe they were enrolled in a plan inappropriately.

3. Most expensive plans

   Summary of MedPAC’s comments on Medicare Advantage payment levels and its recommendations for addressing differences between plan types and traditional Medicare.

4. New PFFS plan provisions designed to protect patients

   List of CMS requirements intended to improve plan education, disclosures, sales oversight, and provider support before marketing can resume.