Bloomberg Law: Look-Alike Medicare Plans Have Regulators ReThinking New Rules (October 17, 2019)

Low-income individuals who are dually eligible for both Medicare and Medicaid are being targeted by private “look-alike” plans that imitate Dual Eligible Special Needs Plans (D-SNPS) and promise extra benefits, but often don’t deliver and can expose enrollees to extra costs. Justice in Aging Directing Attorney Amber Christ was interviewed for the article, in which she stated, “So they sign up thinking that they’re getting something more, but what ends up happening is because there’s no coordination [between Medicare and Medicaid], they end up getting billed for services that they would have gotten free under the Medicaid program. There’s just an increased risk for that kind of improper billing to happen.”

The CMS had proposed new restrictions on marketing the look-alike plans but has walked away from the proposal, saying in an April letter that some Medicare Advantage plans felt look-alikes have a “legitimate place in the Medicare Advantage marketplace in areas where there are no DSNPs.” This article is behind a paywall. This is a summary.