Client Alerts & Newsletters

Center for Medicare and Medicaid Services Issues a Final Rule on Medicare + Choice ("M+C")


On November 28, 2003 the Center for Medicare and Medicaid Services issued a final rule enabling Medicare + Choice ("M+C") plans to offer reductions in the standard Medicare Part B premium, with the intent of making M+C plans more attractive to beneficiaries. The rule makes conforming changes to the current M+C regulations to implement section 606 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 ("BIPA"). M+C organizations can elect to receive a reduction in their monthly capitation payments under 42 CFR § 422.250(a)(1), 80% of which would be applied to either reduce or eliminate the standard Medicare Part B premiums otherwise paid by, or on behalf of, Medicare enrollees. The new regulations, added as 42 CFR § 408.21, limit the premium reduction to an amount that cannot be greater than the standard premium amount determined for the year under § 1839 of BIPA. The premium reduction must be a multiple of 10 cents, and the reduction will be applied to all beneficiaries enrolled in the M+C plan, regardless of who pays or collects the premium. Finally, the reduction can never be less than zero and will not result in a payment to a beneficiary in any given month. To be eligible for the Part B premium reduction, beneficiaries must be enrolled in an M+C plan that offers the reduction as an additional benefit. After determining applicable premium reductions, CMS will notify beneficiaries of their new benefit check amounts.

For more information, please contact the professional(s) listed below, or your regular Crowell & Moring contact.

Crowell & Moring LLP is an international law firm with approximately 550 lawyers representing clients in litigation and arbitration, regulatory and policy, and transactional matters. The firm is internationally recognized for its representation of Fortune 500 companies in high-stakes litigation, as well as its ongoing commitment to pro bono service and diversity, equity and inclusion. The firm has offices in Brussels, Doha, London, Los Angeles, New York, Orange County, San Francisco, Shanghai, and Washington, D.C.

View Desktop Site | Mobile Sitemap |

Contact | Subscribe | Terms of Use | Privacy Statement | Alumni

© Crowell & Moring LLP 2021
Attorney advertising - prior results do not guarantee a similar outcome.