CMS Director of Medicare Chris Klomp, CMS Administrator Dr. Mehmet Oz and President Donald Trump
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The Centers for Medicare & Medicaid Services is considering a policy to automatically enroll seniors in a Medicare Advantage plan, according to STAT.
Chris Klomp, director of Medicare and deputy administrator for CMS, told STAT his team is mulling the feasibility of models that would either automatically enroll beneficiaries into a private Medicare Advantage plan or an accountable care organization that participates in the Medicare Shared Savings Program or similar program.
Klomp said either choice would be better than enrolling beneficiaries in a fee-for-service arrangement, which is Medicare. Individuals could still opt into a different insurance arrangement, he said.
Klomp is senior advisor to Health and Human Services Secretary Robert F. Kennedy, Jr.
In February, Kennedy announced in an email to staff that he was remaking his leadership team, putting Klomp in charge of overseeing all HHS operations, according to Politico.
Currently, original Medicare is the default option for seniors who don't make a choice. Over half of seniors enrolled in a Medicare plan choose a Medicare Advantage plan.
Moving to MA as the default option is part of the conservative Project 2025 policy blueprint, which has made other recommendations that HHS has initiated such as Medicaid work requirements.
Project 2025 said: "Encourage more direct competition between Medicare Advantage and private plans. Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America's large and growing cohort of seniors. The program provides beneficiaries with a wide range of competitive health plan choices—a richer set of benefits than traditional Medicare provides and at a reasonable cost. Equally as important, the MA program has been registering consistently high marks for superior performance in delivering high-quality care. Critical reforms are still needed to strengthen and improve the program for the future."
Specifically, the blueprint said, "Make Medicare Advantage the default enrollment option."
Other policy recommendations include giving beneficiaries direct control of how they spend Medicare dollars, removing policies that micromanage MA plans, replacing the formula-based payment model with a competitive bidding model, reconfiguring the current risk adjustment model, and removing restrictions on key benefits and services, including those related to prescription drugs, hospice care and medical savings account plans.
The blueprint recommends moving original Medicare to value-based payments but gives no specifics.
Medicare Advantage is a value-based program in which pay is unrelated to the volume of services. However, the program has been found to cost the federal government more than original Medicare. Also, MA insurers have been struggling in the past year to meet the financial challenges of higher medical utilization and spending.
Email the writer: SMorse@himss.org