Enhancing Medicare Advantage Benefits for Patients and Providers


The AMGA says that expanding Medicare Advantage benefits would benefit patients, physicians, and others in the health care industry.

For Medicare Part C, also known as Medicare Part C, and Medicare Prescription Drug Benefit Program (Medicare Part D), some policy and technical changes have been approved for 2025 by the association. A public comment period ended at the end of 2023 for the U.S. Centers for Medicare & Medicaid Services.

According to AMGA President and CEO, addressing chronically ill patients’ holistic needs, including social drivers that influence their health outcomes, is crucial to their overall well-being. Getting the most out of your coverage and benefits can be achieved if patients are informed about the services available.

In addition to behavioral health access, Special Supplemental Benefits for the Chronically Ill (SSBCI), social drivers of health, and other topics, AMGA provided its recommendations.

Behavioral health

Including outpatient behavioral health providers in network adequacy reviews would be a step towards increasing access to necessary mental health care. AMGA suggested this would include addiction treatment providers, marriage and family therapists, mental health counselors, and behavioral health providers.

AMGA said MP plans should incorporate in-person care into their networks to improve access to behavioral health services. Telehealth is important, but patients should not be left without in-person care, they said.

Special Supplemental Benefits for the Chronically Ill

Benefits under SSBCI are designed to maintain or improve beneficiaries’ health or overall well-being over time. SSBCI qualifications will be changed as part of the CMS proposal. The AMGA supports it.  Plans must submit to CMS upon request bibliographical information demonstrating effectiveness of an SSBCI under the new standard.

According to the AMGA letter, the proposed rule acknowledges that MA plans SSBCI offerings have grown substantially since they were introduced. As such, AMGA applauds CMS’ proposal to help ensure that SSBCI improves or maintains beneficiaries’ health and supports their efforts to address a wide range of nonmedical needs.

Prior authorizations

According to AMGA, prior authorizations are disproportionately affecting underserved communities. CMS proposes using committees to evaluate PA policies and procedures in light of health equity. PA may not be adequately affected by that, so AMGA advocates eradicating PA, not just reforming it. According to the letter, AMGA does not object to proposed committee reforms, but we advocate accelerated approval processes to help communities and beneficiaries deal with overly restrictive PA policies.

Fast-track appeals

MA beneficiaries should have access to a fast-track appeals process, according to the association. Quality improvement organizations should review “untimely fast-track appeals regarding terminations of home health care services or outpatient rehabilitation services,” AMGA stated. In current regulations, MA and traditional Medicare have different appeal processes.