Former and current CMS officials urge Medicare enrollees to review options amid benefit changes

Current and former leaders at the Centers for Medicare and Medicaid Services advised Medicare beneficiaries to carefully compare their choices during enrollment, saying recent policy shifts have made the program more complicated.

At The Hill’s “Bang for Your Buck: Get the Most from Your Medicare Benefits” event, held in partnership with the Alliance for Aging Research, CMS Deputy Administrator John Brooks and former CMS chief operating officer Jonathan Blum said provisions in the Inflation Reduction Act, including the Medicare Drug Price Negotiation Program, have altered the way Medicare benefits are structured.

Brooks said people should shop around even if they are happy with their current coverage.

“On average, beneficiaries will be able to choose among 28 or so plans in Medicare Advantage, and 97 percent of beneficiaries will have access to 10 or more plans,” Brooks said. “But the averages can conceal the fact that healthcare is local, and so in different healthcare markets and in and with specific plans, there can be a lot of changes from year to year.”

The Hill’s contributing editor Kathleen Koch noted that the first negotiated Medicare drug prices took effect recently, and some beneficiaries have seen copays rise for the first 10 drugs.

“The drug plan itself negotiates with the drug manufacturer to get the price that it’s paying, but the beneficiary is usually paying a much lower price than that,” Brooks said. “And so you can have these changes in how the difference between what the plan is paying and what the beneficiary is paying that shift over a year over year, and so some of those changes could be just as significant in terms of patient out of pocket, even if the drug plan itself is paying a lower amount.”

Blum, who served in both the Obama and Biden administrations, said plans and patients still need time to adapt to the IRA’s changes, and Congress has a part to play in helping that transition.

The law overhauled Medicare Part D prescription drug coverage, including setting a cap on out-of-pocket costs at $2,100 for 2026 and creating the Medicare Prescription Payment Plan, which lets beneficiaries spread prescription costs evenly through the year instead of facing a larger upfront bill.

“The IRA — whether that you support the IRA, don’t support the IRA — we all have to agree that it made fundamental changes to the Part D program. It changed the benefit structure, gave catastrophic coverage for the first time for for for drug benefits. Those changes were put in place very, very quickly … meaning that plans have to adjust their premiums; they have to get used to these new benefits,” Blum said.

“We have to think about the program really adjusting to the new world that we’re in. And so that I think is going to be one of the key questions that Congress has to consider going forward is, how do we finance the program?” he added.