AAFP Presses CMS on Contraception, Medicare Advantage Plans

Issues Were Subjects of Resolutions at 2015 Congress of Delegates

April 27, 2016 02:22 pm News Staff

In recent letters to CMS Acting Administrator Andy Slavitt, the AAFP addressed two patient care issues that were brought to its attention by the Academy's 2015 Congress of Delegates (COD) held in September 2015 in Denver.

[Things to consider]

In the first letter,(2 page PDF) AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., urged CMS to review -- and revise as necessary -- its coverage of contraceptive options "to include coverage of all FDA-approved contraception options for men and women of reproductive age enrolled in Medicare and Medicaid."

Wergin reminded Slavitt that even though the majority of Medicare beneficiaries are ages 65 and older, nearly 920,000 women between the ages of 18 and 44 were covered by Medicare in 2011.

"Contraception is an often overlooked aspect of care for women with chronic conditions and disabilities," said Wergin.

Furthermore, he pointed out that all Medicaid programs are required to cover family planning services and supplies without cost sharing.

"However, since there is no federally defined standard for family planning, the range of contraceptive products and services that states cover varies by state and differs depending on how an individual qualifies for Medicaid," he continued.

He noted that CMS could improve contraceptive coverage for Medicaid patients simply by "defining a standard applicable across all states."

Wergin referred Slavitt to the AAFP's policy that supports Medicare coverage for all FDA-approved methods of contraception as well as other policies that support reversible contraception methods including long-acting reversible contraceptives and over-the-counter oral contraceptives.

He pointed out that most individuals with private health insurance have comprehensive coverage of contraception. However, without cost-sharing, people insured through public programs do not enjoy the same coverage.

"These men and women are vulnerable to gaps in contraceptive coverage and/or shouldering higher out-of-pocket costs for birth control," he said.

"Affordable access to all FDA-approved contraception options is still not within the reach of all men and women in the U.S.," said Wergin. He urged CMS to "expand its coverage of contraceptive options to all FDA-approved contraceptive options for men and women of reproductive age enrolled in Medicare and Medicaid."

The letter was in direct response to resolution No. 303, which was introduced at the 2015 COD by the New York and Ohio AAFP chapters; the substitute resolution adopted by the congress served as a guide to the AAFP's request to CMS.

A second letter(1 page PDF) -- also sent to Slavitt on April 20 -- asked CMS to work with Medicare Advantage Plans to help educate patients, providers and others on advantage plan benefits and coverage.

Wergin noted the substantial increase in patient enrollment in Medicare Advantage plans and said CMS had an obligation to ensure that enrollees were provided assistance with plan selection and enrollment -- and to ensure enrollees "understand their health care coverage under different Medicare Advantage plans."

The additional outreach to patients would support CMS' goal to improve patient access to quality care, said Wergin.

He underscored the importance of ensuring that Medicare beneficiaries understand their choices so that they can make informed decisions and "carefully select the plan that fits their needs."

The advantage plan letter fulfilled the AAFP's obligation related to COD resolution No. 305 -- introduced by the Indiana chapter and adopted by the 2015 COD -- that asked the AAFP to help educate physicians about coverage provided by Medicare Advantage plans.