New Medicare Model Could Change Benefits

The Innovation Center, a part of the Centers for Medicare & Medicaid Services (CMS), is considering a new Medicare model that could result in significant changes to benefits. The potential new model is called Direct Provider Contracting (DPC).

A DPC model could potentially give beneficiaries reduced cost sharing or increased services that Medicare does not currently cover. DPC is intended to make healthcare providers more accountable for the cost and quality of care they deliver to beneficiaries. Under DPC, Medicare could pay providers a monthly fee to deliver a specific set of services to beneficiaries, who would gain greater access to the physicians. However, some advocates are concerned whether the new model would retain Medicare’s current limits on balance billing and private contracting.

Under current Medicare rules, about 95% of physicians are participating providers who agree to accept Medicare’s approved payment amounts as full payment for Medicare-covered services. Patients may be billed for Medicare cost-sharing, but cannot be balance-billed for additional charges. A small number of physicians opt out of Medicare and have private contracts with Medicare beneficiaries. These doctors do not accept payment from Medicare and any beneficiaries using their services must pay for all charges themselves. These doctors must have private contracts for all Medicare beneficiaries. They cannot choose patients by severity of illness or charge different patients different amounts.

At this point, it is too early in the process to know if these protections will remain in the new DPC model.
Read more about Direct Provider Contracting (DPC)
Please note that CMS is not taking public comments. If Medicare is important to you,
Contact your Indiana congressional representatives.