Proposed rule would set medical loss ratio for some Medicare plans

02/19/2013 | Hill, The

Profits and overhead costs for Medicare Advantage plans and the Medicare Prescription Drug Benefit Program would be limited to 15% under a rule proposed by the Centers for Medicare and Medicaid Services. The remaining 85% of such plan premiums would have to go toward medical expenses and other "direct benefits to beneficiaries," according to the rule, which is now subject to a 60-day comment period. The proposal also specifies that providers that fall short of the guidelines could be subject to penalties and could lose their contracts.

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Hill, The

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