MedPAC Reviews Medicare Payments for Physicians and Insurance Agents 

The Medicare Payment Advisory Commission (MedPAC) met on March 6 and 7 to discuss reforming Physician Fee Schedule (PFS) updates, Medicare insurance agents, and other topics.  

MedPAC reviewed and discussed two draft recommendations for updating payments to physicians and other health care providers under the Medicare PFS. The first recommendation, if adopted, would encourage Congress to replace current-law updates with an annual update based on a portion of the growth in the Medicare Economic Index (MEI), such as MEI minus 1 percentage point. The second recommendation, if adopted, would urge Congress to direct the Centers for Medicare & Medicaid Services to improve the accuracy of relative payment rates for clinician services by regularly updating cost data and ensuring that the methodology used to determine payment rates for different services reflects the setting in which clinicians practice medicine. Commissioners expressed substantial and broad support for these draft recommendations, and the commission will likely vote on final recommendations in the April meeting to include in their June 2025 report to Congress.   

Additionally, commissioners reviewed background and preliminary work related to the use of Medicare insurance agents and Medigap plans, specifically looking at how these factors impact beneficiary choice. Commissioners voiced concerns related to plan bias from agents potentially misleading beneficiaries and concerns that beneficiaries may be priced out of Medigap plans if they need to switch from Medicare Advantage to Medicare Fee-for-Service after their initial enrollment period. While MedPAC does not plan to include a chapter on these topics in their report to Congress this cycle, the commission does plan to continue their work on these topics in future cycles.