MEDICARE ALERT: Direct Contracting Entities

The majority of seniors are enrolled in traditional Medicare. Nearly 40% are enrolled in a Medicare Advantage plan, but that decision was made by the enrollee. The situation is different under a DCE. If your primary provider signs up with one of these DCE’s, patients are automatically transferred to this new entity. There is no affirmative decision required by the enrollee for this change to occur.

It should be pointed out that enrollment in a DCE does NOT terminate your coverage under traditional Medicare. You retain all your prior rights, coverage, and benefits. As a pilot program, however, DCE’s utilize a coordination of care and payment approach, which the Centers for Medicare and Medicaid Services (CMS) believes will improve patient care. Unlike traditional Medicare where providers receive a set fee for services, DCE’s receive a capitation amount for each enrollee. DCE’s are allowed to keep up to 40% of whatever amount is left over, once medical services are paid. On January 1, this program is going to be euphemistically known as REACH (Realizing Equity, Access, and Community Health).

RPEA has strong concerns about any Medicare enrollment process that does not involve an affirmative decision by the enrollee. To describe this procedure as “sneaky” is an understatement.

RPEA has contacted the members of the New York Congressional Delegation urging them to intercede with the Biden Administration to terminate this program (seven Representatives have already done so). We are also sharing this information on social media, and joining the PROTECT MEDICARE coalition. Medicare is one of the most efficient federal programs. Efforts to dismantle and privatize Medicare are not in the best interests of seniors who rely on this vital program.

NYSHIP EMPIRE PLAN: Enrollment in a DCE will NOT affect your Medicare coverage under the Empire Plan.

To read more about Direct Contracting and REACH click here.

RPEA, keeping you informed and advocating on your behalf.  Not yet a member of RPEA? You can join online today – click here.