The Coverage Parity for Medicare Patients Act of 2023 directs the federal government to establish a demonstration program that would expand coverage decisions for Medicare beneficiaries based on what private insurance plans cover. Starting by January 1, 2026, the program would deem certain items and services as medically necessary for Medicare patients if they meet three criteria: they are covered by a significant number of private health plans in the patient's state, they are safe and effective, and they are not experimental or are part of an approved clinical trial. The demonstration would begin in at least five states or three Medicare administrative contractor regions selected by the Secretary of Health and Human Services, with the option to expand to additional areas. The program must run for at least four years, after which the Secretary can only terminate it following a 60-day public comment period. This change would essentially align Medicare's coverage decisions more closely with private insurance standards, potentially giving Medicare beneficiaries access to treatments and services that private insurers commonly cover.
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