Some states see more Medicare Advantage advertisement complaints

Photo: Manuel Breva Colmeiro/Getty Images

A number of states have been hit with complaints about Medicare Advantage marketing, with the Centers for Medicare and Medicaid Services saying the number of Medicare beneficiary complaints about private sector marketing for Medicare Advantage plans more than doubled from 2020 to 2021.

A new report released by Senate Finance Committee Chairman Ron Wyden, D-Ore., implored the federal agency to take action, mitigating some of the allegedly misleading advertising that can obfuscate a plan's true benefits and more.

The Senate Finance Committee Majority Staff launched an inquiry in August, collected information on marketing complaints from 14 states and found evidence that beneficiaries are being inundated with aggressive marketing tactics as well as false and misleading information.

A number of real-life scenarios were discovered. In one instance, seniors shopping at their local grocery store were approached by insurance agents and asked to switch their Medicare coverage or MA plan. In another insurance agents selling new MA plans told seniors their doctors are covered by the new plans. Seniors who switched plans found out months later that their doctor is actually out-of-network, and they have to pay out-of-pocket to visit their doctor.

Some seniors received mailers that look like official business from a federal agency, yet the mailer was a marketing prompt from an MA plan or its agent or broker. Calling seniors has also been an issue, with some insurance agents calling seniors about 20 times per day to convince them to switch their Medicare coverage.

"Widespread television advertisements with celebrities claim that seniors are missing out on benefits, including higher Social Security payments, in order to prompt seniors to call MA plan agent or broker hotlines," according to the letter.

WHAT'S THE IMPACT?

The report revealed that these are not isolated incidents, but rather a consistent national picture. 

The issues were reported more frequently with respect to MA plans compared to stand-alone Part D plans. And nine of the 10 states reporting quantitative complaint information found an increase in complaints from 2020 to 2021 that mirrored the trend found by CMS.

The investigation also uncovered a range of predatory actions, according to the letter. Agents were found to sign up beneficiaries for plans under false pretenses. They might tell a beneficiary that coverage networks include preferred providers even when they don't. Of particular concern to the committee were reports across states of agents changing vulnerable seniors' and people with disabilities' health plans without their consent.

For its part, CMS has taken some positive steps to address the issue, but Wyden and the committee argued there's more to be done. 

"During the Trump Administration, Medicare program oversight deteriorated significantly," the letter read. "Several key protections against misleading and predatory MA marketing practices were undone."

The committee recommended a number of actions, including:

• reinstating MA plan requirements loosened during the Trump administration.
• monitoring MA disenrollment patterns and using enforcement authority to hold bad actors accountable.
• requiring agents and brokers to adhere to best practices.
• implementing robust rules around MA marketing materials and closing regulatory loopholes that allow cold-calling.
• supporting unbiased sources of information for beneficiaries, including State Health Insurance Assistance Programs and the Senior Medicare Patrol.

THE LARGER TREND

Kathryn A. Coleman, director of the CMS' Medicare Drug and Health Plan Contract Administration Group, recently sent a letter to all Medicare Advantage Organizations (MAOs) and prescription drug plan sponsors saying CMS will enhance its review of MA-related marketing materials. Such materials should be submitted under the "File and Use" regulatory authority for MA and Part D drug plans.

CMS has reviewed thousands of complaints and hundreds of audio calls, and said it identified numerous issues linked to television and newspaper ads, mailings, and internet searches. The agency called numbers associated with these ads in a "secret shopping" campaign meant to monitor these advertisements.

"Our secret shopping activities have discovered that some agents were not complying with current regulation and unduly pressuring beneficiaries, as well as failing to provide accurate or enough information to assist a beneficiary in making an informed enrollment decision," wrote Coleman.

She reminded MAOs and Part D sponsors that they're responsible for the marketing activities of the agents, brokers and other third-party entities with whom they contract.

CMS put forth a number of recommended best practices for MAOs and Part D sponsors, including ensuring beneficiaries know how to file a marketing complaint with 1-800-MEDICARE or the plan and letting beneficiaries know that it's important to provide an agent or broker name, if possible.

It also suggested to sponsors that they ensure all agents and plan marketing materials clearly state when certain benefits may not be available to all enrollees.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com