Senators call for more Medicare Advantage consumer protections
The senators charge that the Trump administration weakened the basic consumer protections Congress had enacted and relaxed CMS' oversight.
Photo: Manuel Breva Colmeiro/Getty Images
Eleven Democratic senators have sent a letter to the Centers for Medicare and Medicaid Services, asking the federal government to enact stronger consumer protections for Medicare Advantage in light of their concern over marketing practices for the program.
This concern was spurred, in part, by a recent report released by Senate Finance Committee Chairman Ron Wyden, D-Ore., alleging that misleading MA advertising can sometimes obfuscate a plan's true benefits.
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.
As a result of these practices, the senators said, "seniors, people with limited financial resources, and people with disabilities were subject to higher out-of-pocket costs, difficulty accessing care, and delayed care due to the uncertainty of their coverage."
While the number of complaints regarding misleading MA marketing is growing, the concerns themselves are not new, the senators said. Congress addressed marketing abuses in the MA program as far back as 2008, with CMS issuing civil monetary penalties to MA plans related to their marketing tactics. One of those cases resulted in CMS opening a Special Enrollment Period for beneficiaries to seek new plans.
The Democratic senators charge that the Trump administration weakened the basic consumer protections Congress had enacted and relaxed CMS' oversight. They urged the current administration to take a number of steps.
WHAT'S THE IMPACT
CMS should reinstate consumer protections in place prior to the Trump administration, such as prohibiting educational and marketing events from occurring on the same day at the same location, and requiring marketing materials to describe the grievance and appeals process, the letter said.
CMS should also track rapid disenrollments and those receiving Special Enrollment Periods for marketing issued by MA plans as well as by brokers and agents; require agents and brokers accountable through the agency's regulations of MA plans to review a beneficiary's prescription drugs and regularly visited healthcare providers to ensure that a new or renewing plan meets a beneficiary's needs; and prohibit MA plans from contracting with entities that design materials to suggest they are from the Medicare program or another federal agency.
They also urged the federal agency to support what they consider unbiased sources of information for beneficiaries, including State Health Insurance Assistance Programs and the Senior Medicare Patrol.
THE LARGER TREND
The letter acknowledged that CMS has taken some steps to curb potentially troublesome MA marketing. Kathryn A. Coleman, director of the agency's 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
