Medicare Advantage bill introduced by senators to stem complaints

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The Medicare & You handbook is mailed out to qualified consumers.

Photo: Susan Morse/Healthcare Finance News

U.S. Senators Maggie Hassan (D-NH) and Roger Marshall, M.D. (R-KS) have introduced the bipartisan Medicare & You Handbook Improvement Act, which is meant to ensure that when seniors assess their Medicare coverage options, they have the necessary information they need on health plan choices and supplemental insurance.

The bill was crafted partly in response to rising complaints among seniors over aggressive marketing practices for Medicare Advantage plans.

The Centers for Medicare and Medicaid Services acknowledged these complaints in October, saying some of the recent Medicare Advantage advertisements and marketing materials have been “confusing, misleading or inaccurate,” at least in the minds of consumers.

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.

She reminded Medicare Advantage Organizations (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.

Hassan and Marshall’s bill seeks to improve education materials for seniors during the annual Medicare Open Enrollment period, and is in response to concerns that seniors have shared about inadvertently selecting Medicare plans that do not best meet their healthcare needs.

“When deciding whether to enroll in traditional Medicare or a Medicare Advantage plan, seniors rely on the official Medicare & You handbook,” said Hassan. “Unfortunately, the handbook does not fully address the challenges Medicare Advantage can create for seniors. My bipartisan bill would address this by improving the handbook and adding key information that is currently missing.”

Marshall said he has grown “increasingly concerned” about mass marketing ad campaigns during open enrollment.

“The Medicare & You handbook has improved over the years, but still lacks on sharing some vital information on health plan choices and supplemental health insurance,” he said.

WHAT’S THE IMPACT

The Medicare & You handbook is the official handbook that guides new and current Medicare beneficiaries on the Medicare program. Published by CMS, the handbook is mailed to every Medicare household each fall and includes a summary of Medicare benefits, patient protections, a list of available health and drug plans and some FAQs on Medicare.
Notably, it provides a comparison of Original Medicare and Medicare Advantage. While the handbook has evolved over the years to be more reader-friendly, it does not maintain information on techniques that help MA plans control costs, the Senators said.

The bill would require CMS to include a description of what utilization management techniques are, including prior authorization and step therapy, and how a beneficiary can find which techniques apply under a specific MA plan or prescription drug plan.

It would also task CMS with including a description of the network sizes of MA plans relative to the number of health care providers who accept Original Medicare; and an explanation that when seniors switch to a MA plan and later switch back to Original Medicare, they may be prohibited from purchasing supplemental coverage or else have to pay significantly higher premiums.

The bill is meant to complement the Improving Seniors’ Timely Access to Care Act, legislation that purports to modernize Medicare Advantage and make healthcare delivery more patient and doctor friendly. That bill – sponsored by Marshall and cosponsored by Hassan – has support from 50 Senators and from more than 500 national and state organizations. 

Hassan also joined colleagues in calling for the Biden administration to implement additional consumer protections in Medicare Advantage following an increase in reports of deceptive marketing practices aimed at seniors in the program, and joined the New Hampshire Congressional Delegation in urging CMS to take action to protect eligible New Hampshire Medicare beneficiaries subject to aggressive and potentially predatory marketing tactics related to the sale of Medicare Advantage plans or other insurance products.

THE LARGER TREND

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 in October.

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: [email protected]

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