Senators call for Medicare Advantage consumer protection | So Good News


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Eleven Democratic senators have sent a letter to the Centers for Medicare and Medicaid Services, asking the government to establish stronger consumer protections for Medicare Advantage in light of their concerns about the commercial nature of the program.

This concern was fueled, in part, by a recent report released by Senate Finance Committee Chairman Ron Wyden, D-Ore., saying that misleading MA advertising can sometimes overstate a plan’s true value.

The Senate Finance Committee Majority Staff launched an investigation in August, gathering information on advertising complaints from 14 states and finding evidence that beneficiaries are being targeted by aggressive marketing tactics and false and misleading information.

As a result of these practices, officials said, “seniors, low-income people, and people with disabilities were experiencing high out-of-pocket costs, difficulty accessing care, and delays in care due to uncertainty about their status.”

Although the number of complaints about misleading MA marketing is increasing, the concerns are not new, the senators said. Congress has addressed market abuse in the MA program since 2008, with CMS imposing financial penalties on MA plans based on their marketing practices. One of those cases prompted CMS to open a Special Enrollment Period for beneficiaries to find new plans.

Democratic senators say the Trump Administration has weakened basic consumer protections that Congress enacted, and reduced CMS oversight. They urged the present authorities to take action.


CMS should restore consumer protections in place before the Trump administration, such as banning educational and commercial events from being held on the same day at the same location, and requiring marketing tools to report complaints and complaints, the letter said.

CMS must also monitor those who are actively disenrolled and who are receiving Special Enrollment Periods promotions offered by MA plans and brokers and agents; require agents and brokers to be held accountable through the MA organization’s plans to regularly review prescription drugs and attend to them to ensure that the new or revised plan meets the beneficiary’s needs; and prohibits MA plans from contracting with organizations that produce equipment that purports to be from the Medicare program or another federal agency.

He also urged the federal agency to support what he sees as unbiased sources of information for beneficiaries, including State Health Insurance Assistance Programs and the Senior Medicare Patrol.


The letter acknowledged that CMS has taken steps to reduce MA advertising that can be problematic. Kathryn A. Coleman, director of the Medicare Drug and Health Plan Contract Administration Group, recently sent a letter to all Medicare Advantage Organizations (MAOs) and drug plan sponsors stating that CMS will increase its review of sales materials related to MA. Such items must be filed under the “File and Use” section of the MA and Part D drug plan administration.

CMS has reviewed thousands of complaints and hundreds of phone calls, and said it identified many problems associated with TV and newspaper ads, mailers, and Internet searches. The agency called the numbers associated with these ads in a “mystery shopping” campaign that was supposed to monitor the ads.

“Our private procurement practices have found that some providers are not following existing laws and are putting undue pressure on beneficiaries, as well as failing to provide accurate or sufficient information to help a beneficiary make an enrollment decision,” Coleman wrote.

He reminded MAOs and Part D agents that they are responsible for marketing the products of agents, brokers and other affiliates.

CMS provided several best practices to encourage MAOs and Part D sponsors, including ensuring that beneficiaries know how to respond to marketing complaints with 1-800-MEDICARE or the plan and informing beneficiaries that it is important to provide the name of the sponsor or broker, if applicable.

It also recommended that sponsors ensure that all sponsors and promotional materials clearly state whether certain benefits may not be available to all subscribers.

Twitter: @JELagasse
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