In a statement to the Senate Finance Committee, ACP says more program transparency, up-to-date clinician directories and passage of key legislation are needed to improve MA plans
Nov. 17, 2023 (ACP) -- The Senate Finance Committee recently held a hearing on deceptive practices of Medicare Advantage plans, and the American College of Physicians provided input with recommendations on how to best rein in such practices and better protect older individuals' health.
In a statement to the committee, ACP called for more Medicare Advantage program transparency at the consumer level, including details on available benefits, cost-sharing arrangements and premium costs, up-to-date clinician directories and passage of key legislation that would streamline prior authorization and limit step therapy.
Medicare Advantage plans are offered by private insurance companies approved by Medicare. Medicare pays these companies to cover Medicare benefits. More than half of eligible Medicare beneficiaries are enrolled in Medicare Advantage plans in 2023, and the average Medicare beneficiary has access to 43 Medicare Advantage plans, according to a study by KFF.
However, not all Medicare Advantage plans are created equally, said Brian Buckley, ACP senior associate for legislative affairs.
“Many of these plans work very well for older individuals, and we are just concerned about a few bad actors who may be misleading them,” he said. “When patients sign up for Medicare Advantage programs, they should receive accurate information regarding coverage costs and benefits of the plan.”
Unfortunately, this is not always the case.
These plans should also provide beneficiaries with a “clear and understandable” means to compare benefits and options when deciding between a Medicare Advantage plan and traditional Medicare, Buckley explained.
The process of “seamless conversion” into these plans should be stopped, he said. Newly eligible Medicare beneficiaries should not be automatically enrolled into their insurer's Medicare Advantage plan without their knowledge, understanding and consent.
Inaccurate, outdated Medicare Advantage “provider” directories have been a problem for a while, according to Buckley. “We urge the Senate to require Medicare Advantage plans to update their directories every month to ensure that patients have access to accurate directories when they choose a plan or health professional,” he said, noting that “provider” directories should also include information on the health care professional's gender, medical group and facility affiliations.
ACP is urging the committee, the Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General and other groups to investigate potentially fraudulent activity and the misuse of risk stratification by Medicare Advantage plans.
Some plans may game the risk stratification system to boost profits. Essentially, a higher risk score means more money, so Medicare Advantage plans have financial incentives to thoroughly document beneficiaries' diagnoses. This is not the case with traditional Medicare plans.
This issue is on the government's radar. In April 2023, CMS finalized a rule that banned advertisements that do not mention a specific plan name and use Medicare logos or language that could cause potential enrollees to believe that the ads come from the government. This rule also calls on celebrities, such as Joe Namath, William Shatner and Jimmy Walker, who tout these plans in commercials to disclose what insurance plan they are advertising.
In the letter to the Senate Finance Committee, ACP highlighted pending legislation that, if passed, would help make sure older individuals are getting the care they need when they need it.
“We urge the Senate to approve the ‘Improving Seniors' Timely Access to Care Act of 2023,’ which streamlines the process of prior authorization and requires companies to provide a more rapid response if a service or treatment is covered,” Buckley said.
This bill has been approved by the House Ways and Means Committee, and the House Energy and Commerce Committee has slated the bill for approval. “We need the Senate to act and the House to fully pass it as well,” he explained. “This would be a big win.”
ACP also urges Congress to pass the Safe Step Act, which streamlines step therapy exception requests for patients and their physicians.
There is a lot that members can do to help advocate for older individuals. “Contact senators and representatives about these specific bills and urge them toward approval,” Buckley encouraged. ACP offers grassroots action alerts that make this simple on its Legislative Action Center.