WASHINGTON, D.C. – A new report from Medicare Rights Center calls for important reforms to the Medicare Advantage (MA) programme, citing concerns over misleading marketing practices, limited access to care, and financial incentives that prioritize enrollment over beneficiary needs. The report, released today, proposes measures to enhance clarity, strengthen oversight, and empower seniors to make informed healthcare choices.
The Medicare Advantage program, initially designed to offer seniors alternative ways to receive Medicare benefits through private insurance plans, has experienced rapid growth in recent years. As of October 2023, over 30.8 million Americans – more than half of all Medicare beneficiaries – are enrolled in MA plans,according to data from the Centers for Medicare & Medicaid Services (CMS). however, this expansion has been accompanied by increasing scrutiny regarding plan quality and marketing tactics.
The Medicare Rights Center report identifies several key areas for enhancement. It advocates for reinstating the “meaningful difference” standard, a previous CMS requirement ensuring MA plans offered genuinely distinct benefits compared to traditional Medicare. Standardizing plan designs, similar to the approach taken with Medigap and Affordable Care Act Marketplace plans, is also recommended to simplify the selection process for beneficiaries. The report highlights that the current complexity of MA plans contributes to confusion and inequities in access to care.
A significant concern raised is the practise of “upcoding,” where MA organizations may inflate risk scores to receive higher payments from CMS. The report calls for closing loopholes that facilitate this practice and increased regulation of broker compensation, as financial incentives can motivate brokers to steer beneficiaries towards plans that maximize their own earnings rather than best serving the individualS healthcare needs. Specifically, the report points to the potential for brokers to receive bonuses based on enrollment numbers, creating a conflict of interest.
Empowering Medicare beneficiaries with clear,accessible information is paramount to ensuring they can navigate the complex landscape of Medicare Advantage plans and choose the option that best aligns with their health needs.
The report emphasizes the critical need for improved information and resources for Medicare beneficiaries. While tools like the Medicare Plan Finder exist, the report notes their limitations, specifically the inability to search for plans based on preferred providers.Furthermore, the State Health Insurance Assistance Program (SHIP) counselors, who provide expert enrollment guidance, are often underfunded, limiting their capacity to assist the growing number of beneficiaries seeking help. The Medicare Rights Center recommends increased funding for both Medicare Plan Finder enhancements and SHIP programs nationwide. Currently, SHIP programs operate with an average annual budget of $180,000 per state, according to the national Association of State Health Insurance Assistance Programs (NASHIP).
The report also suggests CMS should directly address common decision-making factors for beneficiaries, such as access to specific doctors and hospitals, coverage for prescription drugs, and out-of-pocket costs. A recent Kaiser Family Foundation poll (November 2023) found that 60% of Medicare beneficiaries report difficulty understanding their plan options.
For further information, the full Medicare Sustainability policy series is available at www.medicarerights.org/policy-series/medicare-sustainability.
