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Wednesday, December 7, 2022

Medicare Advantage bill introduced by senators to stop complaints

The Medicare & You Handbook is mailed to qualified consumers.

Photo: Susan Morse/Healthcare Finance News

US Senators Maggie Hassan (D-NH) and Roger Marshall, MD (R-KS) introduced the bipartisan Medicare & You Handbook Improvement Act, which aims to ensure that when seniors are evaluating their Medicare coverage options, have the necessary information they need. need about health plan options and complementary insurance.

The bill was crafted in part in response to growing complaints from seniors about aggressive marketing practices by Medicare Advantage plans.

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

Kathryn A. Coleman, director of the agency’s Medicare Drug and Health Plan Contract Management Group, recently sent a letter to all Medicare Advantage Organizations (MAOs) and prescription drug plan sponsors saying that CMS will improve its review of marketing materials related to MA. Such materials must be submitted under the regulatory authority of “Archive and Use” for MA and Part D drug plans.

She reminded Medicare Advantage Organizations (MAOs) and Part D sponsors that they are 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 educational materials for seniors during Medicare’s annual open enrollment period and addresses concerns seniors have shared about involuntarily selecting Medicare plans that don’t better meet their needs. healthcare needs.

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

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

“The Medicare & You Handbook has improved over the years, but it still needs to share vital information about health plan options and supplemental health insurance,” he said.


The Medicare & You Handbook is the official handbook that guides current and new Medicare beneficiaries through the Medicare program. Published by CMS, the handbook is mailed to all Medicare households each fall and includes a summary of Medicare benefits, protections for patients, a list of available health and drug plans, and some frequently asked questions about Medicare.
In particular, it provides a comparison of Original Medicare and Medicare Advantage. While the manual has evolved over the years to be easier to read, it does not contain information on techniques to help MA plans control costs, the Senators said.

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

I would also ask CMS to include a description of the MA Plans’ network sizes in relation to the number of health care providers that accept Original Medicare; and an explanation that when seniors switch to an MA plan and then return to Original Medicare, they may be prohibited from purchasing supplemental coverage or have to pay significantly higher premiums.

The bill is meant to complement the Senior Citizens’ Timely Access to Care Improvement Act, legislation that aims to modernize Medicare Advantage and make health care delivery friendlier for patients and doctors. That bill, sponsored by Marshall and cosponsored by Hassan, has the support of 50 senators and more than 500 national and state organizations.

Hassan also joined colleagues in calling on the Biden administration to implement additional consumer protections in Medicare Advantage following a rise in reports of deceptive marketing practices targeting seniors in the program, joining to the New Hampshire Congressional Delegation to urge CMS to take action to protect those eligible. New Hampshire Medicare beneficiaries subjected to aggressive and potentially predatory marketing tactics related to the sale of Medicare Advantage plans or other insurance products.


CMS has reviewed thousands of complaints and hundreds of audio calls, and said it identified numerous problems related to television and newspaper ads, mail and Internet searches. The agency called the numbers associated with these ads in a “secret shopping” campaign aimed at monitoring these ads.

“Our undercover shopping activities have discovered that some agents were failing to comply with current regulation and undue pressure on beneficiaries, as well as failing to provide accurate or sufficient information to help a beneficiary make an informed enrollment decision,” Coleman wrote in October. .

CMS presented a number of recommended best practices for MAOs and Part D sponsors, including ensuring that beneficiaries know how to file a marketing complaint with 1-800-MEDICARE or the plan and that beneficiaries know that it is It is important to provide the name of an agent or broker, if possible.

He also suggested sponsors make sure all plan agents and marketing materials clearly state when certain benefits may not be available to all members.

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com

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