Federal lawmakers and activists are turning up the heat again with attacks on Medicare Advantage, a month after 300 members of Congress told the federal agency that oversees the system to make it easier to manage.
Prominent progressives such as Rep. Rosa DeLauro (D-CT) and Sen. Elizabeth Warren (D-MA), who blasted Medicare Advantage as being a “scam” by private insurers, headlined a press conference Tuesday in Washington. Numerous speakers derided the program and used the social media hashtag #reclaimMedicare to advocate bringing patients back under the banner of traditional Medicare.
Just over half of individuals eligible for Medicare are enrolled in Medicare Advantage plans, according to information released by the Centers for Medicare & Medicaid Services in May. In January, 30.2 million of the 59.8 million people who have Medicare Parts A and B were enrolled in private plans. That’s a massive increase from 2007, when just 19% of those eligible opted for Medicare Advantage.
“It is time to call out so-called Medicare Advantage for what it is,” DeLauro said. “It’s private insurance that profits by denying coverage and using the name of Medicare to trick our seniors.”
The program certainly needs improvement, a pair of experts told McKnight’s Long-Term Care News Wednesday.
Tyler Overstreet Cromer, head of ATI Advisory’s Medicare Innovation Practice, said CMS has strengthened marketing requirements “to tamp down on confusing or even deceiving ads about MA.”
“Successful implementation of these policies will be key steps to addressing these concerns,” Overstreet Cromer said. “Additionally, more can be done to provide clear information about what supplemental benefits are and are not so consumers can make more informed decisions. More data and transparency can be powerful tools to help consumers understand their benefit choices and tradeoffs between offerings like supplemental benefits and use of tools like prior authorization across their Medicare options.”
Prior authorization was a target of the letter from the nearly 300 Members of Congress. They wrote that it “remains an enormous burden on doctors’ practices and a threat to patient care. … Insurers continue to delay and even deny covering necessary care and overstep medical decision-making while increasing their profits.”
Legislation has been introduced in both the House and Senate to modernize the prior authorization process. Another bill from three House Democrats, called the “Save Medicare Act,” would prohibit private insurance companies from using the word “Medicare” in their plans.
Susie Mix, CEO of Mix Solutions, told McKnight’s that the most important thing lawmakers will learn after digging into MA is that seniors are not receiving the same or even better benefits than traditional Medicare plans would provide.
“[The] diversion of patients going home versus a SNF, and prior authorization debacles are just the beginning,” she said. “Looking further into the process, they will see that in many cases, these patient stays are being dictated by an algorithm made up by a group that has gathered data and fed it to a program.”
