As discussed in a previous CMA Alert (Aug. 22, 2022), the Centers for Medicare & Medicaid Services (CMS) published a Request for Information (RFI) that “seeks input from the public regarding various aspects of the Medicare Advantage program. Responses to this request for information may be used to inform potential future rulemaking or other policy development.” The RFI can be accessed from the Federal Register here. Comments were due August 31, 2022. The Center’s submitted comments are available here. In our previous Alert, we provided top-line sample comments, and encouraged Medicare stakeholders to weigh in.
Drafted in collaboration with some of our partners, the Center’s comments focused on a wide range of issues applicable to the Medicare Advantage (MA) program, ranging from how individuals with chronic conditions fare, prior authorization, network adequacy, MA marketing and more. The introduction to our comments states [citations omitted]:
The Center for Medicare Advocacy bases our policy work on our experience serving Medicare beneficiaries. While Medicare Advantage (MA) may work for many, we don’t hear from these individuals. Instead, we hear from beneficiaries – commonly those who are sicker and have greater health needs – who have been poorly served by their MA plan. Certainly, beneficiaries in traditional Medicare face barriers to coverage and care, which we devote much of our time addressing. However, from our experience assisting Medicare beneficiaries, and borne out by independent research, many of these barriers are exacerbated for beneficiaries enrolled in Medicare Advantage. We are better able to speak to MA deficiencies, than successes, and therefore target our comments primarily on the former.
On a systemic level, there is a growing imbalance between MA and the traditional Medicare program, including in payment – leading to significant, wasteful overspending – along with expansions in coverage under MA without similar expansions in traditional Medicare, and far more favorable enrollment opportunities into MA than other types of coverage. It will take Congressional intervention to truly right this ship, but there is much that CMS can and should do in this regard.
The universal, traditional Medicare program, preferred by most beneficiaries, has been neglected for years, while the private Medicare Advantage (MA) system has been repeatedly bolstered and promoted. Over the last several years, a number of legislative, regulatory, and policy changes have combined to create an imbalance between traditional Medicare and Medicare Advantage (MA). For example: coverage expansions such as the ability to provide new supplemental benefits were added for MA, but not for traditional Medicare; enrollment periods were changed to favor MA; and the scope of coverage by Medicare supplemental insurance policies (Medigaps) was restricted. Further, despite provisions of the Affordable Care Act that reined in excessive overpayments to MA plans, there is still evidence that MA is costing the Medicare program more than traditional Medicare spends per individual, with mixed health outcomes. We have offered policy recommendations to counter some of these issues over the years, and do so again here.
In recent testimony before Congress, the General Accounting Office (GAO) stated that “[d]ue to our concerns about the program’s susceptibility to mismanagement and improper payments as well as its size and complexity, we have designated Medicare, including Medicare Advantage, as a high-risk program. We—along with [OIG] and others—have identified significant concerns with CMS’s oversight of the MA program [citations omitted].”
Over the last several years, a number of unimplemented recommendations concerning improving and enhancing various aspects of MA oversight have been issued by the Office of Inspector General, the General Accounting Office and the Medicare Payment Advisory Commission – as well as consumer advocacy organizations.
As a growing number of Medicare beneficiaries enroll in MA plans, CMS must adjust its resources and staff accordingly, and enhance its oversight and enforcement of MA and MA plan sponsors.
We urge CMS to incorporate our recommendations for improving Medicare Advantage in future rulemaking and other policy.