Center for Medicare Advocacy

Advancing Access to Medicare and Healthcare

Medicare Works.
Medicare Advantage Wastes.

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What is Medicare? Medicare is the cherished national health program for older people and people with disabilities, which covers everyone eligible, anywhere in the country. Some consider it Real Medicare because private, for profit Medicare Advantage has not turned out to be an advantage for the Medicare program or many enrollees.

For many years, the Center for Medicare Advocacy has advocated for legislative and administrative efforts to address the growing inequities between Medicare and Medicare Advantage; inequities which have encouraged the growing privatization of the Medicare program. These inequities include:

  • Overpayments to MA plans that unnecessarily drive-up program spending, and further tip the scales away from traditional Medicare by luring enrollees with “extras” using these excess funds;
  • Unequal scope of covered benefits (e.g. dental, hearing, vision)
  • Unequal access to coverage options, primarily due to lack of access to Medigap plans, and
  • Lax oversight of MA plans which has led to decidedly mixed outcomes for MA enrollees, particular those who are or become seriously ill.

Private Medicare Advantage plans boast record profits while they undermine the entire Medicare program by unnecessarily raising program costs, while at the same time putting the most vulnerable beneficiaries at risk.

Unfortunately, despite years of work by the Center, policy makers are only beginning to acknowledge these issues, let alone act on them.

For more information about the differences between Medicare and Medicare Advantage, and about MA enrollment, see our Medicare Advantage information page.

A Decade Plus of CMA Coverage of MA Issues

Medicare Advantage Payment Rates for 2025 Released April 4, 2024

MA plans will still be significantly overpaid, even after these adjustments take effect.

Study Examines Health Equity Differences between Medicare and Medicare Advantage April 4, 2024

"MA plans’ care management strategies do not provide appropriate care to all patients"

Report on Improper Payments Shows Billions Wasted on Private Medicare Plans March 28, 2024

Both amounts are increases from 2022. And they only keep going up.

Medicare Program Cannot Afford Medicare Advantage “Stability” – Especially as New Study Shows Inferior Home Health Care Provided by MA Plans March 7, 2024

Industry's idea of MA "stability" is continued wasteful overpayments, despite documented poor coverage and outcomes.

Medicare Advantage Plans Under Scrutiny by Department of Justice and Office of Inspector General February 29, 2024

Medicare Advantage isn’t working for any group: the government, patients, taxpayers, and now even investors.

Medicare Advantage Proposed Payment for 2025 and Other Updates February 22, 2024

The Centers for Medicare & Medicaid Services (CMS) has issued proposed Medicare Advantage (MA) and Part D payment rates for 2025.  As discussed below, the insurance industry is already trying to pressure the agency to increase their payment in the final announcement.  In addition, there have been other recent MA policy developments, including a request ...

Medicare Program Proposes to Increase Medicare Advantage Payment for 2025 February 1, 2024

MA overpayments go up again, wasting billions.

As Medicare Advantage Enrollment Grows, So Does Awareness of Problems January 24, 2024

Much more action is required by both CMS and Congress to rein in out of control MA plans.

Medicare Advantage Industry Support Letter Circulating in Senate – Center for Medicare Advocacy Urges Senators Not to Sign On January 18, 2024

Instead of promoting “payment and policy stability” for insurance companies, ensure that all Medicare beneficiaries have access to the care they need.

Advocacy Tip for Medicare Advantage Enrollees Facing Difficulty Obtaining In-Network Care January 18, 2024

The Center regularly hears from MA enrollees and those who assist them that they are unable to obtain medically necessary care from an in-network provider.

Center for Medicare Advocacy Submits Comment on Proposed 2025 Medicare Advantage and Part D Rule January 11, 2024

While positive, there is room for more MA oversight .

Improving Medicare by Reining in Medicare Advantage Overpayments: Policy Options January 11, 2024

Legislative and academic proposals that could use recouped MA overpayments to expand Medicare.

Insurance Industry Group Issues Misleading Medicare Advantage Report December 7, 2023

Industry seems to think providing less care is a good thing.

Advocates Send Letter Regarding Misleading MA Advertising December 7, 2023

Advertising misleads those eligible for both Medicare & Medicaid

STAT News Report Further Exposes Medicare Advantage Misconduct Concerning Prior Authorization Using Restrictive Algorithmic Tools November 16, 2023

CMA has been trying to raise awareness of the inappropriate use of restrictive algorithmic software for years.

Medicare Advantage Focus: Drawbacks During Annual Enrollment Period November 2, 2023

Finally, an increase in news coverage about Medicare, Medicare Advantage, and needed improvements that is more objective, and neutral.

Center Testimony for Senate Hearing on MA Marketing November 1, 2023

There are many things that Congress and the Centers for Medicare & Medicaid Services (CMS) can and should do to address Medicare Advantage problems.

Senate Finance Committee Holds Hearing on Medicare Advantage Marketing Misconduct October 19, 2023

Addressing the many issues brought up at the hearing is a start, but more is needed. We hope this is the first in many oversight hearings leading to meaningful change in Medicare Advantage rules and financing.

Connecticut Medicare Advantage Plans Announce Changes for 2024 October 12, 2023

Insurers offering MA plans focus on easy-to-provide “additional” benefits. We encourage beneficiaries to look carefully at all their coverage options.

Counterweight to Medicare Advantage Marketing Still Needed October 5, 2023

Materials from the Medicare program itself should be straightforward and unbiased in their presentation of Medicare coverage options.

New Study – Medicare Advantage Overpayments as High as $140 Billion a Year October 5, 2023

The amount of overpayments, if not wasted on private MA plans, could eliminate Medicare Part B premiums or fully fund Part D, and more.

Look Before You Leap: Medicare Annual Enrollment Period Approaches September 28, 2023

Many challenges are faced by Medicare beneficiaries who are trying to navigate the Medicare coverage landscape. Look before you leap.

Medicare Advantage Plans Receive Bloated Bonus Payments with Little to Show for It August 24, 2023

Bonus payments don't mean better care, and ratings systems are flawed and inaccurate.

Growing Chorus to Protect and Expand Traditional Medicare August 24, 2023

25 sitting members of Congress advocating for traditional Medicare.

Policymakers Must Address Medicare Advantage Abuses August 3, 2023

Medicare Advantage plans are overpaid and abuse the prior authorization and coverage determination process. It is getting harder for policymakers to ignore these issues. 

Highlighting the Harms of Medicare Advantage: Advocates and Members of Congress Rally to Support Real Medicare July 27, 2023

The Center has long called for reforms to Medicare Advantage and is proud to partner with organizations like Be A Hero to help raise awareness of the problems with private Medicare Advantage.

Media Advisory: Medicare Advantage Patients and Families Join Members of Congress to Call for an End to Wrongful Delays and Denials July 20, 2023

The Call for an End to Wrongful Medicare Advantage Delays and Denials takes place in Washington, D.C.. on Tuesday July 25th, 4:30 pm Eastern at the House Triangle,

Ongoing Scrutiny of Medicare Advantage Plans July 13, 2023

Overpayments to MA plans now exceed $75 billion annually, and access to care problems, including inappropriate use of prior authorization, are widespread.

New Research Outlines Extent of Medicare Advantage Overpayments: It’s Much Worse Than We Thought June 22, 2023

"Overpayments to Medicare Advantage plans now exceed 20% or $75 billion annually, underscoring the urgent need for reform.”

CMS Report Highlights Quality of Care Concerns in MA June 22, 2023

Dually eligible beneficiaries with disabilities fare worse on several quality measures, and inequities exist among all duals compared to non-duals.

Senate Committee Holds Hearing re: Medicare Advantage Denials and Delays in Care May 18, 2023

Senate hearing, House Committee presses major insurer, Ady Barkan on the harms of privatized Medicare, and more.

Medicare Advantage Enrollment Passes 50%: Much More Oversight and Accountability Is Needed May 11, 2023

Recent measures fall far short of stemming the flow of billions of dollars in annual wasted payments.

Special Report | Recent Medicare Advantage (MA) and Part D Rule – Important Consumer Protections re: MA Prior Authorization and Marketing May 4, 2023

Rule includes improvements to prior authorization process and consumer protections re: marketing.

Be A Hero Joins the Fight for a Strong Traditional Medicare Program April 27, 2023

Be a Hero is concerned about the various problems with, and costs of, private Medicare Advantage (MA) plans.

CMS Issues Final Medicare Advantage Payment Rates for 2024 and Final Rule Addressing Prior Authorization, Marketing, and Other Issues April 6, 2023

Delayed and limited efforts to rein in MA overpayments aren't enough.

Medicare Advantage: It’s Not “Over-reach” – It’s Fraud March 30, 2023

It’s high time that this over-reach of private Medicare Advantage plans is called what it is: Fraud. 

Medicare Advantage Under Increased Scrutiny Pending Final Payment and Oversight Rules March 23, 2023

Insurance industry continues to fight against efforts to increase oversight and rein in their overpayments.

Barriers to Care for Medicare Advantage Enrollees Highlighted even as Insurance Industry Continues Effort to Retain Their Overpayments March 16, 2023

What have Medicare Advantage enrollees – and the public – gotten in return for wasteful overpayments to MA plans? More restrictive coverage and care.

New Campaign: Finalize Proposed MA Payment Changes & Crack Down on Waste and Abuse March 16, 2023

Remind Members of Congress and the Administration that insurance companies are abusing Medicare Advantage by overcharging seniors and taxpayers by billions of dollars each year.

Medicare Advantage Industry Continues to Fight Minor, Overdue Course Corrections March 9, 2023

Minor MA changes are long-overdue and good for Medicare and those who need it, but the industry continues to lie about them and fight them.

Medicare Advantage Industry Continues to Mislead Public to Protect Their Overpayments March 2, 2023

MA industry calls 1.03% pay raise a “cut” and threatens enrollees in scare tactics to get more.

70 Members of Congress Call for Medicare Advantage Reforms, Including Reining in Overpayments February 16, 2023

We applaud these members of Congress for standing up for all Medicare beneficiaries who would helped by these reforms.

Center for Medicare Advocacy Comments on Proposed Part C & D Rule February 16, 2023

After years of administrations letting the MA program do as it will, we applaud the proposals in this rule,

Insurance Industry Response to Proposed Medicare Advantage Payment for 2024 February 16, 2023

Proposed Medicare Advantage Payment Rates for 2024 are actually a smaller RAISE, not even close to a cut.

Traditional Medicare or Medicare Advantage? February 9, 2023

Don't just be tempted by minor extras - think about overall needs - and remember what "Insurance" means.

Medicare Advantage Updates – Audits, Payment, and Prior Authorization February 9, 2023

CMS is finally addressing overpayments to private plans, denials by prior authorization, and more.

Center for Medicare Advocacy Statement on Recent Medicare Advantage Payment Policies and Proposals February 3, 2023

While steps taken to increase MA oversight are encouraging, the Administration must hold fast, and Congress should act to stop wasteful overspending.

Medicare Advantage Round-Up December 15, 2022

MA Issues finally seem to be getting more attention in the media and independent reports. We urge policymakers to respond.

CMS Issues Proposed Rules Impacting Medicare Advantage – Part C & D Rule for 2024, and Separate Prior Authorization Rule December 15, 2022

Rules address several advocate concerns, but there is more work to do.

Medicare Annual Enrollment Period Ends December 7th December 1, 2022

Medicare Annual Enrollment ends soon, but there are still chances to get out of an MA plan.

Disputes with Medicare Advantage Plans: Know the Difference Between Appeals and Grievances November 17, 2022

Knowing the difference between these two ways of raising issues with your plan is key to safeguarding your Medicare rights.

Sale of “Ancillary Products” to Fill Gaps in Medicare Advantage Highlight Both Coverage Shortfalls and Need for Stronger Regulation of the MA Marketplace November 17, 2022

An overhaul of Medicare Advantage marketing rules, among other things, is urgently needed.

Senate Report Highlights Widespread Medicare Advantage Marketing Misconduct – But the Driving Forces of Misconduct Are Broader November 10, 2022

The onslaught of Medicare Advantage marketing, and the legions of agents and brokers incentivized by commissions, bonuses and other rewards, must be addressed.

Special Report | Recent Articles and Reports Shed Light on Medicare Advantage Issues October 31, 2022

Fraud and overpayments to Medicare Advantage clearly drain public funds, but is there political will to address the problem?

Recent Articles Address Medicare Advantage Overpayments and Inappropriate Denials October 13, 2022

"Medicare Advantage" wastes Medicare money and limits care through repeated, harassing denials. It's not an advantage.

“Medicare & You” Continues to Reverse Bias Towards, and More Accurately Describe, Medicare Advantage September 28, 2022

Medicare & You handbook continues to improve, but there's room for more.

Kaiser Family Foundation Releases Report Regarding Differences Between Traditional Medicare and Medicare Advantage September 21, 2022

MA is touted as "better" than Medicare, but it costs us all more, and offers no true "Advantage."

Center for Medicare Advocacy Submits Comments re: Medicare Advantage September 1, 2022

Barriers to care are even worse for those in MA. CMS must increase oversight and enforcement.

New from the Center: Form to Contest Multiple Medicare Denials Issued by Medicare Advantage Plans August 25, 2022

MA plan issuing repeated, frequent non-coverage notices despite the need for care? File a Grievance with this new form.

Medicare Agency is Seeking Comments on Medicare Advantage August 22, 2022

On August 1, 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 ...

Report: Nursing Home MA Issues Survey August 18, 2022

CT Nursing homes report having consistent issues with Medicare Advantage plan denials and delays.

NEJM Perspective: ACO REACH – A Progressive Value-Based Payment Model, Promoting Equity July 21, 2022

While the effectiveness of ACO REACH remains to be seen, maintaining equity should be a central policy goal.

Voices of Medicare | Medicare Advantage Network Inadequacy July 7, 2022

Enrollees should be assured that all MA plans have adequate provider networks, as is the case with traditional Medicare.

Call to Action – Policy Makers Must Increase Medicare Advantage Oversight and Rein in Overpayments May 5, 2022

Five related articles focusing on MA inequities, denials, oversight, waste and more.

Medicare Advantage is Not the Solution to Medicare Equity or Solvency Problems May 5, 2022

Medicare Advantage is essentially good for Medicare Advantage plans but too often not for beneficiaries.

Office of Inspector General (OIG) Issues Another Report Highlighting Inappropriate Medicare Advantage Denials May 5, 2022

Prior authorization and other utilization management tools are barriers to care that MA enrollees are often unaware of until they need to access services.

Insurance Industry v. Provider Response to OIG Report re: MA Denials May 5, 2022

Industry tries to downplay, discredit, and otherwise deflect from damning OIG report, but providers and provider groups concur with findings.

OIG Report Estimates of Inappropriate MA Plan Denials May be Understated May 5, 2022

MA plans routinely deny care that should be covered under Medicare law.

(Most) Policymakers Fail to Act on Medicare Advantage Oversight and Overpayment May 5, 2022

Address the growing inequities between Medicare Advantage (MA) and traditional Medicare that favor MA, and encourage the growing privatization of the Medicare program, to the detriment of those who rely on it.

Government Watchdog Issues Another Report Highlighting Inappropriate Medicare Advantage Denials April 28, 2022

Evidence of ‘widespread and persistent problems related to inappropriate denials of services and payment."

When Artificial Intelligence in Medicare Advantage Impedes Access to Care: A Case Study April 21, 2022

MA plans are using proprietary, algorithm-driven systems to make decisions about approving coverage for services, causing mass denials.

Members of Congress Send Letter to CMS Urging Agency to Address Medicare Advantage Overpayments April 21, 2022

“Medicare Advantage has failed to achieve savings in any year since its inception”... “axpayers and Traditional Medicare beneficiaries are subsidizing the surplus profits of Medicare Advantage plans,” says congressional letter.

Commonwealth Fund Blog Series About Medicare Advantage April 7, 2022

Posts touch on many issues that the Center for Medicare Advocacy has been highlighting,

A Special Alert about Medicare’s Future | Don’t Let Traditional Medicare “Wither on the Vine*” March 31, 2022

Address the growing imbalance between Medicare Advantage and traditional Medicare before the wasteful, private Medicare plans devour the bedrock Traditional Medicare program.

Medicare Advantage Plans Pitch to People Turning 65 March 17, 2022

Insurance companies, brokers, eager to sell MA policies because MA is so profitable for them.

Recent Solicitation Scams Target Medicare-Eligible Adults March 17, 2022

Heads up - Increase in phone and email solicitations targeting Medicare-eligible adults.

CMS Needs to Rein in Medicare Advantage Overpayments and Heighten Oversight of Insurance Industry March 10, 2022

CMS fails to use their discretion to address wasteful Medicare Advantage (MA) overpayments, or increase oversight of MA plans.

House GOP Accuses Dems of Trying to Rein in Medicare Advantage Overpayments in Order to Expand Benefits to All Medicare Beneficiaries: If Only This Were True… March 3, 2022

Despite the potential insolvency of the Part A Trust Fund, both parties continue to ignore their obligation to address Medicare Advantage overpayment.

CMS Releases Proposed 2023 Rule for Medicare Advantage and Part D Plans January 13, 2022

A number of provisions will considerably help consumers, but, in other ways, the proposed rule falls short of providing needed protections.

Reminder: Limited Opportunity to Make Certain Medicare Plan Changes Through the End of March January 6, 2022

Medicare Advantage Open Enrollment Period runs through March 31st.

Study Published in Health Affairs Finds that Medicare Advantage Quality Bonus Program Has Not Improved Quality January 6, 2022

Higher star ratings correlate with increased beneficiary enrollment, but they did not improve quality of care.

New Analysis Provides More Evidence of Wasteful Medicare Advantage Overpayments November 18, 2021

Medicare overpaid the private health plans by more than $106 billion from 2010 through 2019.

Landscape of Medicare Advantage (MA) and Part D Plans in 2022 November 11, 2021

Millions face cost increases if they stay in current plans.

As the Medicare Annual Enrollment Period Progresses, Beware of Marketing Misconduct November 11, 2021

Warnings about general agent and broker conduct, misleading TV advertisements, educational vs. marketing events , and potential recourse.

New Issue Brief | Retiree Auto Enrollment in Medicare Advantage Plans – Choice is Under Threat October 14, 2021

The Center for Medicare Advocacy has heard from numerous dissatisfied beneficiaries faced with automatic enrollment by former employers in private MA plans that done meet their needs.

Special Report | Medicare Annual Enrollment Period Starts Tomorrow – Look Before You Leap October 14, 2021

Most people on Medicare don't bother checking plans each year, and for those who do, the means of comparison are often flawed.

Health Affairs Blog Highlight How the Medicare “Money Machine” Draws Medicare Advantage Plans and Investors into Direct Contracting Demonstrations October 7, 2021

The MA program is “fundamentally flawed,” including risk-adjustment scoring and structural overpayments.

CMS Releases Private Medicare Rates – Choose Your Coverage Wisely September 30, 2021

People with Medicare should carefully examine their coverage choices each year to decide on the options that best meet their health needs.

New Research Raises Questions About Medicare Advantage Payments September 23, 2021

Private Medicare Advantage plan sponsors game the system at the cost of taxpayer money.

MEDICARE & YOU 2022 – An Important First Step Towards Reversing Bias in Favor of Medicare Advantage September 20, 2021

While there is still work to do, the new Handbook makes important strides towards reversing the bias in favor of MA that was prevalent in recent editions.

Medicare is at a Crossroads – Time to Dispel Myths Hindering an Historic Expansion of Benefits September 2, 2021

We clear up the myths and falsehoods being circulated by opponents of historic Medicare improvements.

Report Examines High Spending on Medicare Advantage Plans August 19, 2021

The privatized Medicare Advantage program has never generated savings relative to traditional Medicare. In fact, the opposite is true.

Medicare Advantage Costs and Coverage Concerns August 12, 2021

MA promises of saving taxpayer money have utterly failed, and often with worse coverage and care.

Kaiser Family Foundation Issues Report Comparing Cost-Related Problems for Medicare Advantage Enrollees and Beneficiaries in Traditional Medicare July 8, 2021

CMS must exert greater oversight of the Medicare Advantage program.

Reminder: Medicare Advantage Open Enrollment Period Ends March 31st March 25, 2021

MA enrollees can still switch MA plans or go from an MA plan to traditional Medicare with a Part D plan until next next week.

Policy-Makers Should Review Overpayments to Medicare Advantage when Considering Medicare Fiscal Solvency March 18, 2021

Medicare payments are higher for MA enrollees than the program would spend for similar beneficiaries in traditional Medicare.

Medicare and the Dilemma of “Choice” March 11, 2021

Choice in Medicare can be both burdensome and unequal.

Final 2022 Rule for Medicare Parts C and D Released By Trump Administration February 4, 2021

Rather than focus on plan sponsor “burden,” CMS should focus on consumer education and access to care.

Medicare’s Annual Enrollment Season Enters Final Weeks: Few People Compare Options, and the Means of Comparison are Often Flawed November 19, 2020

Most Medicare beneficiaries do not use the market-based system of Medicare Advantage and Part D plan selection as intended.

MA Plans Allowed to Report Less Data about Appeals Outcomes October 1, 2020

CMS rolls back beneficiary protection in the name of reducing “MA plan burden."

Final Rule for Medicare Parts C and D Includes Weakened Standards for Medicare Advantage Networks May 28, 2020

On May 22, 2020, the Centers for Medicare & Medicaid Services (CMS) published a final rule regarding Medicare Advantage (Medicare Part C) and Part D prescription drug plans (“C & D Rule”). The rule is entitled “Medicare Program; Contract Year 2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, ...

Case Study: Medicare Advantage and Repeated Coverage Denials Amid the COVID Crisis May 14, 2020

  Mr. A, is a retired professor from a state university. He was auto-enrolled in his state’s retiree Medicare Advantage (MA) plan. The plan prospectus states that it covers an unlimited number of days in a skilled nursing facility (SNF). An active 73-year old, Mr. A went to his primary care doctor because he was experiencing some ...

Medicare Trustees Report: Projections Similar to Last Year, and Savings Are Available April 30, 2020

On April 22, 2020, the Medicare and Social Security Trustees released their 2020 annual report, which offers projections concerning the fiscal health of the Medicare and Social Security programs.  The Medicare Trustees estimate that the Part A Trust Fund will be depleted by 2026, unchanged from last year’s projection. As noted in a summary issued by ...

Center for Medicare Advocacy Submits Comments on Proposed Medicare Parts C and D Rule April 9, 2020

On February 18, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule entitled Medicare and Medicaid Programs; Contract Year 2021 and 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4190-P). The ...

Reminder: Medicare Advantage Enrollment Period Ends this Month; Ongoing Opportunity for Special Enrollment Period March 12, 2020

Medicare Advantage Open Enrollment Period (MA-OEP) Effective 2019, for the first 3 months of the calendar year there is a continuous open enrollment and disenrollment period relating to Medicare Advantage (MA) plans called the Medicare Advantage Open Enrollment Period, or MA-OEP. This opportunity is only available to individuals who are enrolled in an MA plan as ...

The Myth of “Choice” in Private Insurance, Including Medicare Advantage March 5, 2020

Policy makers often promote the concept of “choice” as a key pillar of health care and insurance, including within the Medicare program. The importance and availability of “choice” becomes less clear, however, the closer one examines what choice actually means with respect to health insurance coverage – including in the Medicare program. Wendell Potter’s New York ...

Articles Highlight Medicare Advantage Concerns February 27, 2020

MA Limitations, Favoritism, and Quality & Access Issues – New York Times A recent article in the New York Times highlights a number of concerns about the Medicare Advantage (MA) program, many of which have been raised by the Center for Medicare Advocacy.  The concerns include the growing imbalance between MA and traditional Medicare, the limitations ...

Medicare Advantage Continues to Drive Up Medicare Costs – Congress Must Act to Level the Playing Field with Traditional Medicare February 4, 2020

The Center for Medicare Advocacy has long advocated for leveling the playing field between Medicare Advantage (MA) and traditional Medicare. Over the last several years, however, legislative and regulatory policy changes have continued to tip the scales in favor of MA over traditional Medicare. Such efforts include the as-yet-unimplemented Executive Order issued by President Trump ...

Medicare Advantage Marketing Matters: Case Study January 16, 2020

Mr. G, a retired professional, is a Medicare beneficiary in his 80s with advanced Parkinson’s disease who experienced a bad fall at home. He was hospitalized and then went to a skilled nursing facility for rehabilitation. Mr. G has always had original Medicare along with a stand-alone Part D plan and a Medicare supplemental (“Medigap”) ...

Government Watchdog Agency Once Again Finds Wasteful Medicare Advantage Overpayment December 20, 2019

The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) recently released a report entitled “Billions in Estimated Medicare Advantage Payments From Chart Reviews Raise Concerns”. The report highlights that in the current risk adjusted payment system that is meant to provide Medicare Advantage (MA) plans with higher payment for sicker ...

Wasting Time Waiting for Prior Authorization – At What Physical and Emotional Cost? December 5, 2019

Mr. Sullivan had been experiencing involuntary hand tremors, muscle weakness and cramping, tripping and balance problems, and occasional slurring of his speech. He thought these symptoms were the result of overwork and fatigue. But rather than improving over time, his symptoms worsened in intensity and became more frequent. He and his wife were increasingly alarmed ...

Family History of Colon Cancer Should Increase the Frequency of Colonoscopies, but Ultimately the MA Plan, Not the Treating Doctor, May Determine When Procedures Will Occur November 21, 2019

Ms. McNeil has a family history of colon cancer that is well known to her doctors. Her mother’s father died of colon cancer at age 52, her father died of colon cancer at 76. Ms. McNeil and all of her siblings have had pre-cancerous polyps removed during each of multiple colonoscopies over the years. Because ...

MA Plan Prior Authorization Requirements Cause Problems in a Skilled Nursing Facility (SNF) Leading to Patient Re-Hospitalizations November 14, 2019

The SNF referenced here is a highly rated, privately owned, non-profit facility with almost 100 beds. The SNF serves traditional Medicare patients for an average of 14 to 21 days per admission. Typically, as long as the SNF documents that a patient has received necessary daily skilled care in the SNF after at least a ...

Medicare is Being Privatized. Where is the Outcry? November 14, 2019

For years, the Center for Medicare Advocacy has warned of wasteful overspending on private Medicare Advantage (MA) plans, the limitations on access to physicians and health care provided by MA, and the difficulties in obtaining the same coverage from the plans as is available in real Medicare. (See Case Study below.) Despite these efforts, Medicare Advantage ...

Medicare Enrollment Problems Persist November 7, 2019

Problems with Medicare Plan Finder Persist As reported by SHIPs across the country and some of our partner organizations, problems with the new Medicare Plan Finder (MPF) persist during the current Medicare Annual Election Period, which lasts through December 7, 2019. These problems include: inaccurate information about covered drugs and costs, non-formulary drugs, dosage options, copays ...

Medicare Enrollment and Medicare Advantage Updates October 24, 2019

On October 22, the Center for Medicare Advocacy and the National Committee to Preserve Social Security and Medicare launched the second annual Medicare Fully Informed Project, with a variety of unbiased, accurate, up-to-date, and comprehensive information about the full range of Medicare coverage options. The Medicare Fully Informed Project includes an array of tools to ...

Medicare Fully Informed Project October 21, 2019

Providing Medicare Beneficiaries with Complete, Objective Information to Help Them Make the Best Enrollment DecisionThe Center for Medicare Advocacy and the National Committee to Preserve Social Security and Medicare partnered on an education and outreach project to support Medicare beneficiaries and those who assist them enroll and re-enroll in Medicare. The Medicare Fully Informed Project ...

Center for Medicare Advocacy Analysis of President’s Medicare Executive Order: October 10, 2019

Among Vague Language and Proposals, Real Harm to Medicare Beneficiaries On October 3, 2019, President Trump issued his “Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors” (EO). Much of the language of the EO is vague, and much is unknown about what polices might emerge from it. Some of the proposals are clear ...

Connecticut Congressional Delegation Concerned about Medicare Advantage Network Provider Terminations in the State October 3, 2019

As noted in a press release issued by Rep. Rosa DeLauro’s office, on September 30, 2019, members of Connecticut’s congressional delegation sent a letter to the President of Anthem Blue Cross Blue Shield to “express our concern regarding the recently announced provider terminations from Anthem Blue Cross and Blue Shield’s (Anthem) Medicare Advantage (MA) network ...

Senator Brown Leads Call for Better Oversight of Medicare Advantage Plans September 19, 2019

Senator Sherrod Brown (D-OH) recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, urging the Administration “to be better stewards of taxpayer dollars and conduct sufficient oversight of Medicare Advantage plans, to ensure they are appropriately managing the health care needs of older Americans and people with disabilities” ...

Medicare Platform: Objective Information and Consumer Protections Face Challenges September 5, 2019

At the beginning of the current session of Congress, the Center for Medicare Advocacy laid out a Medicare Platform for the New Congress to guide improvements to Medicare and possible expansion of the Medicare-covered population. One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to preserve ...

Advocates Issue Joint Letter Raising Alarms about New Medicare Plan Finder and Revisions to MA and Part D Marketing Guidelines August 29, 2019

On August 27, 2019, the same day that the Centers for Medicare and Medicaid Services (CMS) debuted the updated Medicare Plan Finder (MPF) tool, four beneficiary advocacy organizations – the Center for Medicare Advocacy, Justice in Aging, Medicare Rights Center, and the National Council on Aging – sent a joint letter to CMS raising concerns ...

Support Traditional Medicare by Leveling the Playing Field with Medicare Advantage August 15, 2019

The Center has previously written about how legislative and regulatory policy changes are tipping the scales in favor of Medicare Advantage (MA) over traditional Medicare. For example, coverage expansions such as the ability to provide new supplemental benefits have been advanced in MA but not in traditional Medicare. In recent years, this has been exacerbated ...

Private Medicare Advantage Plans Overbill Medicare July 25, 2019

This week the CT Mirror published a Kaiser Health News article about overpayments to private Medicare plans. The article, originally titled “Insurers Running Medicare Advantage Plans Overbill Taxpayers By Billions As Feds Struggle To Stop It” underscores the need for improved oversight and enforcement of Medicare Advantage plans. According to the Kaiser Health News article, MA ...

Report Highlights Overpayments to Medicare Advantage Plans and Raises Important Policy Considerations May 23, 2019

The Kaiser Family Foundation (KFF) recently released a report entitled “Do People Who Sign Up for Medicare Advantage Plans Have Lower Medicare Spending?” (May 2019). As summarized in the report, “Even after risk adjustment, the results indicate that beneficiaries who choose Medicare Advantage have lower Medicare spending – before they enroll in Medicare Advantage plans – than similar beneficiaries who ...

Article Raises Concerns about Medicare Advantage and Calls Attention to Limited Medigap Access April 25, 2019

A recent Bloomberg News article highlighted an important issue for Medicare beneficiaries: limited access to Medigap plans. The Center for Medicare Advocacy has long advocated for improved access to Medigap plans for all Medicare beneficiaries. Medigap plans are private plans that provide supplemental health insurance for beneficiaries in Traditional Medicare to assist with out-of-pocket medical expenses, ...

The Growing Disparity Between Medicare Advantage and Traditional Medicare: CMS Publishes Final MA Telehealth Benefit Rule April 18, 2019

The Centers for Medicare & Medicaid Services (CMS) published a Final Rule this week implementing provisions of the Bipartisan Budget Act of 2018. As detailed in this Rule, Medicare Advantage (MA) plans will be allowed to offer telehealth services as a basic benefit starting in 2020. The Rule limits this telehealth benefit to services available ...

Medicare Advantage Case Spotlight March 14, 2019

The son of a hospitalized patient recently called the Center for Medicare Advocacy. His father was ready for discharge. Physicians at both the hospital and the inpatient rehabilitation hospital (IRH) agreed that the patient would benefit from IRH services. However, the patient’s Medicare Advantage (MA) plan refused to authorize IRH care.  The plan instead said ...

Center for Medicare Advocacy Submits Comments to CMS’ Draft 2020 Call Letter for Medicare Advantage and Part D March 7, 2019

On January 30, 2019, the Centers for Medicare & Medicaid Services (CMS) issued Part II of its draft 2020 Call Letter, an annual set of proposed rules, guidelines and clarifications for Part C Medicare Advantage (MA) and Part D plans that want to participate in Medicare in the following calendar year. In collaboration with several ...

Improve and Expand Medicare: CMS Should Provide Objective Information About Medicare Options February 14, 2019

Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to preserve and expand consumer protections and quality coverage for all Medicare Beneficiaries – including parity between traditional Medicare and private Medicare ...

Improve and Expand Medicare: Create Parity Between Medicare Advantage and Traditional Medicare February 7, 2019

Recently, the Center for Medicare Advocacy laid out our Medicare Platform for the New Congress. One of the core considerations to improve Medicare for all beneficiaries, now and in the future, is the need to preserve and expand consumer protections and quality coverage for all Medicare Beneficiaries – including parity between traditional Medicare and private Medicare ...

Center Submits Comments on Proposed Medicare Prescription Drug Rule January 31, 2019

The Center for Medicare Advocacy recently submitted comments to a Notice of Proposed Rulemaking issued by the Centers for Medicare & Medicaid Services (CMS) entitled “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses” (CMS-4180-P).  The Center’s comments are available at: https://www.medicareadvocacy.org/center-comments-on-modernizing-part-d-and-medicare-advantage/.   Currently, Part D prescription drug plans (PDPs) and ...

Today Ends the Medicare Annual Enrollment Period; Does it Begin a New Private Era for Medicare? December 7, 2018

As reported widely, including in The New York Times, and HHS Secretary Azar says he sees Medicare Advantage as the future of Medicare: ...

In Her Own Words: A Beneficiary’s Take On Medicare Advantage Steering December 6, 2018

Dear CMA, I am a retiree and my health plan is Medicare. I am retired 13 years and never have had any problem with my Medicare coverage. Most of my doctors accept Medicare and I have been very pleased with their services. I have become increasingly troubled by the targeted ads to seniors on TV telling viewers ...

Amidst Medicare Open Enrollment, CMS Reports High Rates of Inaccuracy in Medicare Advantage Provider Directories December 6, 2018

The Medicare Annual Coordinated Election Period (ACEP) is the most crucial time of year for Medicare beneficiaries to make decisions about how they wish to receive their Medicare coverage.  This year the Administration seems to be actively promoting Medicare Advantage plans. However, at the same time that this steering toward private plans is occurring, the ...

As Medicare Enrollment Period Draws to a Close, MA Steering Continues – Advocates & Members of Congress Write Letters of Concern to CMS November 30, 2018

As we approach the final week of the Medicare Annual Coordinated Election Period (ACEP), individuals continue to make decisions about how they want to access their Medicare benefits in 2019.  Consumer advocates are concerned, however, that the information put out by the Medicare program about coverage options is incomplete and continues to promote one option ...

Important Health Policy Article Published In New England Journal of Medicine: “Medicare Advantage Checkup” November 29, 2018

The November 2018 New England Journal of Medicine features a article by KFF’s Tricia Neuman and Gretchen Jacobson of the Kaiser Family Foundation (KFF) that “examine the extent to which Medicare Advantage plans are achieving goals with respect to benefits, out-of-pocket costs, plan choice, federal spending and quality. They also highlight areas where more evidence ...

Government Watchdog Agency Raises Concerns About Medicare Advantage Denials October 18, 2018

The Department of Health and Human Services (DHHS) Office of Inspector General (OIG) recently issued a report entitled “Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and Payment Denials” (OEI-09-16-00410) (see summary and full report). Among the report’s findings are that when beneficiaries and providers appealed preauthorization and payment denials, MA plans “overturned ...

Court Ruling May Lead to Even More Overpayments to Medicare Advantage September 13, 2018

As reported in FierceHealthcare, “Medicare Advantage insurers scored a significant legal victory” when a U.S. District Court judge recently “struck down a 2014 rule requiring to report and return overpayments.”  Further, according to Modern Healthcare, this ruling “leaves the federal government with fewer tools to combat upcoding practices that cost the taxpayer-funded Medicare program ...

Studies Differ Regarding Traditional Medicare and Medicare Advantage July 12, 2018

Researchers studying patients with hip fractures found that patients with Medicare Advantage (MA) plans have shorter stays in skilled nursing facilities (SNFs) and receive less rehabilitation than patients in traditional Medicare, but are, nevertheless, less likely to be readmitted to an acute care hospital within 30 days or to become long-term care residents.  These findings ...

Tipping the Scales Toward Medicare Advantage (at the Expense of Medicare) June 21, 2018

Ranking Committee Members Echo Advocates’ Complaints to CMS about Draft 2019 Medicare & You As discussed in a previous CMA Alert, the Center for Medicare Advocacy, Justice in Aging and the Medicare Rights Center recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) raising “strong objections to serious inaccuracies” in the draft ...

Advocates Raise Concerns About Inaccuracies and Bias in Draft MEDICARE & YOU Handbook May 31, 2018

The Center for Medicare Advocacy, Justice in Aging and the Medicare Rights Center recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) raising “strong objections to serious inaccuracies” in the draft 2019 Medicare & You Handbook, and urged CMS to rectify the errors prior to dissemination.  As stated in a joint press ...

Center for Medicare Advocacy Submits Comments on New CMS Medicare Marketing May 3, 2018

On April 26, 2018, the Center for Medicare Advocacy provided comments to the Centers for Medicare & Medicaid Services (CMS) in response to an April 12, 2018  Request for Input on the 2019 Medicare Communications and Marketing Guidelines (MMG).  Unlike previous opportunities to provide comment, CMS did not offer draft language for revisions to the ...

Tipping the Scales Toward Medicare Advantage March 21, 2018

Part C of the Medicare program, also known as Medicare Advantage (MA), is an option available to Medicare beneficiaries who wish to receive their benefits through private insurance companies, primarily HMOs.  In 2017, more than 19 million Medicare beneficiaries (33%) were enrolled in MA plans.  MA enrollment is projected to continue to grow, rising to ...

Center for Medicare Advocacy Submits Comments to CMS’ Draft 2019 Call Letter for Medicare Advantage and Part D March 8, 2018

On February 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued its draft 2019 Call Letter, an annual set of proposed rules, guidelines and clarifications for Part C Medicare Advantage (MA) and Part D plans that wish to participate in Medicare in the following calendar year.  In collaboration with several other advocacy organizations, ...

JAMA Calls for Release of Medicare Advantage Data – A Full Review of MA is Long Overdue March 8, 2018

The Journal of the American Medical Association (JAMA), recently published a Viewpoint article entitled “Time to Release Medicare Advantage Claims Data” by Niall Brennan, Charles Ornstein, and Austin B. Frakt (February 19, 2018).  After pointing out that almost 33% of the Medicare population is enrolled in Medicare Advantage (MA) plans at a cost of over $200 billion a year, ...

Medicare Advantage Enrollees Have Fewer SNF Options than Traditional Medicare Beneficiaries January 24, 2018

“Medicare Advantage Enrollees More Likely to Enter Lower-Quality Nursing Homes Compared to Fee-For-Service Enrollees,” a report recently published by Health Affairs, examines the quality of skilled nursing facilities (SNFs) used by Medicare Advantage (MA) enrollees and traditional Medicare beneficiaries. As the title indicates, the authors of the report found that traditional Medicare beneficiaries “tended to ...

Alert – Tax Cut Harm Just Got Worse; This Week in Sabotage; CMS Pushing MA Plans; SNF Deregulation November 15, 2017

Tax Cut Bill Just Got Worse. Health Care at Risk. This Week in Sabotage CMS Steering to Medicare Advantage Administration And Nursing Home Industry: Lockstep in Deregulating Nursing Facilities & Reducing Resident ProtectionsTax Cut Bill Just Got Worse.  Health Care at Risk.Free Webinar Series Next Webinar: Hospital Observation Status Update January 24, 2018 3:00 p.m. ET  Presenters: Center for Medicare Advocacy Litigation Director, attorney ...

CMA Alert – Remember You CAN Choose Original Medicare; Equitable Relief; This Week’s Sabotage News October 25, 2017

You Can Choose Original Medicare: CMS Over-Emphasizes Private Medicare Advantage Plans in Open Enrollment Roll-Out CMS Extends Equitable Relief  CMA Joins 30 Organizations in Amicus Brief in Support of Court Challenge to Trump ACA Sabotage And THIS Week in ACA Sabotage…Auto-Enrollment… And No Time to Switch More Repeal Disguised as ReformYou Can Choose Original Medicare: CMS Over-Emphasizes Private Medicare Advantage ...

CMA Alert – Critical Issue Roundup: MA Overpayment; HH Payment; Observation; More August 16, 2017

Former CMS Administrator Comments on Medicare Advantage Overpayments Proposed Home Health Rules – Payments Drive Delivery of Care, Harming Beneficiaries Observation Status Harms Low-Income Medicare Beneficiaries Poll: Americans Favor Making the ACA WorkFormer CMS Administrator Comments on Medicare Advantage Overpayments In Austin Frakt’s August 7, 2017 The Upshot blog in the New York Times (“Medicare Advantage Spends Less on ...

Center Urges CMS to Preserve and Strengthen Consumer Protections in Medicare Advantage and Part D April 26, 2017

As noted in a previous Alert, the Center for Medicare & Medicaid Services (CMS) recently finalized their 2018 Call Letter.  In the same document, CMS issued a Request for Information regarding ideas for “regulatory, sub-regulatory, policy, practice and procedural changes to better accomplish” the goals of “using transparency, flexibility, program simplification and innovation to transform ...

Insurer Reaches Agreement with Provider Network – After Frightening Medicare Advantage Enrollees April 19, 2017

Last month in Connecticut, United Healthcare (UHC) set off a panic among its Medicare Advantage (MA) enrollees by sending out letters indicating that they would no longer be affiliated with Hartford HealthCare HHC), one of Connecticut’s largest provider networks. These MA enrollees often received multiple letters – one for each of their HHC providers. One older ...

CMS Releases Final 2018 Call Letter: Too Little for Consumers April 12, 2017

On February 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued its draft 2018 Call Letter, an annual set of proposed rules, guidelines and clarifications for Part C Medicare Advantage (MA) and Part D plans that wish to participate in Medicare in the following calendar year.  In collaboration with several other advocacy organizations, ...

What Would Work Better for You? Deciding Between Traditional Medicare and a Medicare Advantage Plan November 9, 2016

In last week’s Alert, we posed 10 questions to ask before deciding between traditional Medicare and a Medicare Advantage Plan. This week we discuss what your answers may mean.Do you qualify for payment assistance or have access to other coverage through any of the following…Medicare Savings Program? Part D Low Income Subsidy? Employer/Military/Other Insurance? Medigap Plan?Response: Contact the ...

10 Questions to Ask Before Deciding Between Traditional Medicare and a Medicare Advantage Plan November 3, 2016

Do you qualify for payment assistance or have access to other coverage through any of the following… :Medicare Savings Program? Part D Low Income Subsidy? Employer/Military/Other Insurance? Medigap Plan?Which providers/facilities will you want to use?How important is it to you to continue seeing them? Do they accept Medicare? What Medicare Advantage Plan networks do they participate in?Are you comfortable with ...

CMS Suspends New Applications for MA “Seamless Conversion” Enrollment October 26, 2016

In a June 2016 Weekly Alert the Center wrote about a process called “seamless conversion enrollment” used by some insurance companies that offer Medicare Advantage (MA) plans to capture enrollment among their pre-Medicare plan enrollees.  As we noted, “Medicare rules allow MA plan sponsors to ‘develop processes to provide seamless enrollment in an MA plan ...

The Center’s Long-Time Concerns Gain Attention August 31, 2016

Prescription Drug Pricing An excellent and well-timed (given #Epi-gate) article appeared in this week’s Journal of the American Medical Association discussing the reason drug costs are so high in the U.S. According to the article, the major cause is the “granting of government-protected monopolies to drug manufacturers, combined with restriction of price negotiation at a level ...

Medicare Beneficiaries Still Prefer Traditional Medicare June 8, 2016

A recent post by health economist Uwe Reinhardt in the Journal of the American Medical Association Forum discusses the fact that despite all the support Medicare Advantage (MA) plans have received, the vast majority of Medicare beneficiaries still prefer Traditional Medicare. 30% of Medicare recipients now receive their coverage through MA plans. This is largely because MA ...

Case Study: Enrolled In a Medicare Advantage Plan Without Her Knowledge Through “Seamless Conversion Enrollment” June 1, 2016

October 21, 2016 – Update on Seamless Conversion: CMS is revisiting the seamless conversion enrollment policy and is temporarily suspending its acceptance of any new seamless enrollment proposals. Read more…Ms. M., a Medicare beneficiary living in the Southwest, turned 65 in October 2015 and became eligible for Medicare on October 1st. On September 30th she signed up ...

Government Auditor Finds Billions in Improper Payments to Medicare Advantage Plans Coupled with Inadequate Oversight by Federal Regulator May 11, 2016

This week the General Accounting Office (GAO) issued a report entitled “Medicare Advantage: Fundamental Improvements Needed in CMS’s Effort to Recover Substantial Amounts of Improper Payments.  The report states that the Centers for Medicare & Medicaid Services (CMS) estimates that about 9.5% of its annual payments to Medicare Advantage (MA) organizations were improper – totaling ...

CMS Policy Change Allows Windfall for Medicare Advantage Plans Under Sanction March 16, 2016

On March 8, 2016, the Centers for Medicare and Medicaid Services (CMS) released a memorandum entitled “Suspension of Policy Providing for Automatic Reduction of Star Ratings for Contracts Operating Under Intermediate Sanction.” Through this memo, CMS has suspended its policy of lowering the star ratings of Medicare Advantage plans that are under sanction for violations of ...

Kaiser Family Foundation Releases Reports on MA and Part D in 2016 October 15, 2015

In a report entitled “Medicare Part D: A First Look at Plan Offerings in 2016” (October 2015), the Kaiser Family Foundation analyzed the Part D market in 2016 and found, among other things, that:In 2016, beneficiaries in each region will have a choice of 26 PDPs, on average, down by 4 from 2015. The average PDP ...

GAO Issues Report Concerning CMS Oversight of Medicare Advantage Provider Network Adequacy October 1, 2015

This week, the General Accounting Office (GAO) issued a report entitled “Medicare Advantage: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy” (August 2015, publicly released September 28, 2015).  This report reviews how the Centers for Medicare and Medicaid Services (CMS) ensures adequate access to care for Medicare Advantage (MA) enrollees. The report was requested ...

Case Study: Home Health Coverage and Medicare Advantage Plan Responsibilities August 13, 2015

The Center for Medicare Advocacy received an e-mail inquiry from an individual requesting assistance advocating for her sister, Mrs. B.  Mrs. B is a Medicare beneficiary enrolled in a Medicare Advantage plan and in need of home health services.  The questions raised demonstrate several important issues that often arise with both the home health benefit ...

Reports of Import – Trustees and Kaiser Family Foundation July 23, 2015

Medicare Trustees Report – Medicare Part A Solvency Remains Stable On July 22, 2015, the Medicare and Social Security Trustees issued the 2015 Annual Report of the Boards of Trustees of the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. Good News: In short, the projected solvency of the Part A Trust ...

Final 2016 CMS Call Letter for Medicare Parts C and D Released April 9, 2015

Every year, the Centers for Medicare and Medicaid Services (CMS) issues payment, performance and other rules that apply to Medicare Advantage (MA) and Part D plans that choose to participate in the Medicare program in the following calendar year. Commonly referred to as the “Call Letter,” this document is first released in draft form, subject ...

Center for Medicare Advocacy Co-Authors Report Published by the Kaiser Family Foundation Comparing Consumer Protections in Major Health Plans March 26, 2015

The Kaiser Family Foundation (KFF) has published a report entitled “Comparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified Health Plans and Medicaid Managed Care Organizations.” The report is authored by Center Senior Policy Attorney David Lipschutz, former Center Policy Attorney Andrea Callow (now at Families USA) and Karen Pollitz, MaryBeth Musumeci ...

Center for Medicare Advocacy Submits Comments to Draft 2016 Call Letter for Medicare Parts C and D March 12, 2015

Every year, the Centers for Medicare and Medicaid Services (CMS) releases a draft of payment, performance and other rules that apply to Medicare Advantage (MA) and Part D plans that choose to participate in the Medicare program in the following calendar year. Commonly referred to as the “Call Letter,” this document is first released in ...

2016 Medicare Advantage (Part C) and Part D Final Rule Issued February 19, 2015

On February 12, 2015, the Centers for Medicare and Medicaid Services (CMS) published final rules entitled “Medicare Program; Contract Year 2016 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs” Applicable to the 2016 plan year ...

Update on MA and Part D Plans October 23, 2014

A Brief Survey of Recent Reports, and a New Special Enrollment Period for 2015 Medicare's Annual Coordinated Election Period (ACEP) for Medicare Advantage and Part D plans began on October 15th and runs through December 7th.  During the ACEP, often referred to as "open enrollment," Medicare beneficiaries who do not have a Part D plan can ...

Impact of ACA on Mid-term Elections; Beneficiary and Family-Centered QIOs; and More September 11, 2014

Kaiser Family Foundation Poll: Potential Impact of Affordable Care Act (ACA) on the Mid-term Elections On September 9, 2014, the Kaiser Family Foundation issued its August – September 2014 Health Tracking Poll analyzing the potential impact of voter opinion of the Affordable Care Act on the November mid-term elections. The results found that health care broadly was ...

Medicare Advantage Patient Bill of Rights Legislation Introduced in Congress August 1, 2014

Medicare Advantage (MA) plans are increasingly dropping doctors and other health care providers from their contracted networks, often in the middle of a plan year, when most plan enrollees are not permitted to change plans.  MA enrollees often get little advance warning, and some lose access to doctors they have seen for a long time, ...

Center Executive Director Judith Stein Testifies Before House Energy & Commerce Committee about Medicare Advantage Plans March 13, 2014

On March 13, 2014, Center for Medicare Advocacy Executive Director and Founder Judith Stein testified before the House Energy & Commerce Committee, Subcommittee on Health, at a hearing entitled "Keeping the Promise: Allowing Seniors to Keep Their Medicare Advantage Plans If They Like Them."   That testimony is summarized below. The Center for Medicare Advocacy recognizes that ...

Medicare Advantage Payment Reductions Are Good News for Medicare February 27, 2014

On February 21, 2014, the Centers for Medicare & Medicaid Services (CMS) issued its draft 2015 Call Letter to Medicare Advantage (MA) and Part D plan sponsors, which includes a proposed rate for MA payment for 2015.  Much anticipated, the draft Call Letter, which will be finalized in April, was preceded by an aggressive advertising ...

Dual Eligible Special Needs Plans: Considerations for Reauthorization December 5, 2013

Dual Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage (MA) plan that enrolls only individuals dually eligible for Medicare and Medicaid. Though results have been mixed, D-SNPs were created as a possible route to better integration between Medicare and Medicaid, in turn leading to better quality, higher value care. Authority for Special Needs ...

The Medicare Annual Coordinated Election Period Has Begun! October 17, 2013

During the Annual Coordinated Election Period, which runs from October 15th through December 7th, people with Medicare can change their choice of health coverage (whether they receive that coverage through a private Medicare Advantage plan or traditional Medicare), and add, drop or change Medicare Part D drug coverage. For more information and to get help reviewing ...

United Healthcare Dramatically Reducing CT Medicare Advantage Plans – Check in YOUR State October 10, 2013

For 2014, United Healthcare (UHC) is cutting 2,250 doctors from its Connecticut Medicare Advantage (MA) network. UHC is also closing one of its MA plans in New Haven County that serves 2,900 people and taking similar actions in other states.  Medicare Advantage enrollees who visit a doctor, hospital, specialist, or health center outside of UHC’s ...

Medicare Advantage “Cuts?” Don’t Believe it. March 14, 2013

The Affordable Care Act (ACA) is beginning to rein in Medicare Advantage (MA) overpayments by bringing MA payment more in line with what traditional Medicare spends on a given beneficiary.  The insurance industry is not only fighting this payment reform, but has launched a campaign against a 2.3% reduction in payment projected for 2014.   This ...

Reminder: Medicare Advantage Disenrollment Period (MADP) Ends February 14th February 7, 2013

The Medicare Advantage Disenrollment Period (MADP) lasts from January 1st through February 14th of each year.  During the MADP, a beneficiary can switch from an MA plan to traditional Medicare. The new MADP also provides an opportunity to enroll in a Part D drug plan for those who have not already done so. When disenrolling from ...

Picking a Plan During the Annual Enrollment Period? Choose Carefully October 18, 2012

As discussed in last week’s Alert, the current Medicare Annual Enrollment Period lasts until December 7th.  During this time period, Medicare beneficiaries can choose a Medicare Advantage (Part C) or Part D plan for 2013.  This Alert discusses Part C and D plan quality ratings for 2013, and special enrollment periods related to these ratings.  ...

Rewarding Mediocrity: GAO Report Concerning Medicare Advantage “Bonus” Payments April 26, 2012

On April 23, 2012, the Government Accountability Office (GAO) released a report that concludes, among other things, that a Medicare demonstration program providing bonus payments to Medicare Advantage (MA) plans mainly benefits plans whose performance is no more than average.  While the program is supposed to reward quality, in practice it largely rewards plans receiving ...

Forcing Dual Eligibles Into Private Health Plans is No Quick Fix November 22, 2011

The nearly nine million Medicare beneficiaries who are also eligible for some form of Medicaid, the so-called dual eligibles, are the subject of federal, state and local policy discussions because many of them are among the highest users of health care services in the country and thus are very costly to both Medicare and Medicaid.  ...

Medicare Advantage and Part D Changes and Enrollment Updates October 6, 2011

Once again the Medicare Advantage and Part D Annual Coordinated Election Period (ACEP) is upon us; it's time to contemplate Medicare prescription drug and Medicare Advantage choices for another calendar year.  The big news is that the ACEP, while one week longer than in the past, starts and ends much earlier this year.  The ACEP ...

Annual Enrollment Starts October 15 and Ends December 7 for Medicare Part C & Part D Plans September 22, 2011

Fall is the time for Medicare beneficiaries to explore their options regarding Part D prescription drug and Part C Medicare Advantage plans.  In years past, the annual enrollment period began in mid-November and lasted to the end of the year, with any changes or choices made effective January 1st.  Starting this year, that time period ...

New Rules for Medicare Advantage and Part D Plans June 2, 2011

On April 15, 2011, the Centers for Medicare & Medicaid Services (CMS) issued final regulations to provide policy and technical changes to the Medicare Parts C (Medicare Advantage) and D programs.  The regulations address concerns raised by Medicare beneficiary advocates, and implement provisions of the Affordable Care Act.  They also codify into regulation some existing ...

45 Day Disenrollment Period for Medicare Advantage Members January 6, 2011

Starting this year, the Medicare Advantage Open Enrollment Period (OEP) has been replaced by a new Medicare Advantage Disenrollment Period (MADP), which lasts from January 1st through February 14th. During the MADP, one can switch from an MA plan to traditional Medicare.  The new MADP also provides an opportunity to pick up Part D drug ...

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