A recent MedPac presentation details several glaring issues with Medicare Advantage, of which both Congress and all Medicare Advantage enrollees should take careful note. MedPac cannot assess quality of care in Medicare Advantage, the private health plans that cover care for about half of all people with Medicare. The Medicare Advantage plans are not releasing complete and accurate data to enable appropriate oversight, nor is the Centers for Medicare and Medicaid Services (CMS) holding them accountable for failing to do so.
Medicare Advantage plans have failed to disclose complete and accurate data, as they have been required to do, for the last 10 years. Encounter data shows the services people are receiving. And, it is needed for MedPac, the agency that oversees Medicare payments, to assess MA plan quality. According to MedPac, the Medicare Advantage quality data available is not meaningful.
CMS, which oversees Medicare Advantage (MA) plans, has not held MA plans accountable for failing to disclose this data. Consequently, MA plans have little incentive to provide complete and meaningful encounter data. MedPac has spelled out what CMS should do, but CMS has not acted to create the appropriate incentives.
Medicare Advantage plans claim to spend $50 billion on additional benefits for their enrollees in 2021, but there is no good information on how that money is spent. Rather, we know that too often these additional benefits come with high out-of-pocket costs and can be difficult to access.
MedPac recommends that CMS withhold payments to Medicare Advantage plans that do not release complete and accurate encounter data so that they have an incentive to do so. Alternatively, if necessary, Medicare should require Medicare Advantage providers to submit their claims data to an intermediary, who could then ensure it was complete and accurate.
In 2021, Medicare Advantage plans received $350 billion dollars from CMS. It boggles the mind that the government has little reliable data on how Medicare Advantage plans are spending that money and enrollees know so little about the quality of care they offer
Here’s more from Just Care:
- CMS overpays Medicare Advantage plans and lets them keep the extra billions
- Corporate health plans for people with Medicare can be a “Medicare Disadvantage”
- People in Medicare Advantage trade away access to care
- OIG finds widespread inappropriate care denials in Medicare Advantage
- Seven tips for getting a good night’s sleep
Leave a Reply