A new GAO report reveals that the government has little data to know whether Medicare Advantage plans are offering additional benefits and whether their enrollees are using these benefits. Effectively, the government is overpaying the Medicare Advantage plans billions of dollars each year, with little clue of the extent to which the Medicare Advantage plans are using this money for the benefit of their enrollees or for the benefit of their shareholders. This madness must stop before it does irreparable damage to the Medicare program.
Today, about 30 million people with Medicare are enrolled in Medicare Advantage, private health plans that contract with the government to offer Medicare benefits. Medicare Advantage plans have repeatedly been found to inappropriately delay and deny services that Traditional Medicare covers. The “additional benefits” they offer sound good: vision or hearing services, in-home support services and, now, sometimes food and produce. But, it’s unclear who benefits from them.
The Medicare Advantage plans are not providing the Centers for Medicare and Medicaid Services (CMS), the agency that oversees Medicare, with “detailed, service-level utilization data,” the data it needs to assess the value of these additional benefits to Medicare Advantage plan enrollees. What’s worse is that CMS is not demanding the Medicare Advantage plans turn over this data.
The GAO says that three Medicare Advantage plans told it that they are not required to turn over this data for supplemental benefits they offer. CMS says they are required to do so, just as they are required to release data for all Medicare benefits they provide an enrollee. But, CMS does not penalize the Medicare Advantage plans for not turning over complete and accurate data related to the Medicare benefits they cover, so the Medicare Advantage plans can flout their obligations with impunity.
With some supplemental benefits, such as food and produce, there are arguably challenges submitting data. There’s no diagnosis code. But, the Medicare Advantage plans must have a way of recording coverage of this additional benefit, as some claim to pay for it. So, it defies reason that they cannot share their documentation with CMS.
CMS is drafting a workplan and timeline for collecting this information. The outstanding question is whether the extra benefits promote enrollees’ health and function. If so, which enrollees benefit? If not, why is CMS allowing Medicare Advantage plans to spend money on them?
The GAO made just two recommendations to CMS. CMS should make clear to Medicare Advantage plans the supplemental benefit data they must submit for review. And, CMS must put in place a way to ensure that it gets comprehensive data on supplemental benefits that do not have procedure codes. Will CMS have the tools, resources and political will to do so?
Here’s more from Just Care:
- Medicare Advantage benefits: Appearances v. reality
- New government rule lets Medicare Advantage pocket tens of millions of taxpayer dollars they did not earn
- Government rules won’t curtail Medicare Advantage bad acts without stiff penalties
- Case study: Medicare Advantage delays, denials and consequences
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
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