For far too long, insurers offering Medicare Advantage plans have been able to hide the fact their networks are inadequate and mislead prospective and current Medicare Advantage enrollees about the physicians and hospitals in their networks. The Centers for Medicare and Medicaid Services (CMS) has just issued a final rule that requires that insurers share their provider directory data so that CMS can include it in its Medicare Plan Finder, but with no guarantee of accuracy. The Medicare Advantage insurers have little incentive to ensure the accurate reporting of their networks.
Insurers offering Medicare Advantage plans have always had an incentive to mislead the public about their provider networks, making them appear broader and richer than they actually are. The misinformation can boost enrollment. And, the government has never penalized insurers for misleading the public.
The CMS final rule requires insurers to release Medicare Advantage plan network information for each plan they offer and ensure its accuracy every 30 days. Moreover, it requires insurers to attest to the accuracy of their provider information once each year. But, insurers face no punishment for failing to disclose accurate information about their provider networks.
CMS says its goal is to help enrollees compare Medicare Advantage plans in a meaningful way. Yet, its rule has no teeth. Notwithstanding years of insurers providing inaccurate information on provider networks, CMS apparently will not punish insurers for so doing. In addition, the final rule does not even include the proposed provision that insurers attest that their provider network information is consistent with the information they provide CMS regarding the adequacy of their networks.
In short, people with Medicare cannot rely on provider network information to distinguish among Medicare Advantage plans in a meaningful way. Moreover, inconsistent prior authorization protocols among Medicare Advantage plans keep people from making an informed choice. They cannot know whether the Medicare Advantage plan they choose will inappropriately deny them the Medicare benefits to which they are entitled, as the data show too many do. They cannot avoid the bad actor plans, which, according to one major NBER study, result in the preventable deaths of tens of thousands of enrollees each year.
Here’s more from Just Care:
- If Medicare Advantage can’t offer adequate provider networks and accurate directories, why are they in business?
- You still can’t trust Medicare Advantage plan provider directories
- Insurer provider directories misleadingly include physicians who are out of network
- Medicare Advantage inappropriate denials of care abound
- New study finds you can’t meaningfully choose among Medicare Advantage plans
