Medicare Advantage plans are now advertising on people’s electronic health record portals, reports Cheryl Clark for MedPage Today. The Centers for Medicare and Medicaid Services (CMS), which administers Medicare, says this should not be allowed. But, before I explain what’s happening with these ads, let me list some of the many things some Medicare Advantage plans do that are not allowed and that CMS has not been able to address in a meaningful way.
- Medicare Advantage plans inappropriately delay and deny care.
- Medicare Advantage plans do not cover care that Traditional Medicare covers, though they are required to.
- Medicare Advantage plans fail to share complete and accurate data on the services their enrollees receive with the government.
- Medicare Advantage plans fail to keep their provider directories accurate and up to date.
- Medicare Advantage plans fail to code the health status of their enrollees accurately.
- Medicare Advantage plans mislead people through their advertisements.
So, it’s no surprise that Medicare Advantage plans will take advantage of every opportunity to promote their health plans. Marketing Medicare Advantage plans through people’s electronic health record seems par for the course. Why shouldn’t FollowMyHealth, the electronic health record portal, accept money from Medicare Advantage plans in exchange for promoting them? It’s not their concern that their users might be misled to think their doctors are promoting Medicare Advantage plans. They’re simply trying to maximize profits.
CMS has a memo on Medicare Advantage “best practices,” that discourages this type of advertising, even by third parties. But, it’s not clear that it’s illegal or a violation of any contractual obligation.
CMS also has a proposed rule that would require Medicare Advantage ads to specify the Medicare Advantage plans that offer particular benefits and not to generalize about products in Medicare Advantage. It is not yet finalized.
As with prescription drug ads, the Medicare Advantage ads should highlight the risks of enrolling in a Medicare Advantage plan. But, they don’t mention, let alone highlight, their limited provider networks, the restricted geographic scope of their coverage, their referral and prior authorization requirements, their high out-of-pocket costs when you need costly care, or that once you are in a Medicare Advantage plan you likely will not be able to move back to traditional Medicare because you are not guaranteed the right to buy supplemental coverage.
At the very least, CMS should include all these warnings in its Medicare and You Handbook and in all materials it distributes on Medicare Advantage. CMS will never have the tools or the resources to prevent Medicare Advantage plan bad actors from doing everything in their power to maximize their profits, whether it’s misleading prospective enrollees about their benefits, inappropriately delaying and denying care, having inadequate provider networks, not paying hospitals for the services they deliver, or overcharging enrollees for their prescription drugs.
CMS can keep issuing rules that the bad actors will not follow. Or, if it wants to protect Medicare and Medicare Advantage enrollees and providers, it can start canceling contracts and penalizing Medicare Advantage bad actors in meaningful ways. Are there many bad actor Medicare Advantage plans you might ask? Likely, far more than you’d like to believe.
Here’s more from Just Care:
- Medicare Advantage: Tune out the Joe Namath ads
- Medicare open enrollment: Don’t be misled by ads
- Senate Finance Chair looks into deceptive Medicare Advantage marketing practices
- Traditional Medicare v. Medicare Advantage? Different as night and day
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
