Allison Bell reports for Think Advisor on the federal government’s decision to hold off issuing a rule imposing an extra penalty on Medicare Advantage plans for misleading marketing. It appears that too many Medicare Advantage plans would be affected. What’s clear is that so long as corporations can cover Medicare benefits, older adults and people with disabilities will be scammed.
Specifically, the government is not issuing a new penalty on Medicare Advantage plans for misleading marketing that results in people being retroactively disenrolled from Medicare Advantage plans. Its reasoning is that another penalty on Medicare Advantage plans presents too big a change in star-ratings and payments to these plans. It’s a bit like a city determining that it won’t close down restaurants that pose health risks in order to make sure the city has enough restaurants.
CMS claims it needs to use a formal rulemaking process to impose this new penalty. Too many MA plans would be affected. “Overall, we found a decrease in the star assignments for almost one-quarter of MA-PD contracts using the changed complaint measure specifications that include marketing misrepresentation complaints.” Put differently, had CMS imposed the extra penalty, 25 percent of Medicare Advantage plans would have seen lower star ratings and lower payments.
As it is, Medicare star-ratings of Medicare Advantage plans are a farce. No one should rely on them in choosing a plan. A five-star Medicare Advantage plan is about as different from a five-star hotel as night and day. In a five-star Medicare Advantage plan, you can’t count on getting coverage from the doctors and hospitals you want to use, nor can you know whether the copays are affordable.
Needless to say, insurers are pleased with the CMS decision. They get away with misleading people into signing up with them, claiming they are competing to provide important services and being overpaid. Meanwhile, they do not allow MedPAC to assess the quality of care they offer, engage in widespread inappropriate delays and denials of care, and do not let anyone meaningfully distinguish among them. Had the penalty been implemented, one in four Medicare Advantage plans would have seen their star-rating score fall by 24 percent.
Will CMS use a formal rulemaking process to impose the extra penalty. Who knows?
Here’s more from Just Care:
- To strengthen the Medicare Trust Fund, Congress cannot allow Medicare Advantage overpayments to continue
- Well-kept secrets of Medicare Advantage plans
- Medicare Advantage benefits: Appearances v. reality
- MedPAC blasts Medicare Advantage
- Four things to think about when choosing between traditional Medicare and Medicare Advantage plans
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